Hepatitis C: An In-Depth Guide

Québec

Prescription Drug Programs in Québec

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
Health Canada
Guy-Favreau Complex, East Tower, Suite 202
200 René-Lévesque Boulevard West
Montreal, Quebec
H2Z 1X4

Toll-free: 1-877-483-1575

 

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.