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The Policy VaultThe Policy Vault

Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) — United Healthcare

chronic hepatitis C genotype 1a or 3 infection in patients who are treatment-experienced with a regimen containing Sovaldi (sofosbuvir) without an NS5A inhibitor who are without cirrhosis or have compensated cirrhosis

Initial criteria

  • Diagnosis of chronic hepatitis C genotype 1a or 3 infection
  • Patient has prior treatment experience with a regimen containing Sovaldi (sofosbuvir) without an NS5A inhibitor
  • Patient is without cirrhosis OR has compensated cirrhosis (Child-Pugh A)
  • Patient is not receiving Vosevi in combination with another HCV direct acting antiviral agent (e.g., Epclusa, Harvoni, Mavyret, Sovaldi, Zepatier)
  • Physician/provider asserts patient demonstrates treatment readiness, including the ability to adhere to the treatment regimen

Approval duration

12 weeks