Harvoni

Generic: ledipasvir

33.75 MG — Tablet

ANTIVIRALS

Also known as: ledipasvir HARVONI TAB 45-200MG HARVONI TAB 90-400MG
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026 Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Value 2026 Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Local 2026 Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Care 2026 Tier 3 - High Cost Brand ✓ — — Restricted Access PA
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via ledipasvir 		Tier 1 - Preferred Generic ✓ — ✓ 28 per 28 days PA | QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring True Choice (PPO) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Wellcare Assist Open (PPO)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Wellcare Dual Access (HMO-POS D-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred (HMO) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred Select (HMO) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Wellcare Simple Open (PPO)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Wellcare Simple (HMO-POS)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Wellcare Giveback Open (PPO)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Alignment Health Platinum (HMO)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Alignment Health NC Duals (HMO-POS D-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Alignment Health smartHMO (HMO)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum Select (HMO)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Alignment Health AVA (PPO)
via ledipasvir 		Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP)
via ledipasvir 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ For genotypes PA | QL
NC State Health Plan - HDHP 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ For genotypes PA | QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ For genotypes PA | QL
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