Epclusa (sofosbuvir/velpatasvir) — United Healthcare

Initial criteria

• Diagnosis of chronic hepatitis C genotype 1, 2, 3, 4, 5 or 6 infection
• Patient is not receiving Epclusa in combination with another HCV direct acting antiviral agent (e.g., Sovaldi [sofosbuvir])
• One of the following: (a) Patient does not have decompensated liver disease (e.g., Child-Pugh Class B or C) OR (b) Both of the following: (1) Patient has decompensated liver disease (e.g., Child-Pugh Class B or C) AND (2) Used in combination with ribavirin

Approval duration

12 weeks