Medicare AdvantagePrior AuthMedium impact
Sovaldi® (sofosbuvir) (Revised)
Humana·Gastroenterology, Infectious Disease, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for Sovaldi (sofosbuvir) for hepatitis C treatment. The policy now requires patients to fail Epclusa first before Sovaldi can be approved, and prohibits monotherapy use.
Action Required
Before January 1, 2026: Update prior authorization procedures for Sovaldi prescriptions to verify patients have failed Epclusa treatment or have contraindications. Ensure documentation includes hepatitis C genotype, liver disease status, and previous treatment history. Claims without proper prior authorization will be denied.