The Department of Health Care Finance (DHCF) has published the prior authorization clinical criteria for Sovaldi® (sofosbuvir). Sovaldi® is a new oral treatment option for patients with chronic hepatitis C virus (HCV) genotype 1, 2, 3, or 4 infection, including those with hepatocellular carcinoma meeting Milan criteria (awaiting liver transplant) and those with HCV/human immunodeficiency virus (HIV)-1 co-infection. Approved by the Food and Drug Administration (FDA) in December 2013, sofosbuvir is the first direct-acting antiviral (DAA) agent in the nucleoside/ nucleotide polymerase inhibitor class.

 

The Initial Prior Authorization Request Form for Sovaldi® is available on the following websites:

 

Prescribers may refer to the Clinical Criteria for Approving Sovaldi® Form for additional required information to be submitted with prior authorization requests.