Mavyret (glecaprevir/pibrentasvir tablets and oral pellets - AbbVie) — Cigna

Initial criteria

• Patient is age ≥ 3 years
• Patient meets ONE of the following (i or ii): i. Patient does not have cirrhosis; OR ii. Patient has compensated cirrhosis
• Patient has quantifiable HCV RNA
• Patient meets ONE or more of the following (i, ii, or iii): i. Patient has had conversion of negative to positive results in anti-HCV antibody, HCV RNA, and/or HCV core antigen; OR ii. Patient has signs and symptoms of acute hepatitis C virus, according to the prescriber; OR iii. [next criterion likely continues in later section]

Approval duration

8 weeks