Medicare Part D coverage · sofosbuvir · RxCUI 2584199
sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa]
Per the CMS 2026 Part D formulary file, sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] is covered by 3,019 Medicare Part D plans (59.8% of enrollable products), averaging Tier 4.3, with prior authorization required on 99.3% of covering formularies.
- 59.8%
- Plan coverage
- 3,019
- Plans covering
- T4.3
- Avg tier
- 99.3%
- Prior auth required
What the CMS Formulary Data Shows for sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa]
Per the CMS 2026 Part D formulary file, sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] (RxNorm concept RXCUI 2584199, generic name sofosbuvir) appears on 146 distinct formulary files spanning 3,019 Medicare Part D plan offerings - 59.8% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] depends on utilization management as much as tier placement: 99.3% of covering formularies require prior authorization. 0% require step therapy. 57.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 18 Part D beneficiaries filled sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] in 2023, with total plan-and-beneficiary spending of $1,955,322 and an average per-beneficiary annual cost of $108,629.02. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] today.
Coverage Details
- Formularies covering
- 146
- Plans covering
- 3,019
- Coverage rate
- 59.8%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 57.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 18
- Total spending
- $1,955,322
- Avg per beneficiary
- $108,629.02
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
Show the next 30 plans
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | Elderplan, Inc. | T1 | Yes | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | Metroplus Health Plan, Inc. | T1 | Yes | $58.80 | NY |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] covered by Medicare Part D?
Yes, sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] is covered by 3,019 Medicare Part D plans (59.8% of all Part D formularies).
What tier is sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] on Medicare Part D plans?
sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] require prior authorization?
99.3% of Part D formularies require prior authorization for sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa]. Step therapy: 0%. Quantity limits: 57.5%.
How much does Medicare spend on sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa]?
In 2023, total Medicare Part D spending on sofosbuvir 150 MG / velpatasvir 37.5 MG Oral Pellet [Epclusa] was $1,955,322, covering 18 beneficiaries. The average spend per beneficiary was $108,629.02.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- {4 (selinexor 80 MG Oral Tablet [Xpovio]) } Pack [Xpovio 80 MG Once Weekly Carton-80 MG Tablet] T4.3
- 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] T4.3
- 5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] T4.3
- ceftaroline fosamil 600 MG Injection T4.3
- 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe T4.3
- 1 ML ustekinumab 90 MG/ML Prefilled Syringe T4.3
Similar prior-authorization rate
- levalbuterol 0.21 MG/ML Inhalation Solution 99.3% PA
- bosentan 125 MG Oral Tablet 99.3% PA
- bosentan 62.5 MG Oral Tablet 99.3% PA
- sapropterin dihydrochloride 100 MG Oral Tablet [Javygtor] 99.3% PA
- 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] 99.3% PA
- 2 ML guselkumab 100 MG/ML Auto-Injector [Tremfya] 99.3% PA