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Epclusa (sofosbuvir/velpatasvir) — Highmark

acute hepatitis C (Mavyret only)

Initial criteria

  • Member is 18 years of age or older
  • Diagnosis of chronic HCV (ICD-10: B18.2) OR for Mavyret, diagnosis of acute (ICD-10: B17) or chronic HCV (ICD-10: B18.2)
  • Member has not received prior HCV treatment
  • Prescriber provides all of the following information: member’s cirrhosis status