Sovaldi (sofosbuvir) — United Healthcare
chronic hepatitis C genotype 2 infection without cirrhosis or with compensated cirrhosis
Preferred products
- Epclusa (sofosbuvir/velpatasvir)
- Mavyret (glecaprevir/pibrentasvir)
Initial criteria
- Diagnosis of chronic hepatitis C genotype 2 infection
- Patient has not experienced failure with a previous treatment regimen that includes Sovaldi
- Used in combination with 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
- Both of the following: History of intolerance or contraindication to Epclusa (sofosbuvir/velpatasvir) therapy AND History of intolerance or contraindication to Mavyret (glecaprevir/pibrentasvir) therapy OR Patient is currently on Sovaldi therapy
Approval duration
12 weeks