Harvoni (ledipasvir/sofosbuvir) — United Healthcare
Chronic hepatitis C genotype 1 infection, treatment-naïve or treatment-experienced with decompensated cirrhosis
Initial criteria
- Diagnosis of chronic hepatitis C genotype 1 infection
- Patient has decompensated liver disease (Child-Pugh B or C)
- Patient will receive Harvoni in combination with ribavirin
- Patient is not receiving Harvoni in combination with another HCV direct acting antiviral agent
Approval duration
12 weeks