Sovaldi (sofosbuvir) — United Healthcare
chronic hepatitis C genotype 1, 2, 3, or 4 infection with hepatocellular carcinoma awaiting liver transplantation
Preferred products
- Epclusa (sofosbuvir/velpatasvir)
- Harvoni (sofosbuvir/ledipasvir)
Initial criteria
- Diagnosis of hepatocellular carcinoma
- Patient is an active candidate on the waiting list for a liver transplant
- Patient is being managed in a liver transplant center
- Patient has not experienced failure with a previous treatment regimen that includes Sovaldi
- Used in combination with ribavirin
- Physician/provider asserts patient demonstrates treatment readiness, including the ability to adhere to the treatment regimen
- For genotype 1 or 4: History of intolerance or contraindication to Harvoni (sofosbuvir/ledipasvir) therapy AND History of intolerance or contraindication to Epclusa (sofosbuvir/velpatasvir) therapy OR Patient is currently on Sovaldi therapy
- For genotype 2 or 3: History of intolerance or contraindication to Epclusa (sofosbuvir/velpatasvir) therapy OR Patient is currently on Sovaldi therapy
Approval duration
48 weeks