Sovaldi (sofosbuvir) — United Healthcare
chronic hepatitis C genotype 1 or 4 in peginterferon eligible patients without cirrhosis or with compensated cirrhosis
Preferred products
- Epclusa (sofosbuvir/velpatasvir)
- Harvoni (sofosbuvir/ledipasvir)
- Mavyret (glecaprevir/pibrentasvir)
- Zepatier (elbasvir/grazoprevir)
Initial criteria
- Diagnosis of chronic hepatitis C genotype 1 infection OR Diagnosis of chronic hepatitis C genotype 4 infection
- Patient has not experienced failure with a previous treatment regimen that includes Sovaldi
- Used in combination with peginterferon alfa and ribavirin
- Patient is without cirrhosis OR Patient has compensated cirrhosis (Child-Pugh A)
- Physician/provider asserts patient demonstrates treatment readiness, including the ability to adhere to the treatment regimen
- All of the following: History of intolerance or contraindication to Epclusa (sofosbuvir/velpatasvir) therapy AND History of intolerance or contraindication to Harvoni (sofosbuvir/ledipasvir) therapy AND History of intolerance or contraindication to Mavyret (glecaprevir/pibrentasvir) therapy AND History of intolerance or contraindication to Zepatier (elbasvir/grazoprevir) therapy OR Patient is currently on Sovaldi therapy
Approval duration
12 weeks