Sovaldi (sofosbuvir tablets and oral pellets − Gilead, generic for tablets only) — Cigna

Initial criteria

• Patient age ≥ 3 years AND < 18 years
• Patient does not have decompensated cirrhosis (Child-Pugh B or C)
• Medication will be prescribed in combination with ribavirin
• Medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician

Approval duration

24 weeks