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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

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