ribavirin — CareFirst (Caremark)
Chronic hepatitis C (CHC) virus infection
Initial criteria
- For hepatitis C virus (HCV) infection: Approval decisions are based on the Specialty Guideline Management (SGM) of the requested regimen for specific criteria for approval and duration.
- For hepatitis E virus (HEV) infection in organ transplant recipients: Member has chronic hepatitis E virus infection and is an organ transplant recipient.
Reauthorization criteria
- Member continues to meet all criteria in the Coverage Criteria for chronic hepatitis E virus (HEV) infection.
Approval duration
12 months (for chronic hepatitis E virus infection in organ transplant recipients)