Medicare AdvantagePrior AuthMedium impact
Vosevi® (sofosbuvir, velpatasvir, and voxilaprevir) (Revised)
Humana·Infectious Disease, Gastroenterology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has issued a revised prior authorization policy for Vosevi® (sofosbuvir, velpatasvir, voxilaprevir) effective January 1, 2026, with updates as of June 24, 2026. The policy requires prior authorization for this hepatitis C retreatment medication and specifies three clinical approval criteria: chronic HCV diagnosis, non-cirrhotic or compensated cirrhosis status (Child-Pugh Class A), and prior relapse or contraindication to Epclusa. Initial and renewal approvals are limited to 12 weeks based on disease state and genotype per AASLD guidelines.
Action Required
By January 1, 2026: Billing team and prior authorization staff must implement this policy for all Humana Medicare Advantage members requesting Vosevi. (1) Update billing system to require prior authorization before claims submission for Vosevi tablets. (2) Create or update prior auth request template to include verification of all three criteria: HCV diagnosis confirmation, cirrhosis status documentation (with Child-Pugh classification if applicable), and evidence of prior Epclusa relapse or contraindication (including any prior glecaprevir/pibrentasvir treatment history). (3) Train authorization staff that approvals are limited to 12 weeks per treatment cycle and must align with AASLD HCV treatment guidelines based on genotype. (4) Flag that HBV reactivation is a black box warning and rifampin is contraindicated—verify member history before approval. (5) Instruct providers that glecaprevir/pibrentasvir prior treatment is an exception that does not disqualify Epclusa use in determining Vosevi eligibility. Failure to obtain prior authorization will result in claim denials.