Epclusa — Medical Mutual
Chronic Hepatitis C Virus (HCV) Genotype 1-6, Decompensated Cirrhosis (Child-Pugh B or C), Prior Null Responder/Partial Responder/Relapser to sofosbuvir/velpatasvir or Vosevi
Initial criteria
- Patient is age ≥ 3 years
- Patient has decompensated cirrhosis (Child-Pugh B or C)
- Patient has been previously treated with sofosbuvir/velpatasvir OR previously been treated with Vosevi
- Medication will be prescribed in combination with ribavirin
- Medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician
Approval duration
24 weeks