Medicare prescription drug plans will help pay for hepatitis C medications, but the drugs might still lead to high out-of-pocket costs.

Hepatitis C is a potentially life threatening and chronic infection that affects a person’s liver function.

Medicare covers screenings and some medications to treat hepatitis C. Yet there’s a lot to know about how you can get the best cost savings.

Keep reading to find out which parts of Medicare cover hepatitis C detection and treatments, as well as what is not covered.

Medicare divides its services into different parts, including parts A, B, C, and D. Each part is responsible for paying for your medically necessary services and items.

Some ways that your Medicare coverage may pay for costs related to hepatitis C include:

Part A

Medicare Part A covers hospital and inpatient-related services. This portion would pay for costs if you require hospitalization related to your hepatitis C.

Part B

Medicare Part B covers outpatient medical costs. These include:

This means Part B would pay for doctors’ office visits related to your hepatitis C and screening tests for the virus.

However, Medicare covers the costs of the preventive screenings only if you’re considered “high risk.” If you do not meet the criteria for a screening or need a hepatitis C test more than once per year, you may have to pay some of the costs.

Part C

Medicare Part C is also known as Medicare Advantage. This is a combination Medicare plan where a private insurance company provides your Medicare benefits.

Medicare requires that all Advantage plans cover at least the same benefits as Original Medicare (parts A and B). Often, they also include Part D (prescription drug) coverage.

This means you’ll still get coverage for preventive screenings, hospital stays, and doctors’ visits, as well as medications if you have prescription drug coverage through your plan.

Part D

Medicare Part D covers prescription drugs. Many private insurance companies offer various Part D plans. Each company has a list of medications it covers called a formulary.

As of July 2015, Medicare requires all Part D formularies to cover at least one medication that treats hepatitis C. However, this does not mean the medications have a low cost.

Many plans require you to get authorization from your doctor before beginning treatments. You’ll also pay a coinsurance cost for the medication; this can vary by plan.

Medigap

Medigap, or Medicare supplement insurance, is a plan that helps you reduce out-of-pocket costs if you have Original Medicare.

While different plans are available, they generally help pay for costs like coinsurance and premiums for parts A and B, foreign travel emergency care, and more.

Having a Medigap policy may help reduce your out-of-pocket costs if you require care for hepatitis C. However, Medigap does not offer specific coverage for medications or testing.

Medicare may cover some aspects of care for detecting and treating hepatitis C.

Medications

Medicare requires that all eligible individuals have a Part D plan or other creditable prescription drug coverage. These plans usually have a formulary that separates drugs into different tiers based on cost.

One of the most expensive tiers is called the specialty tier. Some of these drugs may cost more than $600 a month.

Drugs to treat hepatitis C often fall under the specialty category, which means they can be expensive even with coverage.

Screenings

Medicare covers screening tests for hepatitis C if you:

  • have a history of using injectable drugs
  • were born between the years 1945 and 1965
  • were the recipient of a blood transfusion before the year 1992

If you’re at high risk for contracting the hepatitis C virus, such as if you continue to use injectable drugs, Medicare covers a yearly screening for hepatitis C. However, you must get the screening test from a healthcare professional who is enrolled in Medicare and accepts the amount that Medicare pays for the service.

Researchers have consistently produced new antiviral medications to treat hepatitis C. Some may be too new for Medicare plans to cover them.

For example, Medicare plans do not yet cover the medications Zepatier (elbasvir and grazoprevir) and Peginterferon (peg interferon alfa-2b).

The FDA has currently approved seven medications to treat hepatitis C. However, not all these drugs will appear on a plan’s Part D formulary. Often, only one medication appears on a plan’s list. As a result, your doctor may prescribe medications to you based on what your plan covers.

Not all hepatitis C medications are the same. Some require that you take them for an extended time period, even up to nearly a year. Some are more convenient to take, have fewer side effects, or are more researched in terms of their risks and benefits.

If your doctor feels that you need a different medication than the one your plan covers, they may be able to write a letter to Medicare or your Medicare Advantage provider and ask for an exemption for your specific situation.

Even with Medicare coverage, medication treatments for hepatitis C can still be costly. According to a 2017 data review, the cost could range from $6,297 to $10,889 for the entire treatment course.

Depending on your income, you may qualify for a low income subsidy. This means you’d get assistance to pay for your medication costs. According to the same review, Medicare beneficiaries with a low income subsidy paid between $10.80 and $1,191 for their total hepatitis C treatment costs.

Several FDA-approved medications can treat hepatitis C. The following are some commonly prescribed medications that Medicare plans may cover:

A 2022 report found that many Part D plans provided some coverage for select brand-name hepatitis C medications rather than generic versions. This may result in a high out-of-pocket cost, which can vary by plan.

Cost is certainly a factor to consider in your hepatitis C treatment. However, complications from hepatitis C can be life threatening. Ideally, you and your doctor can find a treatment plan that will be affordable, safe, and effective for you.

You’ll typically take hepatitis C medications for about 8 to 12 weeks.

The treatment success rate is often high. The Centers for Disease Control and Prevention (CDC) reports that hepatitis C medications cure hepatitis C in about 95% of people who take them.

Medicare covers screenings to detect hepatitis C, often at no cost.

Medicare Part D plans must include at least one hepatitis C treatment medication.

These prescription drugs are often still expensive if you don’t have a low income subsidy to help pay for them.

You can talk with your doctor about ways to save money on your prescriptions and find an option that meets all your needs.