Hepatitis C: An In-Depth Guide

Manitoba

Prescription Drug Programs in Manitoba

Manitoba Pharmacare offers prescription drug coverage to eligible residents. Pharmacare, administered by Manitoba Health, is “a drug benefit program for any Manitoban, regardless of age, whose income is seriously affected by high prescription drug costs.” Manitobans who receive Pharmacare must pay a deductible based on their annual income. Those who cannot afford to pay the deductible in one lump sum may be able to pay it in monthly installments.

To be eligible for Pharmacare, a person must meet all of the following criteria:

  • be eligible for Manitoba Health coverage 
  • have no prescription drug coverage through any provincial or federal drug program
  • have no prescription drug coverage through a private health insurance program
  • have prescription drug costs that exceed the Pharmacare deductible

People who qualify for Pharmacare may be eligible to receive coverage for their hepatitis C medications.

Coverage for Hepatitis C Medications

Once a person's application for Pharmacare has been approved, Pharmacare sends a letter confirming what the person's deductible will be. This is the amount the recipient will pay each year. The deductible is based on the person's level of income. Once a person has paid their deductible, Pharmacare covers the entire cost of eligible prescription drugs. The amount of coverage a person can receive for their hepatitis C medications depends on their deductible. 

Employment and Income Assistance (EIA) clients receive health benefits and prescription drug coverage that will pay for their hepatitis C medications. People may want to talk to their hepatitis specialists and EIA case workers about their coverage options and to get help applying for benefits.

In Manitoba, the following hepatitis C medications are eligible for coverage under the provincial Exception Drug Status Program (EDS):

  • peg-interferon and ribavirin
  • Harvoni (ledipasvir and sofosbuvir)
  • Holkira Pak (dasabuvir + ombitasvir/paritaprevir/ritonavir)
  • sofosbuvir (taken in combination with peg-interferon and/or ribavirin)
  • simeprevir (taken in combination with peg-interferon and ribavirin)

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

  • a positive HCV RNA test
  • HCV genotype
  • elevated ALT levels and/or level of fibrosis
  • whether or not an individual is treatment naïve
  • whether or not an individual is living with chronic hepatitis C

The full criteria for funding of hepatitis C medications can be found in Bulletin 69 of the Manitoba Drug Benefits and Interchangeability Formulary Amendments.

These hepatitis C medications must be approved for coverage under the EDS Program before they can be covered by Pharmacare. People can ask their hepatitis C specialists to submit a request for coverage via phone, mail or fax to the EDS Program. The request will be reviewed to determine if the medications will be covered. Individuals and their specialists will receive a letter telling them whether EIA will pay for the drugs or not. If the request is approved, people will have their hepatitis C medications fully covered through Pharmacare once they have paid their annual deductible. 

For more information about Pharmacare or the EDS program, people can call the Provincial Drug Programs phone line at 1-800-297-8099.

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

Non-Insured Health Benefits – Manitoba Region
First Nations and Inuit Health
Health Canada
391 York Avenue, Suite 300
Winnipeg, Manitoba
R3C 4W1
Toll-free 1-800-665-8507

 

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.