EPCLUSA 50/200 mg Pellet

Also known as Velpatasvir And Sofosbuvir. Coverage in Oklahoma (CMS PDP Region 23).

5 of 11 stand-alone Part D plans in Oklahoma cover this drug on tier 5.

5 of 5 plans apply a prior authorization, step therapy or quantity limit.

43 Medicare Advantage plans in OK do cover it

Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. OK: 43 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$893.1335	$53,588.0160 units	Prior authorization Quantity limit 56 per 28 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$893.1335	$53,588.0160 units	Prior authorization Quantity limit 56 per 28 days
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$848.1209	$50,887.2560 units	Prior authorization Quantity limit 56 per 28 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$893.1335	$53,588.0160 units	Prior authorization Quantity limit 56 per 28 days
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$848.2354	$50,894.1260 units	Prior authorization Quantity limit 56 per 28 days

Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.

See coverage in all 39 regions →