GOODRX HOLDINGS, INC. Key takeaways:
Direct-acting antivirals (DAAs) are oral medications that can cure hepatitis C for most people. They are usually taken daily for 8 to 12 weeks and have few side effects.
DAAs are costly without insurance. This treatment can cost $22,000 to $95,000 or more without coverage. But it is a few thousand dollars or less with insurance.
Discount cards, copay cards, and patient assistance programs can reduce your out-of-pocket costs.
The hepatitis C virus (HCV) causes hepatitis C. Unlike hepatitis A and hepatitis B, there is no vaccine to prevent hepatitis C.
Untreated HCV infections can lead to liver disease and liver cancer. Chronic hepatitis C can also affect organs other than the liver. According to the Centers for Disease Control and Prevention (CDC), more than 12,000 people in the U.S. died in 2022 from this treatable virus.
In fact, hepatitis C is curable. For most people - 95% or more - a single course of treatment with direct-acting antivirals (DAAs) cures the condition. Older treatments, such as ribavirin and interferon, did not cure hepatitis C, and many people experienced serious side effects.
How much is treatment for hepatitis C with insurance?You may pay as little as $0 or as much as a few thousand dollars for hepatitis C medications if you have health insurance. Your expenses will depend on your insurance plan's coverage and your responsibility for cost sharing, such as copays and deductibles.
For Medicare enrollees, out-of-pocket hepatitis C treatment costs range from $3,100 to $5,400. Those with a low-income subsidy for prescription medications, known as Extra Help, may pay $0 for a course of treatment. A copay under this program would cost up to $11.20 in 2024.
If you're enrolled in Medicaid, out-of-pocket costs vary by state. For instance, the cost of Epclusa with Medicaid is typically $15 or less for a full course of treatment. Mavyret costs can be $20 or less per month.
Dual eligibles are people enrolled in both full Medicaid and Medicare. They typically have low out-of-pocket costs for hepatitis C medications.
With commercial insurance, Mavyret prices can be as little as $5 per month using the Mavyret savings card. Epclusa can cost as little as $5 per month with the manufacturer's copay coupon.
Find hepatitis C medications. These are the most common hepatitis C medications, which include older injections and newer pills.
Hepatitis C can be cured. Find out about the pros and cons of direct-acting antivirals, which are medications that can cure hepatitis C.
You may need a prior authorization. Getting your hepatitis C medications covered by insurance may require preapproval from your health plan.
Out-of-pocket costs of treatment for hepatitis C can range from $22,000 to $95,000 or more without insurance.
Using lower-priced generic medications is the biggest factor determining your cost. The average per-treatment cost for lower-priced hepatitis C tablets is $22,000 to $36,000 without insurance. Higher-priced brand-name hepatitis C medication costs average $75,000 to $95,000 or more.
Medication costsHere are recent GoodRx prices for a 28-day supply of hepatitis C oral medications.
Medication* | Dosage form | GoodRx price |
Epclusa (sofosbuvir / velpatasvir) | 28 tablets, 400 mg / 100 mg | $24231.95 |
Sofosbuvir / velpatasvir | 28 tablets, 400 mg / 100 mg | $2456.50 |
Harvoni (ledipasvir / sofosbuvir) | 28 tablets, 90 mg / 400 mg | $30785.26 |
Ledipasvir / sofosbuvir | 28 tablets, 90 mg / 400 mg | $3680.50 |
Mavyret (glecaprevir / pibrentasvir) | 84 tablets, 100 mg / 40 mg | $12831.48 |
Sovaldi (sofosbuvir) | 28 tablets, 400 mg | $27323.40 |
Vosevi (sofosbuvir / velpatasvir / voxelaprevir) | 28 tablets, 400 mg / 100 mg / 100 mg | $24058.28 |
Zepatier (elbasvir / grazoprevir) | 28 tablets, 50 mg / 100 mg | $7258.89 |
*This is not an exhaustive list of medications that treat hepatitis C. Some, such asRebetol (ribavirin), were not included because they must be taken in combination with other medications.
Why does hepatitis C treatment cost so much?Manufacturer expenses are one reason for the high cost of hep C treatments. Advertising spending is often required for a pharmaceutical company to successfully bring a new medication to market. The lack of price negotiations by the federal government affects cost too. People in the U.S. also use new medications at a higher rate than consumers in other parts of the world.
Does insurance cover hepatitis C treatment?Commercial and government-sponsored insurance plans such as Medicaid cover hepatitis C treatments. But they may not cover all available DAAs. These medications are assigned to the highest tier on formularies. You may need prior authorization from your insurance plan to access treatment. This requires you to meet specific criteria, including liver damage, for your health plan to cover your medication.
Here's a closer look at treatment coverage for different types of health insurance.
MedicareDAAs are pills that are typically covered under Part D. Older treatments involving injections or infusions are covered by original Medicare - Part A in inpatient settings and Part B in outpatient settings.
Medicare Advantage plans provide coverage that equals or exceeds original Medicare. They usually include Part D prescription medication coverage.
MedicaidStates and territories run Medicaid programs. They are required to cover nearly all FDA-approved drugs for their medical indications. Currently 28 states have little to no prior authorization requirements for most enrollees.
Commercial insuranceCommercial health plans from an employer or through the Affordable Care Act marketplace may cover hepatitis C treatments. But only some of the available DAAs may be included.
Tricare and veterans benefitsTricare insurance covers HCV medications, including Mavyret, Epclusa, and Harvoni. The U.S. Department of Veterans Affairs (VA) also provides hepatitis C treatment to veterans enrolled in VA health care who are diagnosed with HCV. All FDA-approved DAAs for hepatitis C are available.
What to expect during hepatitis C treatmentA treatment regimen for hepatitis C with DAAs usually consists of taking daily medications for 8 to 12 weeks, but treatment can go as long as 24 weeks. The medication you're prescribed is determined by your hepatitis C virus type (genotype 1, 2, 3, 4, 5, or 6) and whether you have cirrhosis or previous treatment for hepatitis C.
Older treatments, such as ribavirin and interferon, resulted in side effects for most people. But newer oral medications are easier to take with minimal side effects.
How to get treatment if you don't have insuranceThere are programs that can help you pay for some or all of your hepatitis C treatment if you're uninsured:
Clinical trials: You may be able to join a clinical trial to access free hepatitis C treatment and other care.
Gilead Support Path: The Gilead Support Path patient assistant program provides access to Epclusa (brand or generic), Harvoni (brand or generic), Sovaldi, and Vosevi for people without health insurance.
Hep Free NYC: If you live in New York City, you can find help paying for hepatitis C medications through the Hep Free NYC program.
MerckHelps: The Merck Patient Assistance Program provides free access to Zepatier to eligible consumers without health insurance.
MyAbbVie Assist: The myAbbVie Assist patient assistance program provides free medication, including Mavyret, to eligible consumers.
State-sponsored initiatives: Programs such as Florida's prescription medication discount card are often available to people ages 60 and older if they don't have Medicare Part D and meet eligibility guidelines. Search online for "help paying for prescription medications," and add your state's name to the query to find out what's available.
You may be able to get the following hepatitis C medications for free through patient assistant programs or other initiatives if you meet eligibility criteria:
Epclusa (brand or generic)
Harvoni (brand or generic)
Mavyret
Sovaldi
Vosevi
Zepatier
Yes, the CDC reports that DAAs cure at least 95% of hepatitis C cases.
Frequently asked questionsAbout 2.4 million to 3 million people in the U.S. have hepatitis C, but half do not know they have the virus. Lack of awareness about your potential for infection and not having been diagnosed are two major barriers to treatment for a largely curable condition.
People with severe symptoms associated with hepatitis C may be eligible for Social Security Insurance benefits or Social Security Disability Insurance benefits. For instance, chronic liver disease is on the Social Security Administration's listing of impairments.
One side effect of certain hepatitis C treatments, including Epclusa and Harvoni, can be reactivation of a previous hepatitis B infection.
Hepatitis C treatment can be costly, whether you take brand medications or their generic versions. Commercial health insurance and government health insurance programs, such as Medicare and Medicaid, can help pay for some or all of the costs. If you don't have insurance, you may be able to access free or low-cost medication through patient assistance programs, clinical trials, or state or local programs.
Centers for Disease Control and Prevention. (2023). Limited income and resources.
Centers for Disease Control and Prevention. (2024). Numbers and rates of deaths with hepatitis C listed as a cause of death among residents, by demographic characteristics - United States, 2018-2022.
Gnanapandithan, K., et al. (2023). Self-awareness of hepatitis C infection in the United States: A cross-sectional study based on the National Health Nutrition and Examination Survey. PLOS One.
Henry, B. (2018). Drug pricing & challenges to hepatitis C treatment access. Journal of Health & Biomedical Law.
Hepatitis C: State of Medicaid access. (n.d.). 2024 national snapshot report.
Hepatitis C: State of Medicaid access. (n.d.). The time for viral hepatitis elimination is now.
Keikha, M., et al. (2020). HCV genotypes and their determinative role in hepatitis C treatment. Virusdisease.
Medicare.gov. (n.d.). Help with drug costs.
Murrin, S. (2022). Part D plan preference for higher-cost hepatitis C drugs led to higher medicare and beneficiary spending. U.S. Department of Health and Human Services.
National Alliance of State and Territorial AIDS Directors. (2022). Frequently asked questions: Insurance coverage for viral hepatitis treatment and preventive services.
Shapiro, J. R. (2023). Calendar year (CY) 2024 resource and cost-sharing limits for low-incomesubsidy (LIS) - correction. Centers for Medicare & Medicaid Services.
Social Security Administration. (n.d.). 5.00 digestive disorders - adult.
Social Security Administration. (n.d.). Listing of impairments - adult listings (part A).
Thompson, W. W., et al. (2022). Vital signs: Hepatitis C treatment among insured adults - United States, 2019-2020. Morbidity and Mortality Weekly Report.
Tricare. (2024). Specialty drugs.
U.S. Department of Health and Human Services. (2022). Hepatitis C basic information.
U.S. Department of Veterans Affairs. (2020). Hepatitis C medications: An overview for patients.
U.S. Department of Veterans Affairs. (2020). Hepatitis C virus (HCV).
Williams, E., et al. (2023). Medicaid utilization and spending on new drugs used for weight loss. KFF.
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GoodRx Holdings Inc. published this content on 26 June 2024 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 27 June 2024 18:15:09 UTC.
