Hepatitis C: An In-Depth Guide

Nova Scotia

Prescription Drug Programs in Nova Scotia

Nova Scotia Pharmacare helps eligible residents cover the costs of their prescription drugs. To apply for Pharmacare services, people must first be covered by Nova Scotia Medical Service Insurance (MSI). MSI is the government health insurance program that issues health cards to eligible residents and covers the cost of many necessary health services, such as medical, hospital, dental and optometry services.

There are four main Pharmacare programs in Nova Scotia:

Department of Community Services—Pharmacare Benefits

  • Covers the cost of prescription drugs, including medications for hepatitis C, for Income Assistance clients, people with disabilities and children in the care of child welfare.

Family Pharmacare Program

  • Helps families who have no drug coverage or whose prescription drug costs are high in relation to their income. Recipients have to pay an annual fee, which is capped at a certain percentage based on family income. 

Seniors’ Pharmacare Program

  • Assists seniors by paying a portion of the cost of their prescription drugs and medical supplies, based on their income level.

Drug Assistance for Cancer Patients

  • Helps people pay for certain cancer-related drugs if their gross family income is below a certain amount.

Coverage for Hepatitis C Medications

If people receive benefits from one of the following programs, they can apply to have their hepatitis C medications covered:

  • Department of Community Services Pharmacare Program
  • Family Pharmacare Program
  • Seniors’ Pharmacare Program

Income Assistance clients and people who receive benefits through Services for Persons with Disabilities (SPD) will have their treatment covered by the Department of Community Services Pharmacare Program.

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

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

These hepatitis C medications require prior approval as Exception Status Drugs before they will be covered by any of the Pharmacare programs listed above. 

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

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

In Nova Scotia, 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 coverage of exception status drugs, people can ask their specialist to complete the Standard Exception Drug Form and submit it to Pharmacare. The request will be reviewed against the criteria for coverage to determine if the medications will be paid for.

If the request is approved, people will have their medications covered for up to one full course of treatment. People will need to present a valid health card when accessing their medications at the pharmacy.

For more information about the different drug programs in Nova Scotia, people can contact the Nova Scotia Pharmacare Program at 1-800-544-6191.

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:

NIHB Atlantic Region Office
Non-Insured Health Benefits
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.