Harvoni
Generic: ledipasvir
33.75 MG — Tablet
Also known as:
ledipasvir
HARVONI TAB 45-200MG
HARVONI TAB 90-400MG
Harvoni Oral Tablet
Harvoni Oral Packet
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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.
AmeriHealth Caritas NC
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via ledipasvir |
Tier 3 - Preferred Brand | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| 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 |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 3 - High Cost Brand | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Advantage 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 |
Medicare Part D
23 plans| 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 |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via ledipasvir |
Tier 5 - Specialty | ✓ | — | — | PA |
| 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 |
| 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 |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via ledipasvir |
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 |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via ledipasvir |
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 |
| HealthSpring True Choice (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 28 per 28 days | PA | QL |
|
Alignment Health AVA (PPO)
via ledipasvir |
Tier 5 - Specialty | ✓ | — | — | PA |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ For genotypes | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 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 |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Gold Classic Standard | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| Gold Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| Bronze Classic Standard | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| Silver Classic Standard | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| Silver Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| Bronze Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| Gold Elite Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Elite + PCP Saver Plus | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Classic | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Secure | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Classic 4700 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple PCP Saver | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Gold Elite Saver Plus | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Diabetes | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Secure | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Classic | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| AIAN Cost Share | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| AIAN Cost Share | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard (No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard (No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard (No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via ledipasvir |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |