Harvoni (ledipasvir/sofosbuvir) — United Healthcare

Initial criteria

• Diagnosis of chronic hepatitis C genotype 1 infection
• Patient has experienced failure with previous peginterferon alfa +/- ribavirin regimen with/without HCV protease inhibitor or Sovaldi
• Patient has compensated cirrhosis (Child-Pugh A)
• Patient is without decompensated liver disease (Child-Pugh B or C)
• One of the following: (1) Patient will receive Harvoni with ribavirin OR (2) Patient is not eligible for ribavirin
• Patient is not receiving Harvoni in combination with another HCV direct acting antiviral agent

Approval duration

12 weeks if with ribavirin; 24 weeks if ineligible for ribavirin