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Hepatitis C PDL Decision Revised

Story Content Provided by UnitedHealthcare on 2/11/15

Two hepatitis C medications, Harvoni® and Viekira Pak® were recently approved by the US Food and Drug Administration (FDA). Both medications are highly effective when used in patients with appropriate genotypes. Both have very acceptable adverse event profiles. However, both are very costly. To assure access to these and other hepatitis C medications within an affordable pharmacy benefit, we are pleased to announce our Prescription Drug List (PDL) decisions that will result in no negative member impact upon the Feb. 1, 2015, implementation.

While prior authorization (and medical necessity if applicable) has been in effect since the launch of these medications to ensure appropriate coverage review and utilization, the following changes will take effect on Feb. 1, 2015, and July 1, 2015.

Feb. 1, 2015 (existing users grandfathered)

  • Harvoni will be down-tiered to Tier 2
  • Sovaldi will be down-tiered to Tier 2
  • Step therapy applied to Olysio, Victrelis, Viekira Pak (Step 1: Harvoni)
  • Step therapy applied to Sovaldi only for genotype 1 (Step 1: Harvoni)

July 1, 2015 (Jan. 1, 2016 for those on Traditional PDL)

  • Olysio will be up-tiered to Tier 3 (Tier 4 as applicable)

We are happy to offer two Tier 2 options to cover all spectrums of the hepatitis C genotypes. Harvoni, the most prescribed drug because of its convenience, high effective rates and minimal side effects, will be an affordable option for members.

View a summary of all of the hepatitis C PDL decisions.

If you have any questions on hepatitis C or PDL changes, please contact your UnitedHealthcare representative.