Vosevi — Highmark
Chronic hepatitis C virus (HCV) infection – treatment-experienced adults
Preferred products
- Vosevi
- Mavyret
- Epclusa
- Harvoni
Initial criteria
- age ≥ 18 years
- diagnosis of chronic HCV (ICD-10: B18.2)
- prescriber documents previous HCV therapies with reason for discontinuation or failure
- prescriber documents cirrhosis status and liver transplant history
- prescribed regimen is appropriate per FDA labeling and/or AASLD/IDSA guidelines (see table 2)
- prescriber attests member or guardian educated on potential adverse effects of alcohol or IV drug abuse including risk of misuse, abuse, and addiction
- if member has alcohol use disorder OR IV drug abuse OR history of substance abuse within past 6 months, prescriber attests that an offer of referral for substance abuse treatment and care management was made
- appropriate resistance-associated substitutions (RASs) testing performed as applicable
- if request is for non-preferred product, member has contraindication to or is not a candidate for all preferred regimens