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