Prior authorization required
Does Blue Cross Blue Shield (affiliate) require prior authorization for Mavyret?
Blue Cross Blue Shield (affiliate) requires prior authorization for Mavyret 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 |
|---|---|---|---|---|---|
| glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret]1940709 | 254 / 269 | 254 | 0 | 164 | Prior authorization required |
| glecaprevir 50 MG / pibrentasvir 20 MG Oral Pellet [Mavyret]2557910 | 225 / 269 | 225 | 0 | 135 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret]
Mavyret has 2 products in the corpus; this table is for glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret], 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 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 Advantage Choice (PPO) | H0104-016 | 5 | Yes | No | No |
| Blue Advantage Complete (PPO) | H0104-012 | 5 | Yes | No | No |
| Blue Advantage Complete (PPO) | H0104-014 | 5 | Yes | No | No |
| Blue Advantage Premier (PPO) | H0104-015 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-009 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-014 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-014 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Comfort (PPO) | H5959-015 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Comfort (PPO) | H5959-016 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-010 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-010 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-011 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-012 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-013 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-013 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Secure (HMO) | H8547-001 | 5 | Yes | No | No |
| 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 |
| Blue Medicare Choice (HMO) | H3449-026 | 5 | Yes | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 5 | Yes | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 5 | Yes | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 5 | Yes | No | No |
| Blue Medicare Essential (HMO) | H3449-027 | 5 | Yes | No | No |
| Blue Medicare Essential (HMO) | H3449-027 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare PPO Enhanced (PPO) | H3404-003 | 5 | Yes | No | No |
| Blue Medicare PPO Enhanced (PPO) | H3404-003 | 5 | Yes | No | No |
| Blue Medicare Rx Enhanced (PDP) | S5540-004 | 5 | Yes | No | No |
| Blue Medicare Rx Standard (PDP) | S5540-002 | 5 | Yes | No | No |
| Blue MedicareRx Essentials (PDP) | S5726-020 | 5 | Yes | No | No |
| Blue MedicareRx Plus (PDP) | S5726-014 | 5 | Yes | No | No |
| Blue MedicareRx Value (PDP) | S5726-013 | 5 | Yes | No | No |
| BlueCHiP for Medicare Access (HMO-POS) | H4152-022 | 5 | Yes | No | No |
| BlueCHiP for Medicare Enhanced (HMO-POS) | H4152-013 | 5 | Yes | No | No |
| BlueCHiP for Medicare Essential (HMO-POS) | H4152-023 | 5 | Yes | No | No |
| BlueCHiP for Medicare Extra (HMO-POS) | H4152-018 | 5 | Yes | No | No |
| BlueMedicare Complete Rx (PDP) | S5904-002 | 5 | Yes | No | No |
| BlueMedicare Premier Rx (PDP) | S5904-001 | 5 | Yes | No | No |
| BlueMedicare Select (PPO) | H5434-002 | 5 | Yes | No | No |
| BlueMedicare Select (PPO) | H5434-045 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-023 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-024 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-025 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-026 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-030 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-031 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-034 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-035 | 5 | Yes | No | No |
| BlueMedicare Value (PPO) | H5434-036 | 5 | Yes | No | No |
| BlueRI for Duals (HMO D-SNP) | H4152-021 | 5 | Yes | No | No |
| BlueRx Enhanced Plus (PDP) | S1030-001 | 5 | Yes | No | No |
| BlueRx Essential (PDP) | S1030-006 | 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 |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Merit (HMO) | H3384-071 | 5 | Yes | No | Yes |
Showing 100 of 254 covering plans.
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.
Mavyret 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.