EPCLUSA 50/200 mg Pellet

Also known as Velpatasvir And Sofosbuvir. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).

6 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 5.

6 of 6 plans apply a prior authorization, step therapy or quantity limit.

148 Medicare Advantage plans in PA, WV 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. PA: 120 plans · WV: 28 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)$6.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$842.7615	$50,565.6960 units	Prior authorization Quantity limit 56 per 28 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$842.7615	$50,565.6960 units	Prior authorization Quantity limit 56 per 28 days
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$875.7600	—	Prior authorization
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$783.1557	$46,989.3460 units	Prior authorization Quantity limit 56 per 28 days
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$783.1557	$46,989.3460 units	Prior authorization Quantity limit 56 per 28 days
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$842.7615	$50,565.6960 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 →