One of the questions asked by HCV patients to their doctors is, ‘ is mavyret covered by insurance?’ It is also a question I had when I was diagnosed with HCV. Mavyret is an expensive drug; at that time, I was worried about being able to afford it.
The answer to the question is: no, insurance does not cover it, but it depends on a lot of factors. Fortunately, my doctor cleared me as cured of HCV for some time.
I will try to summarize below what I learned from my experience. I hope it can alleviate some anxiety and doubt HCV patients have.
Mavyret and What It Does
Before looking up if your insurance covers mavyret, first, you need to have a clear idea about what it is, what drugs it contains, what it does, the side effects of mavyret, who can consume it, and in what circumstances we can use it.
Mavyret is a popular drug approved by FDA (Food and Drug Administration) to treat the hepatitis C virus in adults and children. Mavyret can cure hepatitis C from type one to type six.
The Hepatitis C virus causes liver inflammation and infection. Both people have hepatitis C but did not take any medicine for it, and people who have taken medicine yet are not cured can consume mavyret.
It comes in the form of tablets and pellets. Tablets contain 100 milligrams of glecaprevir and pellets 50 milligrams of glecaprevir. Children below three years cannot use mavyret as there is a risk of choking.
If it’s pibrentasvir, then tablets contain 40 milligrams of it and pellets 20 milligrams of it. Both are antiviral drugs since hepatitis C is a virus.
There is a catch, though. If patients have liver cirrhosis (scarring), mavyret is not prescribed to them as it can harm their bodies.
More About: Does My Insurance Cover Birth Control Implant?
Efficacy of Mavyret
Mavyret can cure all types of HCV with the same effectiveness. The reason mavyret is popular is that almost 100 percent of the people participating in the clinical trials were cured after a different duration of treatment. This kind of evidence boosts the reliability that people have on mavyret.
Side effects
Is mavyret covered by insurance, or is it not because of the side effects? Some people have doubts as to the intensity of mavyret side effects. It depends on what kind of patient is taking mavyret.
Depending on that, mavyret can cause mild or severe effects on the human body. Since it targets the liver, the bilirubin level might rise because of mavyret. People have also complained of headaches, nausea, tiredness, diarrhea, urine darkening, yellowing skin, etc.
If they persist for a long time or are disrupting your daily life, then consult with your doctor. However, do not discontinue the medicine on your own accord, as it can lower the effectiveness of the treatment.
HBV and Mavyret
Some people can also experience HBV reactivation. HBV is the hepatitis B virus. People with HBC cannot take mavyret as it can rejuvenate the virus.
That’s why doctors require a blood test before prescribing you mavyret. FDA included a boxed warning of this phenomenon. A warning on the box is the highest warning FDA gives.
HBV can cause death and liver failure. Some ways of knowing if HBV is reactivated in your body are eye whitening, pain in the abdomen, yellow skin, and fatigue. So, we can see how dangerous HBV reactivation is.
Allergic Reaction
Furthermore, some people can have allergic reactions to mavyret. An allergic reaction can also be mild or severe.
One of the symptoms of a severe allergic reaction is swelling of the tongue, mouth, throat, feet, eyelid, etc. The swelling can be each body part alone or simultaneously. Patients can also have a problem breathing.
Mild allergic reactions include itchiness and skin rash. Itchiness is caused by HCV or by the increase in bilirubin level.
Dosage
The usual dosage for adults is thrice per day simultaneously and with food. You have to take it by mouth. But the duration of the treatment depends on your doctor and whether you previously had any HCV treatment.
If you have no or minimal liver scarring and ave never had any treatment for HCV then, the duration of your mavyret intake will be probably eight weeks. But the time varies if you have had HCV medication before.
Mavyret reacts to other drugs and in some situations will suddenly be ineffective because of alternative medication. That is why doctors must vet the medication you used before mavyret.
The dosage for children is different than for adults. It depends on their age and weight. While weight loss is not considered a side effect of mavyret, people sometimes experience it.
If the child is older than twelve, the dosage is the same as that of an adult. It is also taken by mouth. However, weight is a factor in the dosage if they are younger than twelve.
These children are recommended pallets by their doctors and directed to take mavyret pallets once daily. If the child weighs less than twenty, the dosage is three packets.
Medicare and Mavyret
If you have Medicare as your medical insurance, then the cost of mavyret depends on your coverage. Some of the coverage plans of Medicare are deductible, post-deductible, donut hole, and post-donut hole.
Post-donut makes mavyret cost less than seven dollars. Medicare will cover most of the expenses.
The other plans do not give as much discount as the post-donut hole. Besides that, mavyret is considered a 5-tier drug in Medicare.
The higher the tier a drug is on, the more it costs.
Coverage Restriction
There are also some restrictions on coverage as mavyret is a specialty drug. Mavyret treats only hepatitis C, so prior authorization is necessary before Medicare covers it.
Here, authorization means that the person who prescribes you mavyret needs to contact your plan before Medicare can subsidize the costs. There is also a limit on how much mavyret you can get.
Medicare will only supply you with mavyret for the duration of your drug intake. Its quantity is restricted as too many antiviral drugs can harm the body.
Why Is Mavyret So Expensive?
The answer lies behind the question, ‘is mavyret covered by insurance?’. Most insurance such as Medicare or Medicaid, do not have plans that cover mavyret. Without insurance, it can cost for than twenty-five thousand dollars for the shortest treatment plan!
Mavyret is a specialty brand-name drug. Specialty means that it only cures hepatitis C in the body. Here, a cure is that the blood test after three weeks post-treatment does not have any trace of HCV.
Mavyret is made from the same drugs used in AIDS and HIV treatment. It can have a significant influence on our bodies. Plus, mavyret is a brand-name drug.
The manufacturer’s research behind the formula, side effects, and treatment cost a lot of money. Moreover, there is no better alternative than mavyret in the market at present.
Market reliance on mavyret can be a reason behind the huge price tag.
Ways To Lower Mavyret Price
If you are not eligible for medical insurance that covers mavyret, there are other ways you can subsidize your costs.
Some companies have their insurance. When joining a new workforce, you should look up the insurance plan they have for their employees. It is also possible to negotiate better coverage during the hiring stage.
The American Healthcare System does not have a national healthcare plan. Their healthcare is made up of many small-range insurance plans.
That is one of the reasons companies do not broadcast the insurance that they have. It is a lengthy bureaucratic process both for the company and the employee.
Other than this, some medical organizations give coupons applicable when purchasing mavyret. There are also manufacture coupons and assistance programs from healthcare foundations.
Moreover, your social and housing status can make you eligible for state aid and other programs. There is a program called Mavyret Patient Support that can help you.
Lastly, contact your pharmacy to see if they have any mavyret subsidy. Some pharmacies have it, so you can change your pharmacy to get a lower price on mavyret.
Don’t be nervous when you first see the price of mavyret. The costs can vary a lot depending on your job, your location, your pharmacy, and your insurance plan.
How Much Does Mavyret Cost for Treatment in General?
There are many factors to consider in the mavyret treatment plan. These factors are,
- The insurance plan you have.
- The amount or type of mavyret you will consume.
- The pharmacy you buy the medicine from.
- Other medicines you take.
- If you are pregnant and breastfeeding.
You can consult your insurance provider to create the most informed plan for your health. They can give you what it might cost per pill.
Your pharmacist can do the same. Some of the questions you can ask them are: will my duration affect the cost of mavyret? What should I do if I cannot continue to afford mavyret? Are there any ways I can minimize the effect of MCV until I can afford mavyret?
Even if you are covered by insurance, try to see if you can apply for financial aid, as it will reduce the costs my advice when budgeting for a mavyret treatment plan is to take it slow.
There is a lot of information about mavyret, and for people in different circumstances, the solution to problems might not be the same.
While mavyret is pricey, you cannot put a price on health. It is also priced competitively compared to other HCV medicines. If you can get the mavyret savings copay card from the manufacturer company, mavyret can cost only five dollars.
Alcohol And Breastfeeding
Alcohol consumption can hasten liver cancer in HCV patients. To know if you can take mavyret and alcohol at the same time, consult your healthcare professional.
As stated above, you cannot take mavyret while pregnant and breastfeeding. The effects of the drug on unborn or small children are unknown, so it’s better not to risk it.
Frequently Asked Questions
For how many days do the patients need to take mavyret?
It depends on the treatment plan. It can take up to 16 weeks.
What kind of drug does mavyret contain?
Mavyret is made up of two antiviral drugs, glecaprevir, and pibrentasvir.
Is mavyret a brand-name drug or a generic drug?
It’s a brand-name drug. That’s why it costs more to buy.
How much does mavyret cost?
According to the production source, an eight-week treatment plan mavyret medication can cost up to twenty-six thousand dollars.
Is mavyret covered by Medicaid?
It depends on the person, but yes, Medicaid does cover mavyret. It can reduce the cost of medicine so that low-income people can afford it.
How much mavyret do I need to take to cure HCV?
If the doctor’s guideline is followed, mavyret can cure hepatitis C in eight to sixteen weeks.
What is the most common side effect of mavyret?
Most patients report that headaches and fatigue come hand in hand with taking mavyret. But other side effects are yellowing of the skin, nausea, diarrhea, etc.
How can I make mavyret included in my insurance?
First, you have to know what your current insurance entails. You can also consult your company if they have company insurance, which covers a vast range of medications.
Conclusion
People suffering from hepatitis C have a common question: Is mavyret covered by insurance? It is because mavyret costs a lot if it is not covered by insurance. It is unaffordable for the general populace.
Since mavyret reviews show that it can cure hepatitis C more effectively than other drugs, people (and doctors) prefer it. However, while various insurance covers it, insurance coverage is always unclear.
People must research and look up what insurance they are eligible for and consider other factors. It is a stressful situation for patients to be in.
Mehedi Hasan is an insurance expert with over 6 years of experience in the industry. He has a deep understanding of various types of insurance policies and is skilled at helping clients find the coverage that best fits their needs. In his current role, Mehedi works as a consultant, advising businesses and individuals on the best insurance options for their specific situations.
He is also a frequent speaker at industry events, sharing his knowledge and expertise with colleagues and professionals in the field. Mehedi holds a degree in insurance and risk management and is committed to staying up-to-date on the latest industry trends and developments. In his free time, he enjoys reading, traveling, and spending time with his family.