Last Updated on May 17, 2020 by

  1. Is Hep C care and medication covered by insurance?
  2. How can I find a Hep C doctor?
  3. What if I don’t have insurance?
  4. What if the Hep C med is not approved by insurance?
  5. 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. 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:

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?

  1. Appeal: A Hep C medication denial can be appealed. Medical providers and patients can contact the health insurance company to file an appeal.
  2. 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.
  3. 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.

Community Health Advocates offers resources to assist providers and patients in filing appeals, fair hearings and greivance 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 C patient navigation program serves patients with hepatitis C at health care facilities in Brooklyn, Manhattan and the Bronx.
    • The Project INSPIRE care coordination program serves patients with hepatitis C at health care facilities in northern 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  (Harvoni: Gilead Support Path, VIEKIRA PAK ProCeed Patient Assistance Program, or Zepatier Merck Patient Assistance Program ).
  • Community Health Advocates offers resources to assist providers and patients in filing appeals, fair hearings and greivance or complaints. Give them a call to get started: 800-614-5400.

Still need help with the cost of care? Email hep@health.nyc.gov and we will do our best to help you.

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