OBJECTIVES: There has been a paradigm shift in the management of hepatitis C with the introduction of sofosbuvir-based regimens. While the focus of existing studies has been on Sustained Virologic Response (SVR), little is known about patient adherence and utilization patterns in clinical practice.  METHODS: Data on clinical effectiveness, adherence, and other utilization patterns of patients using sofosbuvir-based regimens were extracted and analyzed from a national specialty pharmacy database.  Patients who received one of the following FDA-approved regimens from 01/01/2013 to 30/06/2015 were included in the study: sofosbuvir+peginterferon+ribavirin (SOF+PR), sofosbuvir+ribavirin (SOF+R), sofosbuvir+simeprevir (SOF+SIM), or sofosbuvir/ledipasvir (SOF/LDV). Effectiveness data (SVR), adherence [medication possession ratio (MPR) and proportion of days covered (PDC)], and demographic profiles of patients utilizing these regimens were analyzed. The data was analyzed using SPSS Version-22.  RESULTS: A total of 1,361 patients were identified from the pharmacy database and based on inclusion/exclusion criteria, 507 patients were included in the study. Mean age was 55.1 years (+/-9.88), 64.7% were male and 91.9% had commercial insurance. Sixty-one percent were treatment-naïve and 72% of all patients had genotype 1. Seventy-one percent of patients had at least one other co-morbidity, with liver disease and cirrhosis being the most common comorbidity. A majority of the patients used SOF+PR (36.1%), followed by SOF+SIM (30.8%), SOF+R (25.6%), and SOF/LDV (7.5%). Only 9% patients experienced side effects. SVR rates were above 90% for all regimens, except SOF+PR and SOF+R in treatment-experienced patients. Adherence rates were highest with MPR-80 (95.9%-100%) and lowest with PDC-90 (83.5%-90.1%). However, no significant difference was found across regimens. Of the 1,361 patients, treatment discontinuation due to side effects was only 1.3%. CONCLUSIONS: The study is one of the first to describe the real world utilization of sofosbuvir-based regimens. Improving adherence of these expensive regimens has the potential to reduce costs and improve patient outcomes in hepatitis C.