Mavyret (glecaprevir/pibrentasvir) — United Healthcare
hepatitis C genotype 1, 2, 3, 4, 5, or 6 infection in liver or kidney transplant recipients without cirrhosis or with compensated cirrhosis
Initial criteria
- Diagnosis of hepatitis C genotype 1, 2, 3, 4, 5 or 6 infection AND Patient is a liver or kidney transplant recipient 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