Treatment coverage in your region
Prescription Drug Programs
General information on drug coverage and benefit programs offered by the provincial, territorial and federal governments can be found here.
Coverage for Hepatitis C Medications
The Ontario Drug Benefit Program (ODB) and the Trillium Drug Program (TDP) are the two main programs that assist Ontario residents with covering the costs of expensive prescription drugs and may be able to help cover the high cost of hepatitis C treatment medications.
What is the Trillium Drug Program?
The TDP provides drug benefits to Ontarians who have high drug costs in relation to their household income. Residents who do not qualify for any of the other programs can apply for the TDP. An annual deductible and co-payments (based on household income) apply to all recipients of the TDP, which is paid in four installments throughout the year.
What is the Ontario Drug Benefit Program?
How do you apply for coverage of Hep C meds?
In Ontario, peg-interferon and ribavirin are among the drugs that are eligible for coverage under the Exceptional Access Program (EAP). These hepatitis C medications must be approved for coverage by the EAP before they will be paid for by one of the publicly funded drug programs. People can ask their hepatitis C specialist to submit a request form to the EAP for coverage of their hepatitis C medications. The request form will be reviewed against the clinical criteria for coverage, set out by the Committee to Evaluate Drugs (CED).
Boceprevir is also eligible for coverage under the Exceptional Access Program for certain groups of people with genotype 1 hepatitis C.
Some of the factors that are considered when approving funding for hepatitis C medications include:
- a positive HCV RNA test
- HCV genotype
- elevated ALT levels or level of fibrosis
- child-Pugh score or level of cirrhosis
- whether or not an individual is treatment naïve
- whether or not an individual is living with chronic hepatitis C
The full criteria for funding of peg-interferon, ribavirin and boceprevir can be found in the Frequently Requested Drugs document. Funding criteria for epoetin is also included in the document.
The requesting physician will receive a letter from the EAP telling them whether or not coverage will be granted or if more information is required. If the request is approved, people will have their hepatitis C medications covered for a designated time period. A request to extend the period of coverage is usually necessary in order for people to have their medications covered for the duration of their treatment.
If people would like more information about drug programs in Ontario, they can call the Exceptional Access Program Branch (EAPB) of the ODB at 1-866-811-9893 or TTY at 1-800-387-5559.
What about coverage under the Non-Insured Health Benefits program?
Registered First Nations and recognized Inuit people may be able to access coverage for their hepatitis C medications through the Non-Insured Health Benefits (NIHB) program. People can contact NIHB by phone or mail at: