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Mavyret — Medica

Genotype 1 hepatitis C virus with renal impairment (eGFR < 30 mL/min or ESRD), adult (age ≥ 18 years) – new start

Preferred products

  • Zepatier

Initial criteria

  • Patient has met the Hepatitis C – Mavyret PA for PSM Policy criteria AND
  • Patient has been previously treated with pegylated interferon/ribavirin, Incivek, Olysio, or Victrelis AND has completed a course of Zepatier with documentation of failure to achieve SVR 12 weeks post‑therapy OR
  • Patient has been previously treated with Sovaldi + ribavirin ± pegylated interferon/interferon, or Sovaldi + Olysio, or Daklinza, or Epclusa (brand or generic), or Harvoni (brand or generic), or Zepatier

Approval duration

as specified in the Hepatitis C – Mavyret PA for PSM Policy