CurrentCignaPolicy IP0157

Sovaldi Prior Authorization Policy

Defines Cigna's prior authorization, coverage criteria, and limits for Sovaldi (sofosbuvir) for treatment of chronic hepatitis C virus (HCV), including pediatric indications, and applies to Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicySovaldi Prior Authorization Policy

Policy CodePolicy IP0157

Change TypeUpdates to criteria and employer plan preferred product requirement

Effective Date03/01/2026

Next Review Date

Key ActionObtain prior authorization and document specialist prescription or consultation plus age, cirrhosis status, genotype, and intended combination therapy.

SourceLink

POLICY UPDATE CHANGES

Removed criterion related to intolerance or contraindication to both Epclusa and Mavyret for chronic HCV genotypes 2 and 3.

Removed condition 'Life Expectancy Less Than 12 Months Due to Non-Liver Related Comorbidities' from Conditions Not Recommended for Approval.

For Employer Plans: note requiring use of preferred products before approval and referral to PSM025 for preferred product criteria and exceptions.

3FDA-approved or supported use groups listed (Genotype 2, Genotype 3, patients already started)

≥3 yrsMinimum age for covered pediatric use

12 wksGenotype 2 pediatric duration

24 wksGenotype 3 pediatric duration