Mavyret — Cigna
Genotype 2, 3, 5, or 6 Hepatitis C Virus with renal impairment (eGFR < 30 mL/min or ESRD) – 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