Sovaldi — Medical Mutual
Chronic Hepatitis C Virus (HCV) Genotype 3, Pediatric Patients
Initial criteria
- Patient age ≥ 3 years AND < 18 years
- Patient does not have decompensated cirrhosis (Child-Pugh B or C)
- Coverage is provided for patients without cirrhosis OR with compensated (Child-Pugh A) cirrhosis
- 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