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    What is your insurance coverage for Hepatitis-C treatment?


    Hepatitis C, a contagious liver disease, is also known as Hepatitis C. Hepatitis C virus (HCV), is the cause. The spread of HCV is possible when uninfected people come in contact with infected persons’ blood. Most cases of the initial infection don’t show symptoms. Many people don’t even know they have hepatitis C unless their routine medical exam shows that liver damage has occurred.Some people may have HCV for as short as six months. Their bodies are able to clear the infection by themselves. This is acute HCV.Many people develop HCV over time, either chronically or in the long-term. One study shows that HCV is affecting between 2.5 and 4.7 million Americans.

    The goal of treatment was to maintain quality of living until recent years. Today, there are medications that can rid the body of the virus. Learn more about treatment options and insurance coverage.

    What treatment options exist for hepatitis C.

    Many medications are effective in treating HCV.

    Traditional remedies

    Pegylated Interferon and Ribavirin were the primary treatments for HCV up until recently.

    Pegylated interferon combines three types of proteins to stimulate the immune system. This is done to prevent the virus’s spread. It protects healthy cells from infection. Ribavirin is also effective in stopping the virus from reproducing. These drugs are often combined for “peg/riba treatment.”

    Recent medications

    Doctors are now using newer antiviral drugs. Sometimes, these medications are used alongside interferon and/or ribavirin. This is called “triple treatment.”

    The following treatments were approved by the U.S. Drug and Food Administration

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

    These drugs can treat HCV unlike other treatments. Harvoni’s effectiveness in clearing the virus is high.

    These medications can come at a high price. A typical 12-week course in Sovaldi can run up to $84,000.

    What is insurance coverage?

    Because these medications can be very costly, coverage must be obtained by meeting several conditions.

    Sovaldi coverage is not available to everyone. Your insurance company might deny you coverage if your liver disease is severe. You are not eligible for this medication if you have serious kidney damage.

    Your insurance policy will determine how much coverage you have when it comes to paying for these medications. Many people have managed health plans.

    Managed care plans can be based on agreements with medical providers and other healthcare facilities. These plans offer care at a lower cost for members. There are three main types:

    • Health management
    • Preferred provider
    • Point of Service

    Most insurance policies cover HCV treatment. The coverage policy of each plan will dictate whether or not treatment for HCV is medically necessary. BlueCross BlueShield Mississippi requires that you complete a six-month evaluation before you are eligible for an antiviral recommendation.

    Most insurance plans do not cover all HCV treatments. Most insurers cover Sovaldi. It is estimated that the monthly copay will be $75-$175

    Ask your insurance provider about your specific coverage. There may be financial assistance available if your insurance doesn’t cover the antiviral treatment your doctor recommends.

    Are assistance programs available?

    Additional coverage can be provided by healthcare non-profit foundations and pharmaceutical companies.

    Support Path, a Gilead program, is one example. If you are eligible, this program will help you to afford Harvoni and Sovaldi. The program will cost you no more than $5 per monthly copay. If you are eligible and uninsured and you seek treatment, Sovaldi/Harvoni can be provided at no cost.

    To assist you with insurance-related queries, a call center is available.

    The American Liver Foundation has a list of financial aid programs to help you look into your options.

    What you should do now

    If your doctor recommends these medications, you should review your health insurance plan. It’s crucial to find out what your insurance covers, and what your doctor requires in order to be covered.

    Appeal the decision if you are denied coverage. Discuss your concerns with your doctor and discuss the reasons your insurance denied you coverage. You can also work with your insurance provider for treatment. Look into financial assistance programs if your insurance keeps denying you coverage.



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