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Epclusa (sofosbuvir/velpatasvir)United Healthcare

Chronic hepatitis C genotype 1, 2, 3, 4, 5, or 6 infection

Initial criteria

  • Diagnosis of chronic hepatitis C genotype 1, 2, 3, 4, 5, or 6 infection
  • AND one of the following:
  • • Patient does not have decompensated liver disease (e.g., Child-Pugh Class B or C)
  • OR
  • • Patient has decompensated liver disease (e.g., Child-Pugh Class B or C) AND Epclusa is used in combination with ribavirin
  • AND patient is not receiving Epclusa in combination with another HCV direct acting antiviral agent [e.g., Mavyret (glecaprevir/pibrentasvir), Harvoni (ledipasvir/sofosbuvir), Sovaldi (sofosbuvir), Zepatier (elbasvir/grazoprevir)]
  • AND provider asserts patient demonstrates treatment readiness, including ability to adhere to treatment regimen

Approval duration

12 weeks