Does Medicare Part D cover Epclusa?
Epclusa appears on the Medicare Part D formularies of 129 payers in the corpus, across 3,240 plans. 128 payers require prior authorization on every covering plan, 1 on some plans, and 0 on none.
Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 1,738 apply a quantity limit, on at least one Epclusa product.
Prior authorization is set per plan, not per payer. Pick a payer below for its full plan-by-plan breakdown, effective 2026-06-30.
Coverage by payer
| Payer | Plans covering | Require prior auth | Step therapy | Quantity limit | Status |
|---|---|---|---|---|---|
| Humana | 817 | 817 | 0 | 817 | Prior authorization required |
| Aetna (CVS Health) | 643 | 643 | 0 | 0 | Prior authorization required |
| Devoted Health | 415 | 415 | 0 | 0 | Prior authorization required |
| Cigna | 171 | 171 | 0 | 171 | Prior authorization required |
| Kaiser Permanente | 115 | 16 | 0 | 0 | Varies by plan |
| SCAN Health Plan | 74 | 74 | 0 | 0 | Prior authorization required |
| Blue Cross Blue Shield (affiliate) | 61 | 61 | 0 | 45 | Prior authorization required |
| Medco Containment Life And Medco Containment Ny | 60 | 60 | 0 | 60 | Prior authorization required |
| Elevance Health (Anthem) | 54 | 54 | 0 | 52 | Prior authorization required |
| Molina Healthcare | 51 | 51 | 0 | 0 | Prior authorization required |
| Simply Healthcare Plans, INC. | 50 | 50 | 0 | 50 | Prior authorization required |
| Cariten Health Plan INC. | 44 | 44 | 0 | 44 | Prior authorization required |
| Priority Health | 37 | 37 | 0 | 37 | Prior authorization required |
| Careplus Health Plans, INC. | 36 | 36 | 0 | 36 | Prior authorization required |
| Bravo Health Pennsylvania, INC. | 35 | 35 | 0 | 35 | Prior authorization required |
| Zing Health Of Michigan, INC. | 33 | 33 | 0 | 0 | Prior authorization required |
| Freedom Health, INC. | 24 | 24 | 0 | 24 | Prior authorization required |
| Mmm Healthcare, LLC | 20 | 20 | 0 | 20 | Prior authorization required |
| Bluecross Blueshield Of Tennessee, INC. | 17 | 17 | 0 | 17 | Prior authorization required |
| Wellpoint Texas, INC. | 16 | 16 | 0 | 16 | Prior authorization required |
| Optimum Healthcare, INC. | 15 | 15 | 0 | 15 | Prior authorization required |
| Central Health Plan Of California, INC. | 15 | 15 | 0 | 0 | Prior authorization required |
| Wellpoint Insurance Company | 14 | 14 | 0 | 14 | Prior authorization required |
| Clover Health | 13 | 13 | 0 | 0 | Prior authorization required |
| Healthsun Health Plans, INC. | 13 | 13 | 0 | 13 | Prior authorization required |
| Atrio Health Plans | 12 | 12 | 0 | 12 | Prior authorization required |
| Mount Carmel Health Plan, INC. | 11 | 11 | 0 | 0 | Prior authorization required |
| Community Insurance Company | 10 | 10 | 0 | 10 | Prior authorization required |
| HMO Colorado, INC. | 10 | 10 | 0 | 10 | Prior authorization required |
| Compcare Health Services Insurance Corporation | 10 | 10 | 0 | 10 | Prior authorization required |
| Allina Health And Aetna Insurance Company | 9 | 9 | 0 | 0 | Prior authorization required |
| Doctors Healthcare Plans, INC. | 9 | 9 | 0 | 9 | Prior authorization required |
| Mvp Health Plan, INC. | 8 | 8 | 0 | 0 | Prior authorization required |
| Keystone Health Plan East, INC. | 8 | 8 | 0 | 8 | Prior authorization required |
| Network Health Insurance Corporation | 8 | 8 | 0 | 8 | Prior authorization required |
| Fallon Community Health Plan | 8 | 8 | 0 | 8 | Prior authorization required |
| Health Partners Plans, INC. | 8 | 8 | 0 | 8 | Prior authorization required |
| Viva Health, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Martin'S Point Generations Advantage, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Wellpoint Health Plans, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Astiva Health, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Bravo Health Mid-Atlantic, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Summacare INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Champion Health Plan Of California INC | 7 | 7 | 0 | 7 | Prior authorization required |
| Champion Health Plan Of Nevada, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Alterwood Advantage, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Christus Health Plan | 6 | 6 | 0 | 0 | Prior authorization required |
| Gold Kidney Of Florida INC | 6 | 6 | 0 | 6 | Prior authorization required |
| Elderplan, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Connecticare, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Globalhealth, INC. | 6 | 6 | 0 | 6 | Prior authorization required |
| Chinese Community Health Plan | 5 | 5 | 0 | 5 | Prior authorization required |
| Hopkins Health Advantage, INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Oh Chs Snp INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Usable Mutual Insurance Company | 5 | 5 | 0 | 0 | Prior authorization required |
| Gold Kidney Of Arizona | 5 | 5 | 0 | 5 | Prior authorization required |
| Wellpoint Tennessee, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Priority Health Choice, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Hpmp Of Florida, INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Hawaii Medical Service Association | 4 | 4 | 0 | 0 | Prior authorization required |
| Qcc Insurance Company | 4 | 4 | 0 | 4 | Prior authorization required |
| Leon Health, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| Verda Health Plan Of Texas INC | 4 | 4 | 0 | 4 | Prior authorization required |
| Sharp Health Plan | 4 | 4 | 0 | 0 | Prior authorization required |
| Clever Care Of Golden State, INC. | 4 | 4 | 0 | 0 | Prior authorization required |
| Aspire Health Plan | 4 | 4 | 0 | 4 | Prior authorization required |
| Amh Health, LLC | 4 | 4 | 0 | 4 | Prior authorization required |
| Metroplus Health Plan, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Partners Insurance Company INC | 3 | 3 | 0 | 3 | Prior authorization required |
| Mount Carmel Health Insurance Company | 3 | 3 | 0 | 0 | Prior authorization required |
| Community Care Health Plan Of Louisiana, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Village Senior Services Corporation | 3 | 3 | 0 | 3 | Prior authorization required |
| Senior Whole Health, LLC | 3 | 3 | 0 | 0 | Prior authorization required |
| Baycare Select Health Plans, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Cox Health Systems HMO INC | 3 | 3 | 0 | 3 | Prior authorization required |
| Wellpoint New Jersey, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Volunteer State Health Plan | 3 | 3 | 0 | 3 | Prior authorization required |
| Paramount Care, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Aultcare Health Insuring Corporation | 3 | 3 | 0 | 3 | Prior authorization required |
| Mount Carmel Health Plan Of Idaho, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Amerihealth Insurance Company Of New Jersey | 3 | 3 | 0 | 3 | Prior authorization required |
| Vns Choice | 3 | 3 | 0 | 3 | Prior authorization required |
| Mercy Care | 3 | 3 | 0 | 0 | Prior authorization required |
| Usable HMO, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Mclaren Health Plan, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Southeastern Indiana Health Organization, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Wellpoint Iowa, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Wellpoint West Virginia , INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Commonwealth Care Alliance, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Arkansas Superior Select, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Wellpoint Washington, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Neighborhood Health Plan Of Rhode Island | 2 | 2 | 0 | 0 | Prior authorization required |
| Signature Advantage, LLC | 2 | 2 | 0 | 2 | Prior authorization required |
| Primewest Rural Mn Health Care Access Initiative | 2 | 2 | 0 | 2 | Prior authorization required |
| Verda Health Plan Of Arizona, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Partners Insurance Company Of New Jersey INC | 2 | 2 | 0 | 2 | Prior authorization required |
| New Century Health Plan, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Community Health Group | 2 | 2 | 0 | 2 | Prior authorization required |
| Texas Independence Health Plan, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Imperial Health Plan Of California, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Denver Health Medical Plan, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Senior Whole Health Of New York, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Missouri Care, Incorporated | 2 | 2 | 0 | 2 | Prior authorization required |
| Elite Health Plan, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Visiting Nurse Association Of Central New York | 2 | 2 | 0 | 2 | Prior authorization required |
| Trinity Health Plan Of Michigan INC | 2 | 2 | 0 | 0 | Prior authorization required |
| Mount Carmel Health Plan Of New York, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Tsg Guard, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Johns Hopkins Health Plan Of Virginia, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Imperial County Local Health Authority | 1 | 1 | 0 | 1 | Prior authorization required |
| Independent Care Health Plan | 1 | 1 | 0 | 1 | Prior authorization required |
| Itasca Medical Care | 1 | 1 | 0 | 0 | Prior authorization required |
| Connecticare Insurance Company, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Allcare Health Plan, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Santa Clara County Health Authority | 1 | 1 | 0 | 1 | Prior authorization required |
| Kern Health Systems | 1 | 1 | 0 | 1 | Prior authorization required |
| Paramount Insurance Company | 1 | 1 | 0 | 0 | Prior authorization required |
| Orange County Health Authority | 1 | 1 | 0 | 1 | Prior authorization required |
| Health Choice Arizona, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Santa Cruz Monterey Merced San Benito Mariposa Managed Medic | 1 | 1 | 0 | 1 | Prior authorization required |
| San Joaquin County Health Commission | 1 | 1 | 0 | 1 | Prior authorization required |
| Aids Healthcare Foundation | 1 | 1 | 0 | 1 | Prior authorization required |
| Health Plan Of Careoregon, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Santa Barbara San Luis Obispo Regional Health Authority Dba | 1 | 1 | 0 | 1 | Prior authorization required |
| San Francisco Health Authority Dba San Francisco Health Plan | 1 | 1 | 0 | 1 | Prior authorization required |
| Hawaii Medical Service Association (Hmsa) | 1 | 1 | 0 | 0 | Prior authorization required |
| Inland Empire Health Plan | 1 | 1 | 0 | 1 | Prior authorization required |
| West Virginia Senior Advantage, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Healthfirst Insurance Company, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
“Require prior auth”, “step therapy” and “quantity limit” each count a plan when any Epclusa product on its formulary carries that condition.
Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.