Hepatitis C: An In-Depth Guide

New Brunswick

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):  

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:

  • peg-interferon and ribavirin
  • Harvoni (ledipasvir and sofosbuvir)
  • sofosbuvir (taken in combination with peg-interferon and/or ribavirin)
  • simeprevir (taken in combination with peg-interferon and ribavirin)

 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

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

 

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.