ribavirin capsules (generic) — Medica
Hepatitis C Virus (HCV)
Initial criteria
- A) Patient meets ONE of the following criteria (i or ii):
- i. The medication is prescribed in combination with peginterferon alfa; OR
- ii. The medication is prescribed in combination with a direct-acting antiviral for HCV; AND
- B) The medication is prescribed by or in consultation with a gastroenterologist, hepatologist, liver transplant physician, or infectious diseases physician.
Approval duration
1 year