Hepatitis C Direct-Acting Antivirals

Medications listed in the tables and non-FDA approved indications included in these retrospective criteria are not indicative of Vendor Drug Program formulary coverage.

Note: This retrospective drug use criteria provides information from each respective therapies FDA approved package insert. Further guidance for patient specific treatments can be found within the continuously updated American Association for the Study of Liver Disease (AASLD) and the Infectious Diseases Society of America (IDSA) “HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C” guidelines at www.hcvguidelines.org. It is recommended to consult these guidelines prior to initiating therapy to treat hepatitis C infection.

• Revision history
  • July 22, 2022
• Initially developed
  • March 2018