Ledipasvir-Sofosbuvir

90-400 Mg — Tablet

Anti-hepatitis C (HCV) Agents

Also known as: Harvoni Ledipasvir-Sofosbuvir 90-400 Mg Tablet
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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: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Harvoni 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via Harvoni 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026
via Harvoni 		Tier 4 - Preferred Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026
via Ledipasvir/Sofosbuvir 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Value 2026
via Ledipasvir/Sofosbuvir 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Advantage 2026
via Harvoni 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Home with UNC Health Alliance 2026
via Harvoni 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Local 2026
via Harvoni 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Care 2026
via Harvoni 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Value 2026
via Harvoni 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Advantage 2026
via Ledipasvir/Sofosbuvir 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Home with UNC Health Alliance 2026
via Ledipasvir/Sofosbuvir 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
BCBSNC Blue Local 2026
via Ledipasvir/Sofosbuvir 		Tier 3 - High Cost Brand ✓ — — Restricted Access PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026 Tier 4 - Specialty ✓ — ✓ Specialty Pharmacy Required PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HealthSpring Preferred Plus (HMO)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring True Choice (PPO)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring TotalCare (HMO D-SNP)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring TotalCare Plus (HMO D-SNP)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred Savings (HMO)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred (HMO)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
HealthSpring Preferred Select (HMO)
via Harvoni 		Tier 5 - Specialty ✓ — ✓ 28 per 28 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Harvoni 		Tier 5 - Preferred Brand Specialty ✓ — ✓ For genotypes PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via Harvoni 		Tier 5 - Preferred Brand Specialty ✓ — ✓ For genotypes PA | QL
NC State Health Plan - 80/20 Plus PPO 2026
via Harvoni 		Tier 5 - Preferred Brand Specialty ✓ — ✓ For genotypes PA | QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 4 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Tier 4 - Higher Cost ✓ — ✓ PA | QL
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