sofosbuvir/velpatasvir tablets (authorized generic to Epclusa – Gilead) — Cigna

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient does not have cirrhosis; AND
• Patient has not previously been treated for hepatitis C virus; AND
• Patient does not have hepatitis B virus; AND
• Patient is not pregnant; AND
• Patient does not have hepatocellular carcinoma; AND
• Patient has not had a liver transplantation; AND
• Medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician

Approval duration

12 weeks