Harvard Pilgrim has adopted pharmacy policies for two newly available medications for chronic hepatitis C infection. Effective January 10, 2014, Harvard Pilgrim is requiring prior authorization for Olysio (simeprevir) and Sovaldi (sofosbuvir) to ensure their use is clinically appropriate based on FDA-approved indications and clinical guidelines.
Olysio is an oral protease inhibitor approved by the FDA to treat patients with hepatitis C virus (HCV) genotype 1, and must be used in combination with peginterferon alfa and ribavirin. Clinical studies have found that Olysio is less effective in patients with HCV genotype 1a who had an NS3 Q80K polymorphism. Therefore, patients with genotype 1a should be screened for this genetic mutation, and if they test positive, alternative therapy should be considered. Please refer to the Olysio clinical coverage criteria for more information on prior authorization requirements.
Sovaldi (sofosbuvir) is a nucleotide analog NS5B polymerase inhibitor approved by the FDA to treat patients with HCV genotypes 1, 2, 3 and 4, including those with hepatocellular carcinoma awaiting liver transplant and those with HCV/HIV-1 co-infection. Sovaldi is given as part of a dual (with ribavirin) or triple (with peginterferon alfa and ribavirin) therapy regimen, depending on the patient’s genotype. Please refer to the Sovaldi clinical coverage criteria for more information on prior authorization requirements.
To obtain coverage for these medications, please complete the appropriate Medication Request Form and fax it back to MedImpact Healthcare Systems at 888-807-6643. Both medications are available through Accredo specialty pharmacy.
For more information, please visit Harvard Pilgrim’s pharmacy page.