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| NDC Code | 00074262584 |
|---|---|
| Drug Name | MAVYRET 100-40 MG TABLET |
| Generic Name | glecaprevir/pibrentasvir |
| RX/OTC | RX |
| Drug Status | BRAND |
| Drug Route | ORAL |
| SMAC Price | 00000.00000 |
| FUL Price | 00000.00000 |
| Coverage Status | Covered |
Last Updated: February 16, 2026
Drug coverage is subject to hard coding, plan limitations and eligibility. Please submit a claim to determine claim pay/denial status.
For any questions regarding Hawaii Medicaid FFS drug coverage and/or reimbursement, please contact Gary Peton, Pharmacy Services Manager for Conduent State Healthcare LLC, the Hawaii Medicaid Fiscal Agent, at [email protected] or 808-952-5591. Thank you