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Treatment for Hep C costs a lot of money, over $20,000 in many cases. Other impacts on finances include the cost of medications for side effects, nutritious food, travel to medical appointments and housing. Sometimes, side effects make it hard for people to work during treatment and this can reduce their income. Also, even though the drug therapy may be covered, there will still be dispensing fees, co-payment fees (if the person has a drug plan), and costs of travelling to the doctor for appointments and blood tests. This can be a serious hardship if the person lives in a rural or isolated area and must travel distances.

Provincial Programs

Each province has different processes for financial assistance and drug coverage. The specifics listed on this page apply to Ontario’s healthcare and drug coverage programs. For general information on other provinces, read the CATIE Web page on Federal, Provincial and Territorial Drug Access Programs.

Ontario Drug Benefit

The Ontario Drug Benefit (ODB) Program covers the costs of peg-interferon and ribavirin. The ODB Program is available to:

• people receiving social assistance from Ontario Works (OW) or Ontario Disability Support Program (ODSP)
• Trillium Drug Program recipients
• people 65 years of age and older
• residents of long-term care facilities, residents of Homes for Special Care, or people receiving professional services under the Home Care program

In order for people to access peg-interferon and ribavirin from the ODB program, they must first belong to one of the above groups and then have their doctor or nurse complete the Section 16: Individual Clinical Review (formerly Section 8). There are specific circumstances that must be met. These are generally stricter than other drug access processes, such as limited use products.

The doctor fills out the Individual Clinical Review form and outlines the patient’s situation. Eligibility for coverage follows the Canadian Consensus Guidelines for the Management of Chronic Hepatitis C. Generally, some degree of fibrosis must be present and there must be no significant contraindications to treatment. Patients can appeal a decision if they are denied. If their application is found ineligible, people should strongly consider an appeal, especially when they have the support of a doctor. In fact, the guidelines also say that everyone should be considered for treatment and that decisions are made on a case-by-case basis.

Trillium Drug Program

If a person has high drug costs relative to household income, he or she may be a good candidate for the Trillium Drug Program. This program provides the same coverage as the ODB Program and has the same policies and procedures, but differs in that it charges a deductible equal to 4% of the person’s annual net income. Calculating and paying the deductible can be confusing. The yearly deductible is 4% of net household income and is paid in four installments or quarters. Trillium covers drug costs over and above the deductible.

Provincial Healthcare

Provincial healthcare programs, like the Ontario Health Insurance Plan (OHIP), cover the cost of physician services related to hepatitis C, including appointments and tests done during diagnosis, monitoring and treatment.

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.

Peg-Care & Pegassist

The two pharmaceutical companies that make Hep C medications have programs to help people complete treatment. Schering-Plough has the Peg-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). Both programs have 24-hour 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, these programs can even help cover the insurance company co-pay fee, Trillium’s deductible, and a number of other expenses, depending on a person’s specific situation.