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Medicaid Expansion and Restriction Policies for Hepatitis C Treatment
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Download the PDF here
Download the PDF here
July 2024
"This analysis demonstrates an association between Medicaid nonexpansion status and restrictive DAA policies resulting in fewer people with Medicaid receiving DAA treatment."
our study found that jurisdictions with Medicaid expansion treated almost twice as many people compared with jurisdictions without Medicaid expansion
the number of estimated new hepatitis C virus (HCV) infections has more than doubled from 24 700 in 2012 to 69 800 in 2021. After an initial surge of people being treated after the release of DAAs, the number of people treated for hepatitis C has steadily declined from a peak of 164 247 people in 2015 to 83 740 people in 2020. Previous modeling has suggested that a mean of 260 000 people must be treated each year to reach hepatitis C elimination targets. Despite an estimate of more than 1 million people treated with DAAs in the US since 2014, only 34% of people with diagnosed infection had evidence of viral clearanceå
Although the national average drug acquisition cost of DAAs has fallen to as low as $26 000 per treatment regimen and Medicaid programs have gradually relaxed treatment restrictions, many programs still have restrictions in place that limit access to treatment
Conclusions
The findings of this cross-sectional analysis suggest that the number of people with Medicaid who are treated for hepatitis C was lower in jurisdictions with Medicaid nonexpansion and fibrosis and sobriety DAA restrictive policies. While a national hepatitis C elimination initiative including a subscription-based payment model covering Medicaid recipients has been proposed,31 Medicaid programs currently can remove all restrictive DAA prior authorization policies. This could potentially improve timely access to hepatitis C treatment for thousands of people. Fully removing DAA prior authorization could also reduce disparities in hepatitis C treatment access and enhance health equity among people who use drugs or alcohol, people experiencing poverty, and people without access to specialty care. In the absence of urgent interventions to improve access to lifesaving DAAs, hepatitis C treatment rates may continue to decline and diminish national progress of hepatitis C elimination efforts.
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