Prior authorization required
Does Blue Cross Blue Shield (affiliate) require prior authorization for Epclusa?
Blue Cross Blue Shield (affiliate) requires prior authorization for Epclusa on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa]1799218 | 61 / 269 | 61 | 0 | 45 | Prior authorization required |
| sofosbuvir 200 MG / velpatasvir 50 MG Oral Tablet [Epclusa]2288816 | 61 / 269 | 61 | 0 | 45 | Prior authorization required |
| sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa]2584199 | 61 / 269 | 61 | 0 | 45 | Prior authorization required |
| sofosbuvir 200 MG / velpatasvir 50 MG Oral Pellet [Epclusa]2584201 | 61 / 269 | 61 | 0 | 45 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa]
Epclusa has 4 products in the corpus; this table is for sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Anthem Dual Advantage (HMO D-SNP) | H5422-018 | 5 | Yes | No | Yes |
| Anthem Extra Help (HMO-POS) | H5422-013 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage (HMO D-SNP) | H5422-019 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-010 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-010 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-011 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care (HMO-POS C-SNP) | H0544-004 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care (HMO-POS C-SNP) | H0544-010 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) | H4161-014 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) | H4161-015 | 5 | Yes | No | Yes |
| Anthem I CareMore Home Care (HMO I-SNP) | H0544-005 | 5 | Yes | No | Yes |
| Anthem I CareMore Kidney Care (HMO-POS C-SNP) | H0544-015 | 5 | Yes | No | Yes |
| Anthem I CareMore Kidney Care (HMO-POS C-SNP) | H0544-020 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care (HMO-POS C-SNP) | H0544-014 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care (HMO-POS C-SNP) | H0544-019 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) | H4161-016 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) | H4161-017 | 5 | Yes | No | Yes |
| Anthem I CareMore Medicare Advantage (HMO-POS) | H4161-011 | 5 | Yes | No | Yes |
| Anthem I CareMore Medicare Advantage (HMO-POS) | H4161-013 | 5 | Yes | No | Yes |
| Anthem I CareMore Medicare Advantage 2 (HMO-POS) | H0544-002 | 5 | Yes | No | Yes |
| Anthem I CareMore Premium Savings (HMO-POS) | H4161-012 | 5 | Yes | No | Yes |
| Anthem Kidney Care (HMO-POS C-SNP) | H5422-015 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-056 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-061 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-062 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-063 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-064 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-065 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-095 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-096 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-108 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H5422-011 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-002 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-003 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-004 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-005 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-006 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-007 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-009 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-010 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-058 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-066 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-069 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-091 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-098 | 5 | Yes | No | Yes |
| Blue Medicare Advantage Classic PPO (PPO) | H5900-008 | 5 | Yes | No | No |
| Blue Medicare Advantage Enhanced PPO (PPO) | H5900-004 | 5 | Yes | No | No |
| Blue Medicare Advantage PPO (PPO) | H5900-001 | 5 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 5 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 5 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 5 | Yes | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 5 | Yes | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 5 | Yes | No | No |
| Medicare HMO Blue PlusRx (HMO) | H2261-005 | 5 | Yes | No | No |
| Medicare HMO Blue SaverRx (HMO-POS) | H2261-024 | 5 | Yes | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 5 | Yes | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 5 | Yes | No | No |
| Medicare PPO Blue EssentialRx (PPO) | H2230-019 | 5 | Yes | No | No |
| Medicare PPO Blue PlusRx (PPO) | H2230-002 | 5 | Yes | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 5 | Yes | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 5 | Yes | No | No |
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.
Epclusa at other payers
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.