Mavyret — Cigna
Chronic Hepatitis C Virus (HCV), genotype unknown/undetermined, compensated cirrhosis
Initial criteria
- Approve for the duration specified in the Hepatitis C – Mavyret PA for PSM Policy criteria if the patient has met the Hepatitis C – Mavyret PA for PSM Policy criteria.
Reauthorization criteria
- Refer to the Hepatitis C – Mavyret PA for PSM Policy criteria.
Approval duration
duration specified in Mavyret PA for PSM Policy