Does Medicaid Cover Harvoni?

In this article...
  • Learn about Medicaid coverage for hepatitis C treatment. Medicaid does cover Harvoni and other medications, but there are often conditions for coverage.

Harvoni is a pill that can effectively treat hepatitis C. The cost of treatment with this drug can be high, and many people considering this course of treatment will need to know whether Medicaid covers Harvoni.

Does Medicaid Cover Harvoni? 

Each state determines how much its Medicaid program will pay for prescriptions and which medications are covered. Medicaid in many states does cover Harvoni or its generic version. Generally, Medicaid will require that you use a generic version of a drug when one is available. 

You may have to meet certain conditions before Medicaid covers Harvoni or its generic. Because every state sets its own rules for Medicaid prescription drug coverage, the requirements will depend on where you live. Requirements for coverage may include things such as: 

  • Trying another medication first 
  • Being vaccinated for hepatitis A and B 
  • Getting a recommendation from a specialist 
  • Not currently abusing drugs or alcohol 
  • Clinical criteria such as viral load or diagnosis of cirrhosis 

You can check your state's Medicaid website or contact your local Medicaid agency to learn more about the specific requirements where you live. Some states may only cover Harvoni if other hepatitis C treatments don't work for you. 

Viekira Pak is another medication used to treat hepatitis C. Although it consists of different drugs, it works in a way that is similar to Harvoni. Some states have Medicaid plans that prefer treatment with Viekira Pak instead of Harvoni.

How Much Does Generic Harvoni Cost? 

Harvoni is the trade name of a medication made of fixed doses of the drugs ledipasvir and sofosbuvir. A one-month supply of Harvoni can cost more than $30,000. 

Generic versions of these drugs became available in 2019. Generic Harvoni is much cheaper than the brand-name medication but is still expensive. A single month's supply of generic Harvoni tends to cost between $5,000 and $6,000.  

How Long Do You Have to Take Harvoni? 

Most people need to take Harvoni for about three months. However, the range of recommended treatment can be from eight to 24 weeks. The recommended treatment time varies based on various factors, including: 

  • Levels of virus in the body
  • Which genotype of hepatitis C is present
  • Previous treatment for hepatitis C 
  • Whether you also have cirrhosis or HIV

A doctor will recommend the length of treatment based on your medical history. Testing may be done after the recommended treatment period to determine whether you need to take Harvoni for a longer time. The length of treatment is generally the same whether you are taking brand name Harvoni or the generic. 

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