Mavyret — Medical Mutual
Hepatitis C Virus (HCV) Kidney or Liver Transplant Recipient, Genotype 1, 2, 3, 4, 5, or 6
Initial criteria
- Patient age ≥ 3 years
- Patient is a kidney or liver transplant recipient with HCV
- Prescribed by or in consultation with prescriber affiliated with transplant center: gastroenterologist, hepatologist, infectious diseases physician, nephrologist, renal transplant physician, or liver transplant physician
- Genotype-specific criteria:
- Genotype 2, 4, 5, or 6: Approval 12 weeks
- Genotype 1: If NS5A-experienced, NS3/4-naïve with prior relapse after NS5A therapy and no prior NS3/4 treatment: Approval 16 weeks; All others: Approval 12 weeks
- Genotype 3: If prior null/partial/relapse with interferon ± ribavirin or Sovaldi-based: Approval 16 weeks; All others: Approval 12 weeks
Approval duration
12-16 weeks