Paying for Hepatitis C Treatment
One of the primary obstacles to hepatitis C treatment is cost. The costs vary depending on what treatment is being administered, but for most people, treatment entails significant financial burdens or unrealistic options if paid out-of-pocket. The amount of out-of-pocket costs will depend on if you have private insurance, what your policy is, if you qualify for governmental programs or are able to get the treatment subsidized. Costs also vary from country to country.
How much does hep C treatment cost?
Costs are changing, generally becoming cheaper thus these costs are approximate estimates and don’t list all the drugs now available for treatment. Quotes should be provided by your healthcare provider, commercial insurance provider, Medicaid, Medicare, VA, or other applicable healthcare providers/insurers:1,2
- Mavyret (glecaprevir/pibrentasvir) typically costs $39,600 for a 12-week treatment
- Harvoni (ledipasvir/sofosbuvir) typically costs $94,500 for a 12-week treatment
- Zepatier (elbasvir/grazoprevir) typically costs $54,600 for a 12-week treatment
- Technivie (ombitasvir/paritaprevir/ritonavir) typically costs $76,653 for a 12-week treatment
- Epculusa (sofosbuvir/velpatasvir) typically costs $94,500 for a 12-week treatment
What if I cannot afford treatment?
Many affected by hepatitis C don’t have insurance and therefore can’t absorb the high costs of treatment; Others can’t afford the co-pays required by insurance companies. In one study, it was estimated that 30% of those infected have no private insurance.3 Another study estimated the rate at 65%.4 For those who can’t afford treatment, there are patient assistance programs (PAPs) that offer free or reduced cost hepatitis C treatments for individuals with lower income levels who are uninsured or underinsured that don’t meet the qualifications for Medicaid or Medicare.
Many of the pharmaceutical companies that produce these drugs can help you contact a patient advocacy organization, offer reduced treatment programs, or have subsidiaries that can help. For example:
Asegua Therapeutics LLC (A Gilead Sciences subsidiary): Generics of Epclusa and Harvoni
333 Lakeside Drive, Foster City, CA 94404
Medical Information/Customer Service: 1-800-445-3235
Gilead Science: Epculusa, Harvoni and Vosevi
Foster City, CA (Headquarters), 333 Lakeside Drive, Foster City, CA 94404, Phone: +1 650 574 3000, 1-800-GILEAD-5 (1-800-445-3235)
AbbVie Inc: Mavyret
4. Merck covers Zepatier
Kadmon Pharmaceuticals: Ribasphere
P.O. Box 219
Gloucester, MA 01931
Genentech/Roche: Pegasys and Copegus
1 (877) GENENTECH (436-3683)
Patient advocacy programs can often help find affordable medication. A few examples include:
P.O. Box 489
Buckeystown, MD 21717
(877 435 7443).
In addition many states, counties and municipalities have patient advocacy and assistant programs offering a range of services including providing or linking patients to financial support for their treatments.
Will my insurance pay for treatment?
For many who find out they are positive and next realize the cost of treatment, the big question is will my insurance pay for my hep C treatment. Unfortunately this is a complicated question with no clear answers. Insurance companies lack consistency about if and how much they will financially cover of the treatments. Many private insurance companies, as indicated in a 2018 study, rejected claims for treatment at a higher rate 52.4% than did Medicaid 34.5% or Medicare 14.7%.5 Some companies request that patients prove they aren’t using drugs or alcohol before authorizing any treatments or only approve treatment after the patient has documented fibrotic changes in the liver. There is some indication that this may be changing as the costs of DAA’s come down and generic options become available. It’s also clear from the success rate of the DAA’s that, despite the cost, those who receive successful treatments will, in the long run, have fewer costs for more expensive care and procedures such as liver transplants when the disease remains untreated.