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Is Epclusa covered by insurance? | How much does Epclusa cost without insurance? | How to get Epclusa without insurance
Epclusa is a medication used to treat chronic hepatitis C infections (genotypes 1 through 6). Combining two direct-acting antiviral drugs, sofosbuvir and velpatasvir, Epclusa prevents the hepatitis C virus from making copies of itself. The goal of the 12-week treatment is to reduce the hepatitis C virus to undetectable levels in the blood and keep it there. Epclusa and other direct-acting antiviral drugs (DAAs) are highly effective. Over 90% (and 95–99% in some studies) of patients taking DAAs will be cured on the first treatment. Cure rates for retreatment are up to 95%. Adults will take a single 400/100 mg tablet each day with or without a ribavirin tablet, an older direct-acting antiviral. Children will take either tablets or pellets; the dose will depend on body weight. With a monthly price tag in the tens of thousands of dollars, Epclusa can be prohibitively expensive without health insurance coverage. Uninsured patients should not give up hope, though. There are ways to obtain Epclusa at an affordable price.
Is Epclusa covered by insurance?
Epclusa is usually covered by most commercial health insurance plans, Medicare, and some Medicaid plans. Coverage may require prior authorization. The out-of-pocket expense, however, will depend on the insurance plan’s formulary, deductibles, and coinsurance. People with health insurance may qualify for an Epclusa copay coupon, which can reduce the monthly cost significantly. For Medicare patients, 80%, according to Gilead Sciences, Inc., pay $15 or less. 99% of Medicaid-covered patients pay $5 or less per month for Epclusa.
How much does Epclusa cost without insurance?
The full retail price for Epclusa averages $39,000 for 28 tablets, enough for four weeks. Since treatment lasts for 12 weeks, the full cost of Epclusa treatment without insurance is close to $120,000.
There are “less expensive” treatments, but the cost can still be prohibitive for many patients. The approved generic version of Epclusa, sofosbuvir-velpatasvir, has a list price of $24,000 for 28 tablets. We will list other options in the table below.
Over-the-counter medications, dietary supplements, and natural remedies are not effective substitutes for prescription antiviral drugs for controlling HCV infections.
Compare Harvoni prices to related drugs |
|||
|---|---|---|---|
| Drug name | Price without insurance of brand-name drug | SingleCare price | Savings options |
| Epclusa
(sofosbuvir, velpatasvir) |
$38,932 per 28 tablets | $18,545 per 28 tablets of brand-name Epclusa | See updated prices |
| Zepatier
(elbasvir / grazoprevir) |
No coupons at this time. Check back periodically. | More details | |
| Mavyret
(glecaprevir, pibrentasvir) |
No coupons at this time. Check back periodically. | More details | |
| Viekira Pak
(ombitasvir, paritaprevir, ritonavir, dasabuvir). |
No coupons at this time. Check back periodically. | More details | |
| Vosevi
(sofosbuvir, velpatasvir, voxilaprevir) |
$29,904 per 28 tablets | $22,823 per 28 tablets of brand-name Vosevi | See updated prices |
| Harvoni
(ledipasvir, sofosbuvir) |
$37,240 per 28 tablets | $23,551 per 28 tablets of brand-name Harvoni | See updated prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs. The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see updated drug prices.
How to get Epclusa without insurance
Epclusa treatment is highly effective and potentially life-saving but can be unaffordable at full retail price. Many uninsured people will therefore need to find financial assistance to purchase the drug. While some pharmaceutical companies may offer manufacturer coupons or rebates, they aren’t always available, or you may have to meet certain eligibility requirements. When these don’t work, here are other ways to get financial help.
1. Start with a SingleCare discount card
A SingleCare savings card can cut as much as $20,000 off four weeks of Epclusa treatment. Simply download or print a free coupon from SingleCare and take it to a participating pharmacy.
2. Get health insurance
When all the costs of hep C treatment are added up, health insurance is usually a much better deal than paying the cash price for antiviral drugs. Even people who qualify for Gilead’s patient assistance often have health insurance of some kind. Start with the online healthcare marketplace in your state.
3. Enroll in Medicaid
The next step is to research Medicaid eligibility criteria in your state. Medicaid plans can help reduce the cost of Epclusa substantially.
4. Enroll in Medicare Extra Help
For people on Medicare, Medicare Extra Help (Medicare Low Income Subsidy or LIS) could help pay for Epclusa during coverage gaps, as well as reduce the overall cost of treatment. Eligibility criteria, enrollment instructions, and additional information can be found on the Medicare website.
5. Get free or low-cost Epclusa from ADAP
For people with both HCV and AIDS, Epclusa is included in the AIDS Drug Assistance Program (ADAP) formulary. Run by the U.S. Department of Health and administered by individual states, ADAP provides uninsured or underinsured patients free HIV/AIDS prescription medicine. Talk to local or state health officials for enrollment information.
6. Get medical advice about less expensive HCV antiviral treatments
Direct-acting antiviral drugs (DAAs) like Epclusa are considered the first choice to reduce hepatitis C to undetectable levels. There are more than one, and several are considerably less expensive. However, make sure to consult with a healthcare professional, as not all are as effective as Epclusa, and the best drug is often determined by the genetic “type” of the virus.
