- Is Hep C care and medication covered by insurance?
- How can I find a Hep C doctor?
- What if I don’t have insurance?
- What if the Hep C med is not approved by insurance?
- Where can I find help?
1. Is Hep C Care and Medication Covered By Insurance?
Hep C medical care and medications are covered under Medicaid, Medicare and private insurance for many patients. There are no restrictions based on liver disease stage and drug use. Seeing a medical provider experienced in treatment advocacy can help get the medications covered more quickly.
- Find health insurance through the NY Marketplace here.
- Medical providers can use the free online resources Cover My Meds to faciliate the prior-authorization process.
2. How Can I Find a Hep C Doctor?
To find a Hep C doctor in NYC:
- See our Site Locator resource page.
- Visit the NYC Health Map and select Service: “Hepatitis C Treatment”.
- Text LIVER to 877 877.
3. What If I Don’t Have Insurance, or can’t afford my copay?
Through the New York State Department of Health HepCAP program, several NYC health care centers are able to provide free hepatitis C medical care for uninsured or under-insured patients, including undocumented persons.
4. What If the Hep C Med Is Not Approved By Insurance?
New York State Medicaid no longer requires prior authorization for patients who have never been treated for Hep C before, and their medication is covered. However, patients who are being retreated due to treatment failure or reinfection must still complete a prior authorization for Hep C treatment. If the medication coverage is not approved by Medicaid or other insurer, you can do the following:
- Appeal: A Hep C medication denial can be appealed. Medical providers and patients can contact the health insurance company to file an appeal.
- Fair Hearing: If the medication is still not approved after the appeal, a Fair Hearing can be requested. A Fair Hearing is a chance for you to tell an administrative law judge why you think your health insurance should cover your treatment.
- A grievance or complaint should be filed if a recommended medication is denied. Filing a grievance or complaint is the only way health insurance regulators will know there is a problem with patient care. Medicaid patients can reach out to New York State Medicaid Pharmacy program via email NYRx@health.ny.gov or call (518) 486-3209
Community Health Advocates offers resources to assist providers and patients in filing appeals, fair hearings and grievance or complaints. Give them a call to get started: 800-614-5400.
5. Where can I find help getting the medications covered?
- Patient navigators can help you get medical care and treatment:
- The Check Hep Cpatient navigation program serves patients with hepatitis C at health care facilities in Brooklyn, Manhattan and the Bronx.
- There are NYS Hep C Comprehensive Care Programs in the Bronx, Queens, Harlem and Brooklyn.
- Pharmaceutical Assistance Programs cover the cost of Hep C treatment and copays in some cases. See program information for most common medications:
- Mavyret: Abbvie Patient Assistance Program or call 877-628-9738
- Generic Epclusa and generic Harvoni: 855-769-7284 or www.MySupportPath.com; Asegua Therapeutics Patient Support
- Epclusa, Harvoni, Vosevi, Sovaldi: 855-769-7284 or Gilead Support Path
- Zepatier: 866-251-6013 or Merck Patient Assistance Program
- Other patient advocacy programs for financial assistance and medication access:
- Healthwell Foundation 800-675-8416
- Patient Access Network Foundation 866-316-7263
Still need help with the cost of care? Email hep@health.nyc.gov and we will do our best to help you.
Last Updated on December 7, 2022 by HepFree NYC
