Sovaldi (sofosbuvir) — Point32Health
Chronic hepatitis C virus infection genotype 1 or 4 without decompensated liver disease, in combination with peginterferon alfa and ribavirin
Preferred products
- Epclusa
- Harvoni
- Mavyret
Initial criteria
- Documented diagnosis of chronic hepatitis C virus
- Documentation of genotype 1 or 4 infection
- Documentation the patient has not experienced failure with a previous treatment regimen that includes Sovaldi
- Documentation the requested medication will be used in combination with peginterferon alfa and ribavirin
- Documentation the patient is without decompensated liver disease (Child-Pugh Class B or C)
- Documentation of one (1) of the following: a. Trial and failure or intolerance to one, or contraindication of both of the following: Brand Epclusa, Brand Harvoni AND trial and failure or intolerance to, or contraindication to the following: Mavyret OR b. The patient is new to the plan and has been stable on the requested agent prior to enrollment
- Prescribed by or in consultation with a hepatologist, gastroenterologist, or infectious disease specialist
Approval duration
12 weeks