Vosevi (sofosbuvir/velpatasvir/voxilaprevir tablets - Gilead) — Cigna

Initial criteria

• Patient is age ≥ 18 years
• Patient meets ONE of the following (i or ii): i. Patient does not have cirrhosis; OR ii. Patient has compensated cirrhosis (Child-Pugh A)
• Patient meets ONE of the following (i or ii): i. Patient had a prior null response, prior partial response, or relapse after prior treatment with an HCV direct-acting antiviral regimen containing an NS5A inhibitor; OR ii. Patient had a prior null response, prior partial response, or relapse after prior treatment with an HCV direct-acting antiviral regimen containing sofosbuvir (Sovaldi) + a non-NS5A inhibitor
• Medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician

Approval duration

12 weeks