What Is Hepatitis C Medicine Cost Off Insurance- Assistance Options And Drug Types

Although there is no vaccination to prevent hepatitis C, medical advances in recent years have resulted in oral medications that can cure most people. Learn more via this article.

Depending on a person’s insurance policy and overall health, the level of coverage for hepatitis C treatments can vary. The latest medications are more expensive, making hepatitis C therapy more difficult to afford.

What is hepatitis C?

Hepatitis C is a liver infection that can cause permanent damage to the liver. Hepatitis C is the virus that causes it. The condition affects around 2.4 million people in the United States.

However, because it has minimal symptoms, most people are unaware. The virus is transmitted by an infected person’s blood or bodily fluids. The hepatitis C virus, often known as HCV, comes in various forms. Type 1 is the most common in the United States. None are more severe than the others, but they all respond to treatment differently.

Stages of hepatitis C

  • The hepatitis C virus has multiple phases that impact humans in different ways:
  • The period of incubation. This is the period between the initial exposure and the onset of the disease. It can last anywhere from 14 to 80 days, with 45 days the norm.
  • Hepatitis C is a type of acute hepatitis. This short-term disease lasts for six months after the virus enters your system. After that, some persons with the virus will be able to clear it independently.
  • Hepatitis C is a type of chronic hepatitis. The infection progresses to a long-term stage for most people who contract hepatitis C (up to 85 percent) (longer than six months). A persistent hepatitis C infection can result in significant health concerns like liver cancer or cirrhosis.
  • This illness causes inflammation, which causes scar tissue to replace healthy liver cells over time. This typically takes 20 to 30 years, though it might happen sooner if you drink alcohol or have HIV.
  • Cancer of the liver. Cirrhosis increases the risk of liver cancer. Because there are usually no symptoms in the early stages, your doctor will ensure you have regular tests.

How do you get Hepatitis C?

When blood or body fluids contaminated with the hepatitis C virus enter your bloodstream due to contact with an infected individual, hepatitis C spreads.

You can be exposed to the virus from:

  • Sharing injection drugs and needles
  • Having sex, especially if you have HIV, another STD, several partners, or have rough sex
  • Being stuck by infected needles
  • Birth — a mother can pass it to a child
  • Sharing personal care items like toothbrushes, razor blades, and nail clippers
  • Getting a tattoo or piercing with unclean equipment

You can’t catch hepatitis C through:

  • Breastfeeding (unless nipples are cracked and bleeding)
  • Casual contact
  • Coughing
  • Hugging
  • Holding hands
  • Kissing
  • Mosquito bites
  • Sharing eating utensils
  • Sharing food or drink
  • Sneezing

Symptoms of advanced hepatitis C

You could notice acute symptoms along with:

  • Fluid buildup in the abdominal cavity (ascites) or the legs (edema)
  • Gallstones
  • Your brain doesn’t work as well (encephalopathy)
  • Kidney failure
  • Easy bleeding and bruising
  • Intense itching
  • Muscle loss
  • Problems with memory and concentration
  • Spider-like veins on the skin
  • Vomiting blood due to bleeding in the lower esophagus (esophageal varices)
  • Weight loss

Hepatitis C risk factors

The CDC recommends you get tested for the disease if you:

  • Are 18 years of age and older (get tested at least once in your lifetime)
  • Are pregnant (get tested during each pregnancy)
  • Received blood from a donor who had the disease
  • Currently inject drugs (get tested regularly)
  • Have ever injected or inhaled drugs (you should be tested periodically if still using drugs.)
  • Had a blood transfusion or an organ transplant before July 1992
  • Received a blood product used to treat clotting problems before 1987
  • Have been exposed to blood from a person who has hepatitis C
  • Have been on long-term kidney dialysis
  • Have abnormal liver tests or liver disease
  • Have HIV
  • Were born to a mother with hepatitis C

Health care problem

In the United States, rising healthcare expenditures are a severe issue. Increases in healthcare expenses have reduced real income gains for individuals and raised the federal deficit over the last ten years. If current trends continue, healthcare spending will account for over half of the US economy by 2082.

Healthcare spending in the United States is approximately ninety percent higher than many other industrialized countries. This higher level of expenditure is not related to a more considerable prevalence of disease or a higher rate of patient treatment but rather to higher prices. This disparity in spending is primarily due to differences in the use of new technology. The impact of technology on the growth of healthcare costs in the United States is estimated to be between 25% and 75%.

What treatment options are available for hepatitis C?

Several medications can effectively treat HCV:

Traditional medications

Pegylated interferon and ribavirin were the mainstays of HCV treatment until recently.

Pegylated interferon comprises three different proteins that work together to boost the immune system. This is to keep the infection from spreading further. It can help guard against infection in healthy cells. Ribavirin also prevents the virus from reproducing. Combining these drugs is known as “peg/riba treatment.”

Newer medications

Doctors now use newer antiviral drugs. These drugs are sometimes used in conjunction with interferon and ribavirin. The term for this is “triple therapy.”

The U.S. Drug and Food Administration has approved the following new treatments:

  • Harvoni
  • Viekira Pak
  • Zepatier
  • Technivie
  • Epclusa
  • Vosevi
  • Mavyret

These medications, unlike earlier treatments, are capable of curing HCV. Harvoni, for example, is up to 100 percent efficient at eradicating the virus.

The cost of these medications might be relatively high. An ordinary 12-week Sovaldi course, for example, can cost up to $84,000.

How much is the treatment?

The pricing of medications is complicated. New pharmaceuticals are more expensive than older treatments when they first come out.

Other medicine producers do not compete with these medications, and pharmaceutical corporations have complete control over their distribution. As firms develop competing drugs or the medicine becomes available as a generic drug, the market price typically falls due to competition.

In addition, the lower the demand for a specific treatment, the greater the medication’s cost. Because they will be selling the medicines to fewer people, pharmaceutical corporations must make more money per unit.

Hepatitis C is a disease that affects about 3.5 million people in the United States. According to the Centers for Disease Control and Prevention in the United States, up to half of those infected may be unaware of their infection (CDC).

Because hepatitis C is a disease that affects millions of people, the medications should be less expensive. Even yet, current treatment plans can be pretty expensive.

Drug types and costs

According to the journal Open Forum Infectious Diseases, the US Food and Drug Administration (FDA) approved drug treatments known as direct-acting antiviral medications that were only available in oral form to treat hepatitis C in 2014.

Since then, the FDA has approved several hepatitis C treatments. However, the cost of hepatitis C treatment remains significant.

The cost of a medicine can vary based on the drugstore, insurance plan, and a person’s medical history. The following are typical average drug prices for hepatitis C treatments, according to the University of Washington:

  • Ledipasvir-sofosbuvir (Harvoni): The average wholesale cost for Harvoni is $1,125 per pill. An 8-week treatment course is $63,000 while a 12-week treatment course is $94,500, and a 24-week one is $189,000.
  • Simeprevir (Olysio): The average wholesale cost for the medication is $790 per 150 milligrams (mg) capsule. A 28-day supply costs $22,120, and a 12-week supply costs $66,360. Sometimes a doctor will prescribe this along with the medication sofosbuvir, where a 12-week course of treatment for both medications totals about $150,000.
  • Sofosbuvir (Sovaldi): This medication costs $1,000 per 400 mg pill. The total cost for a 12-week course is around $84,000, and doctors will typically prescribe it with other medicines, such as simeprevir.
  • Ombitasvir-paritaprevir-ritonavir and dasabuvir (Viekira Pak): The cost for this medication is $83,319 for a 12-week treatment course. The price for a 24-week treatment course is $166,638.

These prices can fluctuate depending on market conditions, the drugstore a person visits, and the drug’s availability.

Does insurance cover hep C treatment?

Different insurance policies cover different aspects of hepatitis C treatment. Due to the high cost of these medications, you must meet several criteria to be covered.

Many patients, for example, only have a limited amount of time to acquire Sovaldi coverage. Your insurance provider may refuse to cover you if your liver illness is sufficiently advanced. You are no longer regarded as a good candidate for this drug if you have severe renal damage.

The level of coverage you may have varies based on your insurance plan regarding affording these prescriptions. Many people have care management strategies in place.

Managed-care plans are built on contracts with healthcare providers and medical institutions. Members can receive care at a lower cost with these plans. Managed-care plans are divided into three categories:

  • health management
  • preferred provider
  • point of service

HCV treatment must be medically essential in most health insurance policies. The coverage policy of each plan determines whether or not treatment is medically required. For example, before you may be recommended for antiviral medicine, BlueCross BlueShield of Mississippi requires you to go through a six-month review period.

With a few exceptions, not all health insurance policies cover all prescribed drugs for HCV therapy. The majority of insurance companies cover Sovaldi. The monthly copay is estimated to be $75 to $175.

Check with your insurance company to determine what kind of coverage you have. If your insurance company does not cover the antiviral therapy, your doctor advises, you may be able to get financial help from other sources.

How to get help with costs?

Check with your insurer, whether a private firm or Medicare, before beginning hepatitis C therapy. Find out what’s covered and how much you’ll have to pay in co-payments.

When your doctor prescribes a medication, inquire about the price. If you can’t afford your prescription, tell your doctor and pharmacist. They may be able to locate a less expensive therapy, point you in the direction of a less expensive retailer, or provide discount coupons.

If you still can’t afford your prescription or your insurance won’t cover it, there are a few options for assistance.

Several drug companies, states, pharmacies, and charity organizations offer assistance programs. Drug discount cards may also be beneficial. Another option is to participate in clinical trials, studies that test new treatments to see if they’re safe and effective.

If one option doesn’t work out, try another. It may take time to find the resource that’s right for you.

Patient assistance programs

Patient assistance programs run by pharmaceutical corporations help patients afford drugs and medical supplies. If you match the eligibility criteria, they may be able to assist you with:

  • Co-payments on health insurance (what you pay out-of-pocket for a doctor visit or prescription)
  • Excess Deductibles (how much you must pay for health care before your insurance kicks in)
  • After you’ve met your deductible, you’ll be responsible for a percentage of the expenditures.
  • Premiums for health insurance
  • Medical treatment travel expenditures

You can seek support from multiple drug firms on the Pharmaceutical Research and Manufacturers of America and RxAssist websites.

You can apply for assistance on these groups’ websites or call their helplines. Some may request information like:

  • Where you live
  • How many people do you live with
  • Your household income
  • Names of the drugs you’ve been prescribed
  • Your health insurance or prescription coverage type
  • Your doctor’s name and contact information

Any personal information you share is confidential.

Nonprofits and pharmacies

Drug assistance programs for low-income seniors and persons with disabilities are available in about half of the states in the United States. To determine if your state is one of them, go to Medicare.gov.

Nonprofit organizations may be able to help you pay for your hepatitis C medications. If funds are available, the PAN Foundation, for example, may contribute $6,800 per year. Other organizations may not be able to assist you directly, but they may be able to refer you to resources that can.

These are some of the nonprofit groups that offer assistance:

  • Good Days
  • HealthWell Foundation
  • The Hepatitis C Association: Help4Hep
  • Patient Access Network Foundation
  • Patient Advocate Foundation Co-Pay Relief Program
  • The Assistance Fund
  • Patient Services, Inc.

Some pharmacies also help with copays or research ways for you to get financial help, including:

  • Avella Specialty Pharmacy
  • Current Health
  • Rx Outreach

Drug discount cards

The American Liver Foundation and Hepatitis Foundation International, for example, provide complementary medicine savings cards. If you’re uninsured or underinsured, the cards could be a decent choice. Even if you have health insurance, you may be eligible for discounts on medications that your plan does not cover.

You don’t even need to fill out an application to receive one. All you need to do now is print it.

Drug Discount Card from NeedyMeds. Through a company named NeedyMeds, the American Liver Foundation offers a discount card. It’s accepted at 63,000 pharmacies nationwide, including Walmart, CVS, Walgreens, and small drugstores.

You can also discover information about additional programs to aid with healthcare expenditures on the NeedyMeds website.

International Health Savings Card from the Hepatitis Foundation. With this free medicine discount card, you can save up to 30% on your prescriptions. However, it may rise to 75%. The card can be used as a primary insurance plan or for medications that your insurance plan does not cover. Over 56,000 national and regional pharmacies accept it.

Clinical trials

Consult your doctor to see if a hepatitis C medication clinical trial is good for you. On the ClinicalTrials.gov website, you can look for trials in your area.

In a clinical trial, you receive free treatment and care in exchange for assisting scientists in developing new drugs.

Cost-effectiveness of current direct-acting antiviral regimens for hepatitis C treatment

Since the US Food and Drug Administration approved the first direct-acting antivirals (DAAs) in 2011, various cost-effectiveness studies have compared DAA-based regimens to previous standard-of-care regimens to generate ICERs.

They also looked into how cost-effective it would be to remove HCV treatment limits. The ICER for DAAs has consistently been assessed at $100,000 per QALY for all genotypes and fibrosis stages compared to interferon-based regimens.

DAA regimens have been compared in several trials. When choosing between prescribed HCV DAA regimens, the less expensive regimen is generally selected as more efficient use of resources (even if it requires multiple tablet dosing).

Because most DAA regimens have equal efficacy, cost becomes the most critical issue in determining relative cost-effectiveness. Patients awaiting liver transplantation, HIV/HCV-coinfected patients, those with chronic kidney disease, people who inject drugs, and teenagers have all had their cost-effectiveness of HCV treatment calculated in studies with favorable ICERs. At this point, it is acceptable to say that DAA regimens deliver good value for money.

Cost vs. affordability for HCV treatment

Despite mounting evidence that HCV treatment is cost-effective and, in some cases, even cost-saving in the long run, many US payers—particularly those giving Medicaid insurance—continue to restrict access to HCV therapy. Although access has improved as costs have decreased, there are still constraints.

Proposed Medicaid budget cuts would undoubtedly exacerbate the problem because the value of HCV drugs would stay the same while the resources available to provide them would be reduced.

Cost-effectiveness of screening for HCV

Several cost-effectiveness studies show that widespread, one-time HCV testing among all adults in the United States will undoubtedly uncover many HCV cases that are now undiagnosed and that doing so would be cost-effective.

One study used simulation modeling to compare several versions of routine guidance, including regular testing for adults aged 40, 30, and 18, and found that routine testing for all adults aged 18 was cost-effective when compared to risk-based screening and potentially cost-saving when compared to testing only those aged 30 or 40 years (Barocas, 2018).

According to the study, routine testing remained cost-effective unless HCV infection did not influence healthcare usage or quality of life. Another study revealed that regular testing of all persons over the age of 18 is expected to be more cost-effective than risk-based screening, as long as HCV prevalence among those born after 1965 is more significant than 0.07 percent (Eckman, 2019). Both investigations came to identical findings despite being conducted wholly separately and using distinct computer modeling methodologies.

In addition, several studies have looked at the cost-effectiveness of routine HCV testing in a variety of settings, including correctional settings (He, 2016), prenatal care settings (Chaillon, 2019); (Tasillo, 2019), substance use treatment centers (Schackman, 2018); (Schackman, 2015), and federally qualified health centers (Schackman, 2018); (Schackman, 2015). (Assoumou, 2018). Even though linkage to HCV treatment after testing was poor and HCV reinfection among injectable drug users was prevalent, they all concluded that regular testing and treatment for HCV was cost-effective.

Routine HCV testing is generally cost-effective since HCV incidence and prevalence remain high among people who inject drugs, with a noticeably increased prevalence among young adults who may not readily report their stigmatized risk behaviors.

According to studies conducted in urban emergency departments in the United States, 15% to 25% of patients with previously unidentified HCV infection were born after 1965 and had no reported history of injection drug use, and thus were missed by even perfect implementation of risk-based screening (Schechter-Perkins, 2018); (Hsieh, 2016). (Lyons, 2016).

Reinfection is common among drug users, but because screening is a low-cost intervention and therapy is both highly effective and cost-effective, routine testing offers good economic value (i.e., cost-effectiveness) even when many people need to be tested and treated multiple times throughout their lives.

Why is hepatitis C treatment so expensive?

Hepatitis C medications are in great demand, as the illness affects an estimated 2.4 million people in the United States. The high cost of drugs is a result of this.

The expense of drug research and development is also relatively high. And because these treatments have a high cure rate — and there isn’t much competition — drug makers have no motivation to cut the price.

The bottom line

Hepatitis C therapy has improved in recent years, and it is now usually successful. However, the costs of these medications can be high for some people.

While prices may fall in the future, there are no promises. To make hepatitis C drugs more inexpensive, look for rebate programs and financial aid from specialized organizations.

John Otero

John Otero

John Otero is an industry practitioner with more than 15 years of experience in the insurance industry. He has held various senior management roles both in the insurance companies and insurance brokers during this span of time. He began his insurance career in 2004 as an office assistant at an agency in her hometown of Duluth, MN. He got licensed as a producer while working at that agency and progressed to serve as an office manager. Working in the agency is how he fell in love with the industry. He saw firsthand the good that insurance consumers experienced by having the proper protection. John has diverse experience in corporate & consumer insurance services, across a range of vocations. His specialties include Major Corporate risk management and insurance programs, and Financial Lines He has been instrumental in making his firm as one of the leading organizations in the country in generating sustainable rapid growth of the company while maintaining service excellence to clients.

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