Mavyret (glecaprevir/pibrentasvir) — United Healthcare

Initial criteria

• Diagnosis of chronic hepatitis C genotype 3 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 One of the following: (Patient is without cirrhosis OR Patient has compensated cirrhosis (Child-Pugh A) OR Patient is a liver or kidney transplant recipient) AND Patient is not receiving Mavyret in combination with another HCV direct acting antiviral agent

Approval duration

16 weeks