sofosbuvir/velpatasvir — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years
• Patient does not have cirrhosis
• Patient has not previously been treated for hepatitis C virus
• Patient does not have hepatitis B virus
• Patient is not pregnant
• Patient does not have hepatocellular carcinoma
• Patient has not had a liver transplantation
• Medication is prescribed by or in consultation with a gastroenterologist, hepatologist, infectious diseases physician, or a liver transplant physician

Approval duration

12 weeks