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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