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
In Québec, the Public Prescription Drug Insurance Plan is the government insurance plan that offers basic prescription drug coverage to all Québecers who have no access to private group insurance. The Public Prescription Drug Insurance Plan, often called the Public Plan, is administered by the Régie de l’assurance maladie du Québec (RAMQ). To register for the Public Plan people must have a Québec Health Insurance Card.
People who receive financial assistance, and their children who are under the age of 18, are automatically enrolled in the Public Plan and will therefore receive prescription drug coverage to help pay for their medications.
How do you apply for coverage of Hep C meds?
In Québec, the following hepatitis C medications are eligible for coverage under the Public Prescription Drug Insurance Plan:
- daclatasvir and sofosbuvir
- Epclusa (velpatasvir and sofosbuvir)
- Harvoni (ledipasvir and sofosbuvir)
- sofosbuvir (taken in combination with ribavirin)
- Zepatier (grazoprevir and elbasvir)
These hepatitis C medications are considered Exceptional Medications that require prior approval from the Régie before they will be covered by the Public Plan.
Some of the factors that may be considered when approving funding for hepatitis C medications include:
- level of fibrosis
- HCV genotype
- a positive HCV RNA test
- whether or not an individual is living with chronic hepatitis C
- HIV status
In Quebec, 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
People can ask their hepatitis C specialist to submit a request for coverage to the Régie on their behalf. The request will be reviewed to determine if the medications will be covered. Individuals and their specialists will receive a letter telling them whether or not the Régie will pay for their treatment drugs. If the request is approved, people will have their hepatitis C medications covered through the Public Plan once they have paid their contribution fee, (annual deductible and co-insurance fee based on net income).
Financial assistance clients and people who hold a claim slip do not pay the contribution fee but do need to show either their claim slip or direct deposit notification to the pharmacist so that they can receive their medications free of charge.
For more information about the Public Prescription Drug Insurance Plan, people can visit the Régie website or call the department directly at (418) 646-4636 in Québec, (514) 864-3411 in Montréal, or toll-free anywhere else in the province at 1-800-561-9749.
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 – Québec Region
First Nations and Inuit Health
Guy-Favreau Complex, East Tower, Suite 202
200 René-Lévesque Boulevard West