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Harvoni (brand or generic) — Cigna

Genotype 1, 4, 5, or 6 recurrent Hepatitis C Virus post-liver transplantation – new start, adult (age ≥ 18 years)

Initial criteria

  • Patient must have completed a course of therapy with Harvoni (brand or generic) and have documentation that the patient did not achieve a sustained viral response (virus undetectable 12 weeks following completion of therapy) with Harvoni (brand or generic) [documentation required].

Approval duration

duration specified in Hepatitis C – Mavyret PA for PSM Policy