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Mavyret (glecaprevir/pibrentasvir) — United Healthcare

chronic hepatitis C genotype 1, 2, 4, 5, or 6 infection (treatment-experienced with interferon/pegylated interferon/ribavirin/sofosbuvir) with compensated cirrhosis

Initial criteria

  • Diagnosis of chronic hepatitis C genotype 1, 2, 4, 5 or 6 infection AND Patient has prior treatment experience with a regimen including at least one of: Interferon, Pegylated interferon, Ribavirin, or Sofosbuvir AND Patient has no prior treatment experience with an HCV NS3/4A protease inhibitor or NS5A inhibitor AND Patient has compensated cirrhosis (Child-Pugh A) AND Patient is not receiving Mavyret in combination with another HCV direct acting antiviral agent

Approval duration

12 weeks