What to Do When Hepatitis C Treatment is Denied

Take these steps to get the meds you need.

You might've heard horror stories from friends with hepatitis C or in online forums about health insurance companies refusing to cover newer medications that have cure rates above 90 precent. Unfortunately, research is confirming that getting coverage is often a battle.  

Who is Denied
In one small study, almost 1 in 4 people with hep C were denied drug coverage by their health insurance providers. New innovative, oral medications are expensive, and with more than 3 million people living with hep C in the U.S., it's a big bill that many insurance companies are hesitant to pay.

However, most people who were initially denied eventually got their meds, but it was only after a lengthy appeals process. This is still bad news, because during that waiting period, hep C continues to damage your liver.

The study also found that people with advanced liver damage were more likely to get their treatment approved the first time around. In fact, some people with hep C may be deemed "too healthy" for treatment, with insurance companies choosing to limit access to those with the most urgent medical needs.

What You Can Do
If you are denied, it's easy to give up hope, but there are several things you can do to help get the drugs you need:

Write an appeal letter. If you're told no on your first try to get treatment, you can appeal the decision. Each insurance company is different, but most have several levels of appeals. Take the time to research your options and what the appeals process will look like for you. Some doctor's offices may offer to handle this, so ask your doctor if they can help in any way.

See the right doctor. If your doctor is not prioritizing your treatment how you'd like, it might be time to see someone else. There's a good chance you'll be told it's safe to wait to be treated until costs drop or you qualify for coverage. But if waiting makes you uncomfortable, you can always get a second opinion from another doctor. Also, some insurers may only cover hep C prescriptions from specialists, so you may need to seek a referral for a better chance at getting treatment.

Reach out to the drug manufacturer. Many pharmaceutical companies have patient assistance programs to help people pay for their pricey drugs. They're a great resource, especially if you're uninsured. Check out the website of your preferred medication for more info on how you can qualify for financial assistance. 

Be your own advocate. You are the person who cares most about your health, so you'll need to take charge. Be a champion of your health by talking to your doctor about your treatment options. During this potentially exhausting time, you should also be in control of your mental and emotional health. You can join a support group or talk to a therapist regularly.

While trying to get your medication, you should remind yourself that being hep C free is worth the wait and frustration. Fight for your treatment so you can rid yourself of hep C for good and live your happiest, healthiest life.

Medically reviewed in October 2018.

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