Vosevi (sofosbuvir/velpatasvir/voxilaprevir) — Blue Cross Blue Shield of Oklahoma
Hepatitis C genotypes 1, 2, 3, 4, 5, 6 in patients previously treated with NS5A inhibitor or sofosbuvir regimen
Initial criteria
- For patients residing in Ohio with Fully Insured or HIM Shop (SG) plan, approval if: no FDA labeled contraindications AND ONE of the following applies:
- Patient has another FDA-labeled indication for requested agent and route OR
- Patient has another indication supported in compendia for the agent and route OR
- Prescriber provides TWO peer-reviewed journal articles supporting proposed use
Approval duration
12 months