Hepatitis C: An In-Depth Guide
General information on drug coverage and benefit programs offered by the provincial, territorial and federal governments can be found here.
Coverage for Hepatitis C Medications
The Ontario Drug Benefit Program (ODB) and the Trillium Drug Program (TDP) are the two main programs that assist Ontario residents with covering the costs of expensive prescription drugs and may be able to help cover the high cost of hepatitis C treatment medications.
What is the Trillium Drug Program?
The TDP provides drug benefits to Ontarians who have high drug costs in relation to their household income. Residents who do not qualify for any of the other programs can apply for the TDP. An annual deductible and co-payments (based on household income) apply to all recipients of the TDP, which is paid in four installments throughout the year.
What is the Ontario Drug Benefit Program?
How do you apply for coverage of Hep C meds?
In Ontario, the following hepatitis C medications are eligible for coverage as Limited use drug products:
- asunaprevir and daclatasvir
- daclatasvir and sofosbuvir
- Epclusa (velpatasvir and sofosbuvir)
- Harvoni (ledipasvir and sofosbuvir)
- sofosbuvir (taken in combination with ribavirin)
- Zepatier (elbasvir and grazoprevir)
With limited use drug products, a person’s doctor will determine which medications is appropriate for them and if they qualify to have this treatment covered by the provincial drug plan. Each limited use drug product has a specific code that the doctor will write on the person’s prescription. The pharmacist then fills the prescription and will be reimbursed by the government program.
In general, hepatitis C medications no longer need to be approved under the Exceptional Access Program. The one exception to this is if a person needs to be retreated.
Some of the factors that may be considered when a doctor makes decisions about hepatitis C medications include:
- a positive HCV RNA test
- HCV genotype
- level of fibrosis
- child-Pugh score or level of cirrhosis
- whether or not an individual is living with chronic hepatitis C
- whether or not an individual is treatment naïve
- whether or not a person has been previously treated and what their response to treatment was
- HIV status
In Ontario, 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
The full criteria for funding of hepatitis C medications can be found in the Ontario Drug Benefit Formulary/Comparative Drug Index.
What about coverage under the Non-Insured Health Benefits program?
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: