Direct-acting Antivirals for Hepatitis C
Direct-acting antivirals for hepatitis C require prior authorization (F252-112-000) for coverage. Coverage criteria include, but are not limited to:
- Hepatitis C is an accepted condition
- Patient has evidence of active chronic hepatitis C infection
- Drug is prescribed consistent with FDA labeling
Preferred agents in this drug class:
- Glecaprevir/pibrentasvir (Mavyret®).
- Sofosbuvir/velpatasvir (Epclusa®) – for decompensated cirrhosis.
- Sofosbuvir/velpatasvir/voxilaprevir (Vosevi®) – for patients who have failed previous antiviral treatment (see FDA labeling).