Mavyret — Medica
Genotype 4 chronic hepatitis C virus, adult (age ≥ 18 years) – new start
Preferred products
- Epclusa
- Harvoni
- 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 AND has completed a course of Epclusa (brand or generic), Harvoni (brand or generic), or Zepatier with documentation of failure to achieve SVR 12 weeks post‑therapy OR
- Patient has been previously treated with Sovaldi + ribavirin ± pegylated interferon/interferon
Approval duration
as specified in the Hepatitis C – Mavyret PA for PSM Policy