Hepatitis C: An In-Depth Guide

Newfoundland and Labrador

Prescription Drug Programs in Newfoundland and Labrador

The Newfoundland and Labrador Prescription Drug Program (NLPDP) provides financial assistance to people who need help paying for their prescription drugs, so that all residents of Newfoundland and Labrador have access to the medications they need.

The NLPDP offers four plans:

The Foundation Plan

  • Covers 100% of the cost of eligible prescription drugs, including medications for hepatitis C, for people who receive Income Support Benefits (ISB) and certain individuals receiving services through the Regional Health Authorities.

The 65 Plus Plan

  • Provides prescription drug coverage to people 65 years of age or older who receive Old Age Security (OAS) benefits and the Guaranteed Income Supplement (GIS). The plan does not cover dispensing fees.

The Access Plan

  • Provides families and individuals with low incomes access to prescription drug coverage. The amount of coverage is based on net income level and family status. Helps individuals, couples without children, and families with children, including single-parent families, with limited incomes.

The Assurance Plan

  • For individuals and families whose income is affected by the burden of high drug costs. People pay a percentage (5%, 7.5% or 10%) of their net annual income. 

 Coverage for Hepatitis C Medications

Coverage for hepatitis C medications varies depending on the drug plan and income level of applicants. The Access Plan and Assurance Plan  may be of particular interest to people with hepatitis C, as they are intended to help pay for the high cost of eligible drugs. People who receive Income Support Benefits can apply to have their medications covered through the Foundation Plan.

The following hepatitis C medications are included in the Newfoundland and Labrador provincial drug formulary as drugs that are eligible for coverage:

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

 These medications require Special Authorization before they can be covered under the different drug plans listed above. 

To apply for special authorization, people can ask their specialist to complete the Special Authorization Request Form  and submit it to the Department of Health and Community Services. The request will be reviewed against the criteria for coverage  to determine if the medications will be covered. Once the application has been reviewed, both the specialist and the applicant will receive a letter about whether or not the medications will be covered.

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

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

If the request is approved, people will have their medications covered for up to one full course of treatment.

If people would like more information about the different drug plans in Newfoundland and Labrador, they can contact the Department of Health and Community Services by calling (709) 729–4984.

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.