Zepatier — Cigna
Genotype 1 or 4 chronic Hepatitis C Virus – new start
Initial criteria
- Approve for the duration specified in the standard Hepatitis C – Zepatier PA Policy criteria if the patient has met the standard Hepatitis C – Zepatier PA Policy criteria.
Reauthorization criteria
- Refer to the standard Hepatitis C – Zepatier PA Policy criteria.
Approval duration
duration specified in standard Zepatier PA Policy