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The Policy VaultThe Policy Vault

ledipasvir/sofosbuvir (generic) — Medica

chronic hepatitis C virus (HCV) infection

Preferred products

  • Harvoni (brand)

Initial criteria

  • Ledipasvir/sofosbuvir (generic only) is not approved. Offer to review for Harvoni (brand only) using the standard Hepatitis C – Harvoni PA Policy criteria.