Vosevi — Highmark

Chronic hepatitis C virus (HCV) infection – treatment-naïve adults

Preferred products

age ≥ 18 years
diagnosis of chronic HCV (ICD-10: B18.2)
prescriber documents cirrhosis status and liver transplant history
prescribed regimen is appropriate per FDA labeling and/or AASLD/IDSA guidelines (see table 1)
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 when applicable
if request is for Harvoni and genotype 1a or 1b: duration determined as follows:
For 12 weeks of Harvoni, member meets ≥1: HCV RNA >6 million IU/mL OR HIV-infected OR cirrhosis OR prior liver transplant OR prescriber attests 8 weeks inappropriate
For 8 weeks of Harvoni, member meets ALL: HIV-uninfected AND HCV RNA <6 million IU/mL AND no cirrhosis
if request is for Mavyret 12 weeks, member meets ≥1: HIV/HCV coinfected OR prior liver transplant
if request is for non-preferred product, member has contraindication to or is not a candidate for all preferred regimens