| Diagnosis of chronic Hepatitis B, non-cirrhosis.
According to established protocols; lab work required.
Submit Hepatitis B requests using the Chronic Hepatitis B form. See form link below.
Note:
- For treatment of chronic hepatitis C genotype 1, please see Limited Coverage criteria for boceprevir and boceprevir in combination with peginterferon/ribavirin
- For treatment of chronic hepatitis C genotype 2, 3, 4, 5 or 6, please see Limited Coverage criteria for ribavirin in combination with pegylated interferon.
|
1. First approval: 24 weeks
One Renewal: Up to 24 weeks, only if patient demonstrates a positive response to treatment. |
