Prior authorization required

Does Capital Advantage Insurance Company require prior authorization for Mavyret?

Capital Advantage Insurance Company 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	23 / 23	23	0	0	Prior authorization required
glecaprevir 50 MG / pibrentasvir 20 MG Oral Pellet [Mavyret]2557910	23 / 23	23	0	0	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
Capital Blue Cross Basic (PPO)	H3923-048	5	Yes	No	No
Capital Blue Cross Basic (PPO)	H3923-048	5	Yes	No	No
Capital Blue Cross Basic (PPO)	H3923-048	5	Yes	No	No
Capital Blue Cross Classic (PPO)	H3923-013	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Prime (PPO)	H3923-017	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	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.

Mavyret at other payers

Or see Mavyret across every payer at once.

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.