Hepatitis C: An In-Depth Guide

Prescription Drug Programs in New Brunswick

The New Brunswick Prescription Drug Program (NBPDP) provides prescription drug benefits to eligible residents of New Brunswick. To apply for these benefits, a person must have a valid New Brunswick Medicare card (health card). If a person does not have a valid health card, they can contact New Brunswick Medicare to apply for one.

Ten different drug plans are available to eligible beneficiaries (there is no plan specifically for hepatitis C drugs):  

• A (Seniors)—for people 65 years of age or older who receive the Federal Guaranteed Income Supplement (GIS) or qualify based on income level
• B (Cystic Fibrosis)—for people with cystic fibrosis or juvenile or infant sclerosis of the pancreas who do not receive benefits from other sources
• E (Adults in Licensed Residential Facilities)—for people living in a licensed adult residential facility
• F (Social Development)—for people who receive Social Assistance
• G (Special Needs Children and Children in Care of the Ministry of Social Development)
• H (Multiple Sclerosis)—for people with multiple sclerosis who need help paying for certain medications
• R (Organ Transplant)—for people who have received an organ or bone marrow transplant and need coverage for certain medications
• T (Human Growth Hormone Deficiency)—for people under the age of 18 who have a growth hormone deficiency
• U (HIV/AIDS)—for people with HIV/AIDS who need prescription medications
• V (Nursing Home Residents)—for people who live in a registered nursing home

Coverage for Hepatitis C Medications

Coverage for hepatitis C medication varies depending on the drug plan for which people are eligible.  Eligible Social Assistance clients receive prescription drug coverage through Plan F (Social Development) and can apply to have their medications covered through this plan. Social Assistance case workers may request that their clients obtain a letter from their hepatitis specialist in order to receive coverage. Case workers are able to notify their clients about the documentation that is needed to apply for coverage given the individual’s personal health and financial circumstances.

Low-income families and individuals under the age of 65 who have high drug costs and do not receive Social Assistance will have to obtain coverage for prescription drugs through their place of employment or a private health insurance company, as there is no plan available for these residents.

The following hepatitis C medications are included in the New Brunswick list of drugs that are eligible for coverage under the New Brunswick Prescription Drug Program:

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

 This list is known as the NBPDP Formulary. These medications are considered Special Authorization Drugs and therefore require prior approval from the NBPDP before they will be covered.

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

• whether or not an individual is treatment naïve
• whether or not an individual is living with chronic hepatitis C
• a positive HCV RNA test
• HCV genotype
• level of fibrosis
• HIV status

In New Brunswick, 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

To apply for special authorization, people can ask their hepatitis specialist to complete and submit a Special Authorization Request Form to the NBPDP’s Special Authorization Unit. The request will be reviewed against the criteria for coverage to determine whether the medications will be covered. The individual and their specialist will be notified in writing about whether or not the medications will be covered. If the request is approved, a person will receive coverage for up to one full course of treatment. People can access their hepatitis C medications at the pharmacy by showing their Medicare health card.

If people require more information about treatment coverage or drug programs, they can call the New Brunswick Prescription Drug Program at (506) 867-4515.

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 – Atlantic Region
First Nations and Inuit Health
Health Canada
1505 Barrington Street, Suite 1525
Halifax, Nova Scotia
B3J 3Y6                                                                                                                               

Toll-free: 1-800-565-3294