METHODS: The coverage trends for Harvoni in all fifty states were obtained from CMS. For each plan the data was obtained for the tier status, deductibles, and type of restrictions. The coverage trends were analyzed by plan type, state level and at a national level. 

RESULTS: In all fifty states 1168 coverage policies were identified for Harvoni. While Tier coverage varied from 4 to 6, 95% of the plans covered Harvoni at Tier 5. The median number of health plans in each state covering Harvoni was 24. 100% of the plans imposed a prior authorization, an 72% also imposed quantity limits. 100% of the plan coverage was at ‘specialty tier’. The co-insurance for Harvoni ranged from 25%-33%. For majority of the plans (55%, 639 plans) the coinsurance was 25%. Approximately, 37% (427) of the plans had a relatively high coinsurance of 33%. The average 30 day retail price (full treatment cost) for Harvoni was $98,618, with a standard deviation of $1816. The price varied by plan type and not by region/state. The minimum and maximum price in all states were $95,866 (EnvisionRx) and $103,488 (SilverScript).

CONCLUSIONS: U.S. coverage trends for Harvoni shows relatively restricted access with mainly Tier 5 coverage, 100% prior authorization 25-33% co insurance. New policies might be needed to ensure proper access to such drugs for patients.