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Mavyret — Cigna

Genotype 1, 2, 3, 4, 5, or 6 Hepatitis C Virus, kidney transplant – new start

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