Pegasys — Highmark
Chronic Hepatitis C
Initial criteria
- Option 1: Age ≥ 5 years AND diagnosis of chronic hepatitis C with compensated liver disease AND Pegasys will be used in combination with ribavirin
- OR Option 2: Age ≥ 18 years AND diagnosis of chronic hepatitis C with compensated liver disease AND Pegasys will be used in combination with another HCV medication OR the member has a contraindication or significant intolerance to other HCV drugs
Approval duration
12 months