Hepatitis C: An In-Depth Guide

Alberta

Prescription Drug Programs in Alberta

Alberta Health and Wellness provides coverage for prescription drugs through Alberta Blue Cross, an independent health benefits organization. To receive health benefits and drug coverage, you must be registered with the Alberta Health Care Insurance Plan (AHCIP)

In Alberta, eligible residents can access health benefits and prescription drug coverage through the publicly funded prescription drug program. The health plans that are part of this program include:

Supplementary Health Plans

 Prescription Drug Coverage—Non-Group

  • Assists residents under the age of 65 with the cost of prescription drugs.  Members pay a monthly premium and a maximum of $25 for each prescription purchased.

Coverage for Seniors

  • Covers some or all of the cost of prescription drugs for Albertans 65 years of age and older and their dependants, and for recipients of the Alberta Widows' Pension and their dependants.

Palliative Care Drug Coverage

  • Assists with covering the cost of prescription drugs for people in the late stages of a terminal illness who are receiving treatment at home.

Coverage for Albertans with Low Incomes

Income Support

  • Covers the cost of prescription drugs, including medications for hepatitis C, for Income Support clients.

Alberta Adult Health Benefit (AAHB)

  • Covers the cost of most prescription drugs, including medications for hepatitis C, for people who have low incomes and are either pregnant or have high drug costs with no other drug coverage, and for people who have left the Income Support or Assured Income for the Severely Handicapped (AISH) programs and require drug coverage. 

Assured Income for the Severely Handicapped (AISH)

  • Provides health benefits to people under the age of 65 who have a permanent disability that severely affects their ability to earn a livelihood.

Alberta Child Health Benefit

  • Provides prescription drug coverage for children of low-income families.

Additional Coverage

Rare Diseases Drug Program

  • Helps cover the cost of prescription drugs for people with rare genetic disorders, including Gaucher's disease, Fabry disease, MPS-I (Hurler syndrome), Hunter disease or Pompe disease.

Provincewide Services

  • Provides funding for highly specialized procedures and select high-cost drugs but not for hepatitis C medications.

Accessing Hepatitis C Treatment Medication

The amount of coverage people can receive for their hepatitis C medications varies depending on individual prescription drug plans and programs. People who receive Income Support automatically receive health benefits and coverage for prescription drugs. People who have drug benefits through some of the other plans listed above can request coverage for their treatment medications.

In Alberta, the following hepatitis C medications are included in the Drug Benefit List that are eligible for coverage by Alberta Blue Cross:

  • asunaprevir and daclatasvir
  • daclatasvir and sofosbuvir
  • Epclusa (velpatasvir and sofosbuvir)
  • Harvoni (ledipasvir and sofosbuvir)
  • sofosbuvir (taken in combination with  ribavirin)
  • Zepatier (grazoprevir and elbasvir)

Some of the factors that may be considered when approving funding for these hepatitis C medications include:

  • a positive HCV RNA test
  • HCV genotype
  • level of fibrosis
  • previous experience with treatment

In Alberta, a person needs to have a certain level of liver injury (fibrosis stage 2) to qualify for treatment coverage. However, a person does not need to meet this requirement if they have one or more of the following issues:

  • Coinfection with HIV or hepatitis B
  • Fatty liver disease
  • Has previously had an organ transplant
  • other health problems caused by hepatitis C that affect parts of the body other than the liver (extra-hepatic manifestations)
  • Chronic kidney disease (stage 3, 4 or 5)
  • Diabetes and receiving treatment anti-diabetic mediations
  • Are of child bearing age and are planning to get pregnant within the next 12 months

These hepatitis C medications require special authorization  before they can be covered. To apply for approval people can request that their specialist complete and submit the Antivirals for Chronic Hepatitis C Special Authorization Request Form (ABC 60022)  for the medication they want to take and send it to Alberta Blue Cross for review against the Special Authorization Guidelines. The request will be evaluated to determine if a person's hepatitis C medications will be covered through their drug plan.

If people would like more information about health care or drug plans in Alberta, they can contact the Alberta Health Care Insurance Program (AHCIP) toll-free at 310-0000 then dial (780) 427-1432.

Registered First Nations and recognized Inuit people may be able to access coverage for their hepatitis C treatment medications through the Non-Insured Health Benefits (NIHB) program.  People can contact NIHB by phone or mail at:

Non-Insured Health Benefits – Alberta Region
First Nations and Inuit Health
Health Canada
9700 Jasper Avenue, Suite 730
Edmonton, Alberta
T5J 4C3
Tel: 780-495-3302
Toll-free: 1-800-232-7301

 

Some programs can be accessed by all Canadians. Examples include:

Private health insurance

Some health insurance policies offered through private insurance companies include coverage for prescription drugs. These programs often have their own deductible, or co-pay fee, and may have yearly maximums for prescription drugs.

Programs offered by pharmaceutical companies

The pharmaceutical companies that make Hep C medications have programs to help people complete treatment. Merck has the Merck Care program for people taking peg-interferon alpha-2b (known as Pegetron). Hoffman-La Roche has the Pegassist program for people taking peg-interferon alpha-2a (known as Pegasys). Vertex has the Incivek Care program for people taking telaprevir (known as Incivek). Gilead Sciences has the Momentum Support program for people taking sofosbuvir (known as Sovaldi).

These programs have phone support for people on treatment, and part of this support is helping people to access the funding necessary to cover treatment costs. These programs can inform patients about local, provincial, and federal government programs for accessing treatment and can help the patient find out ways to maximize any public funding or private medical insurance (including the appeals process, if the patient also has a supportive doctor). If a person is eligible, some programs can help cover the insurance company co-pay fee, provincial or territorial plan's deductible, and a number of other expenses, depending on a person's specific situation.

Janssen has the Galexos: BioAdvance Patient Support Program for people taking simeprevir (known as Galexos).

AbbVie has the AbbVie Care Program for people taking Holkira Pak.

For more information, contact:

 Pegassist Program

 1-877-PEGASYS (1-877-734-2797)

 Merck Care Program

 1-866-872-5773

 Incivek Care Program

 1-877-574-4298

Momentum Support Program 

1-855-447-7977

Galexos: BioAdvance Patient Support Program

1-855-512-3740

AbbVie Care

1-844-471-2273

People who contracted hepatitis C from a blood transfusion between 1986 and 1990 may be eligible to have hepatitis C treatment expenses covered by the Hepatitis C January 1, 1986 - July 1, 1990 Class Actions Settlement. To learn more about these programs, see Compensation.

Revised 2014.