Hepatitis C: An In-Depth Guide

Ontario

Prescription Drug Programs

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?

Individuals who receive social assistance, either through Ontario Works (OW) or the Ontario Disability Support Program (ODSP), may be eligible for prescription drug coverage through the ODB.

How do you apply for coverage of Hep C meds?

In Ontario, the Ontario Drug Benefit Program outlines hepatitis C medications that are eligible for coverage.

There are no restrictions on provincial access to treatment based on level of liver injury (fibrosis stage) in Ontario. Some other jurisdictions still have restrictions on who qualifies for treatment coverage based on fibrosis level.

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:

Non-Insured Health Benefits – Ontario Region
Health Canada
Sir Charles Tupper Building
2720 Riverside Drive, 4th Floor
Address Locator : 6604E
Ottawa, Ontario
K1A 0K9
 
Toll-free: 1-800-640-0642

 

Costs and Coverage for Treatment in Canada

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.

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.

AbbVie has the AbbVie Care Program for people taking Holkira Pak (dasabuvir, ombitasvir, paritaprevir and ritonavir) or Maviret (glecaprevir and pibrentasvir). Bristol-Myers Squibb Canada has the CLAIRE Program for people taking Daklinza (daclatasvir). Gilead Sciences has the Momentum HCV Support Program for people taking Epclusa (sofosbuvir and velpatasvir), Harvoni (sofosbuvir and ledipasvir), Sovaldi (sofosbuvir) or Vosevi (sofosbuvir, velpatasvir and voxilaprevir). Janssen has the Janssen BioAdvance Program for people taking Galexos (simeprevir). Merck has the Merck Care Hepatitis Program for people taking Zepatier (elbasvir and grazoprevir).
 

For more information, contact:

 Merck Care Program

 1-866-872-5773

 Momentum Support Program (Gilead)

 1-855-447-7977

 Janssen BioAdvance Program

 bioadvance.ca

AbbVie Care 

1-844-471-2273

CLAIRE Program (Bristol-Myers Squibb Canada)

1-844-HCV-2559

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 2018.