Daa Pangenotypic Mavyret denied as duplicate or overlapping therapy by Aetna?

Aetna's specific coverage criteria for daa pangenotypic mavyret are defined in its own published medical/coverage policy and the FDA-approved prescribing label. A successful appeal documents that your medical records satisfy each criterion those sources list — confirmed diagnosis, any required prior treatments (with dates and outcomes), and clinical severity. If the exact criteria weren't included with your denial, request them in writing; your appeal then maps each requirement to the matching fact in your chart.

## Why Aetna Issued a Duplicate-Therapy Denial for Mavyret

Mavyret (glecaprevir/pibrentasvir) is a pangenotypic direct-acting antiviral (DAA) approved for treatment of chronic hepatitis C. Aetna may issue a duplicate-therapy denial when its system detects that another DAA or hepatitis C antiviral has recently been dispensed, is recorded as an active prescription, or was authorized under a concurrent benefit. The plan's position is that two agents targeting the same condition are not simultaneously necessary.

This denial is commonly reversible. Pangenotypic DAAs are not clinically interchangeable in every situation — a patient's genotype, cirrhosis status, renal function, drug-interaction profile, and prior treatment history all influence which agent is most appropriate. If Mavyret is the correct regimen and no other active hepatitis C therapy is actually in use, the appeal can establish that the duplicate-therapy flag was triggered in error.

## Federal Appeal Framework

• ACA Section 2719 / external review: Non-grandfathered Aetna commercial plans must offer independent external review by an accredited IRO after internal appeals are exhausted. The standard window is approximately four months from the denial notice; verify the exact deadline on your Explanation of Benefits. Expedited external review (roughly 72 hours) is available when delay poses a serious health risk.
• ERISA Section 503: Employer-sponsored plans must provide a full-and-fair review, including written notice of the specific criteria applied and an opportunity to submit rebuttal evidence.

## Concrete Appeal Steps and Timeline

1. Request Aetna's written denial letter identifying the specific duplicate-therapy rationale and the other agent flagged as duplicative. 2. Obtain a copy of Aetna's current hepatitis C or DAA clinical policy from their provider portal or member services. 3. File a Level 1 internal appeal within the plan-stated deadline (often 180 days from denial; verify your plan documents). 4. If upheld internally, request external review within the timeframe stated on the denial notice.

## Documentation to Gather

• Diagnosis confirmation: Current hepatitis C genotype, viral load, and liver-disease staging (fibrosis or cirrhosis grading).
• Active medication reconciliation: A complete, current medication list from the prescriber confirming that no other hepatitis C DAA is actively prescribed or being dispensed.
• Prior-treatment history: Names, dates, and outcomes of any previous hepatitis C regimens — establishing whether the flagged "duplicate" agent was actually tried, stopped, or never dispensed.
• Clinical rationale for Mavyret: Prescriber documentation explaining why Mavyret is the appropriate choice for this patient's specific clinical profile, referencing the FDA-approved prescribing label and the applicable AASLD/IDSA hepatitis C guidance.
• Prescriber medical-necessity letter: A letter explicitly addressing Aetna's duplicate-therapy concern and confirming no concurrent active regimen.

## Criteria-Mapping Structure

From (a) the FDA-approved Mavyret prescribing information and (b) Aetna's published hepatitis C clinical policy, list each requirement and provide the corresponding chart answer. Where the duplicate-therapy flag stems from a prior prescription on file, include prescriber documentation confirming that prior regimen has been discontinued and explain the clinical reason Mavyret is now being initiated.