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Mavyret (glecaprevir/pibrentasvir) — United Healthcare

chronic hepatitis C genotype 1 infection (treatment-experienced with NS3/4A protease inhibitor without prior NS5A inhibitor) without cirrhosis or with compensated cirrhosis

Initial criteria

  • Diagnosis of chronic hepatitis C genotype 1 infection AND Patient has prior treatment experience with an NS3/4A protease inhibitor AND Patient has no prior treatment experience with an HCV NS5A inhibitor AND One of the following: (Patient is without cirrhosis OR 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