Epclusa (sofosbuvir/velpatasvir tablets and oral pellets – Gilead) — Cigna
Chronic Hepatitis C Virus (HCV) Genotype 1, 2, 3, 4, 5, or 6, No Cirrhosis or Compensated Cirrhosis (Child-Pugh A)
Initial criteria
- Patient is age ≥ 3 years; AND
- Patient meets ONE of the following (i or ii): i. Patient does not have cirrhosis; OR ii. Patient has compensated cirrhosis (Child-Pugh A); AND
- Patient has not been previously treated with sofosbuvir/velpatasvir; AND
- Medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician
Approval duration
12 weeks