elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier]
elbasvir
RxCUI: 1734642
What the CMS Formulary Data Shows for elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier]
Per the CMS 2026 Part D formulary file, elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] (RxNorm concept RXCUI 1734642, generic name elbasvir) appears on 11 distinct formulary files spanning 86 Medicare Part D plan offerings - 1.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.7.
Real-world access to elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 18.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 23 Part D beneficiaries filled elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] in 2023, with total plan-and-beneficiary spending of $467,651 and an average per-beneficiary annual cost of $20,332.66. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] today.
Coverage Details
- Formularies covering
- 11
- Plans covering
- 86
- Coverage rate
- 1.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 18.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 23
- Total spending
- $467,651
- Avg per beneficiary
- $20,332.66
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier]
4 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue MedicareRx Essentials (PDP) | BLUE CROSS AND BLUE SHIELD OF KANSAS | T5 | Yes | No | $0 | - |
| Blue Cross MedicareRx Value (PDP) | Health Care Service Corporation | T5 | Yes | No | $111.30 | - |
| BlueRx Enhanced Plus (PDP) | BCBS OF ALABAMA & UTIC INSURANCE COMPANY | T5 | Yes | No | $129.50 | - |
| BlueMedicare Complete Rx (PDP) | BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. | T5 | Yes | No | $217.00 | - |
Medicare Advantage Plans (MA-PD) Covering elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier]
82 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | Yes | $0 | WI |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | Yes | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health AllCare Preferred (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum + Instacart (HMO-POS) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Harmony (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Balance (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health the ONE (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health CommUnity (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartSavings (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice Select (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice CalCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Honor+ Plan (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health ValorCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health L.A. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health S.D. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health NC Duals (HMO-POS D-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NV |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NV |
| Alignment Health Platinum Select (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health the ONE + Walgreens (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Heart & Diabetes (HMO-POS C-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health smartHMO (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Dual Select+ (HMO-POS D-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Total Dual+ (HMO-POS D-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health smartSavings (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
Frequently Asked Questions
Is elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] covered by Medicare Part D?
Yes, elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] is covered by 86 Medicare Part D plans (1.7% of all Part D formularies).
What tier is elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] on Medicare Part D plans?
elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] require prior authorization?
100% of Part D formularies require prior authorization for elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier]. Step therapy: 0%. Quantity limits: 18.2%.
How much does Medicare spend on elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier]?
In 2023, total Medicare Part D spending on elbasvir 50 MG / grazoprevir 100 MG Oral Tablet [Zepatier] was $467,651, covering 23 beneficiaries. The average spend per beneficiary was $20,332.66.
Read our methodology - how this data is sourced, computed, and verified.