Skip to content
The Policy VaultThe Policy Vault

PegasysMedica

Recurrent Hepatitis C Virus (HCV) Post-Liver Transplantation, Pediatric and Adolescent (≥ 2 Years and ≤ 17 Years of Age)

Initial criteria

  • age ≥ 2 years and < 17 years
  • medication is prescribed in combination with ribavirin unless there is a contraindication or intolerance to ribavirin according to the prescriber
  • medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or liver transplant physician affiliated with a transplant center

Approval duration

48 weeks