Harvoni — Medical Mutual

Initial criteria

• Patient age ≥ 3 years
• Prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician
• EITHER:
• Approve for 8 weeks if ALL: treatment-naïve AND no cirrhosis AND no HIV AND not awaiting liver transplantation AND baseline HCV RNA < 6 million IU/mL
• Approve for 12 weeks if ANY: treatment-naïve but not meeting 8-week criteria; OR previously treated without cirrhosis; OR treatment-naïve or previously treated AND decompensated (Child-Pugh B or C) cirrhosis AND ribavirin eligible AND medication will be combined with ribavirin
• Approve for 24 weeks if ANY: previously treated AND compensated (Child-Pugh A) cirrhosis; OR treatment-naïve or previously treated AND decompensated (Child-Pugh B or C) cirrhosis AND ribavirin ineligible

Approval duration

8-24 weeks