Harvoni (ledipasvir/sofosbuvir) — United Healthcare
Chronic hepatitis C genotype 4, 5 or 6 infection, treatment-naïve or treatment-experienced without cirrhosis or with compensated cirrhosis
Initial criteria
- Diagnosis of chronic hepatitis C genotype 4, 5 or 6 infection
- One of the following: (1) Patient is without cirrhosis OR (2) Patient has compensated cirrhosis (Child-Pugh A) AND is without decompensated liver disease (Child-Pugh B or C)
- Patient is not receiving Harvoni in combination with another HCV direct acting antiviral agent
Approval duration
12 weeks