Navigating Hepatitis C Treatment and Insurance (original) (raw)

To treat your hepatitis C, you need prescription antiviral meds. Or in severe cases, maybe a liver transplant. These treatments can be costly. And to make matters worse, making your way through the maze of insurance coverage can be confusing.

But there are some ways to better understand the process that gets you the treatment you need.

Hep C Treatment Options

It’s important for you to get early treatment when you have hep C. This reduces the spread of the hepatitis C virus (HCV) and prevents liver damage and complications such as cirrhosis, liver cancer, and even death.

Antiviral drugs work well to rid your body of HCV. Recent developments in these drugs help them work even better than before, with improved outcomes, fewer side effects, and shorter treatment times. Your doctor may have you take a newer antiviral along with an existing one for the most effective treatment. Taking an antiviral for 8-12 weeks cures about 95% of cases.

In addition to treatments, screening can also make a big difference in hep C outcomes. About 40% of people with hep C don’t know they have it.

The CDC recommends screening for all adults at least once, and regular screening for people with a risk of the infection. The Affordable Care Act (ACA) requires insurance plans to cover hep C testing if you’re in a high-risk group.

How Costs Are Set

Your costs for hep C drugs can be steep, even with insurance coverage. But those costs vary, depending on where you get your meds. They might go through multiple organizations before they get to you, and that impacts your cost, as well as what gets reimbursed. They include:

• Pharmaceutical companies, who determine the wholesale price
• Pharmacy benefit managers, who are go-betweens for pharmaceutical companies and health insurance companies
• Medicaid or Medicare, if you qualify
• Specialty pharmacies

The price you pay (your copay or coinsurance) is set by your pharmacy plan.

Before you begin treatment for hepatitis C, ask your insurance company what they will and won’t cover. Your doctor or pharmacist may be able to provide information on how much certain meds cost.

Affording Treatment

If you can’t afford your meds, there are some options you can try:

Patient assistance programs. Pharmaceutical companies or foundations offer these programs for people who have low income or who are underinsured or uninsured, to help cover some of your out-of-pocket costs. They may even provide your meds at no cost to you.

• Medicineassistanttool.org is a search engine that combs through all the biopharmaceutical industry programs.
• Rx Assist is a resource center that helps you find patient assistance programs.
• NeedyMeds has free information on medication and health care cost-savings programs, including prescription assistance programs.
• Support Path is a program that may help you pay for generic hepatitis C treatment whether you have insurance or not.

Copay programs. These programs offer assistance if you have private insurance. They may reduce your copays or coinsurance costs for hepatitis C drugs at your pharmacy. But you might not qualify if you’re enrolled in Medicare, Medicaid, or other government-based prescription plans.

Hep C specific foundations. Some nonprofits allow you to apply for assistance to help pay for your hepatitis C drugs, such as:

• PAN Foundation offers grants that may help you pay medication costs, copays, insurance premiums, and even travel expenses for your hep C treatment.
• Healthwell Foundation may help you with financial barriers to hepatitis C (and other chronic disease) care if you’re underinsured.
• TargetHIV offers a list of patient assistant programs specifically for hepatitis C drug costs.
• National Liver Foundation has a list of financial assistance resources.

Drug discount cards. These cards are typically free, and can reduce your drug costs up to 80%, in some cases. You can’t combine them with your insurance or with government programs, but they might make your medication less expensive. You have to have a prescription to use these cards. Around 63,000 pharmacies across the country accept them.

Some sites, such as American Liver Foundation, offer printable cards online you can use immediately. They usually don’t expire.

Clinical trials. Clinical trials are research studies that test whether new treatments work and are safe. If you participate in one, your treatment and care are free in exchange for helping scientists research new treatments. You can search for ongoing clinical trials at ClinicalTrials.gov.

Photo Credit: RichLegg / Getty Images

SOURCES:

Journal of the American Medical Association: “Most Insured People With Hepatitis C Don’t Get Timely Treatment.”

Mayo Clinic: “Hepatitis C.”

Health.gov: “Hepatitis C Screening: Questions for the Doctor.”

American Association for the Study of Liver Diseases: “Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations for Hepatitis C Treatment Regimens.”

NeedyMeds: “NeedyMeds Drug Discount Card.”

American Liver Association: “Drug Discount Card.”