OBJECTIVES: Restrictive policies on access to new, curative hepatitis C virus (HCV) treatments represent a substantial barrier to care. In this study, we evaluated the access rates to HCV treatment for Medicaid patients in 27 States in 2016-2017.

METHODS: Data were collected using Trio Health’s disease management program and are specific to Medicaid-insured patients prescribed anti-HCV therapy in 2016-2017. Access was defined as dispensed direct-acting antivirals (DAA). Access rates were only calculated for sample sizes of >30 patients. To determine dispense, patients were followed for 150+ days from prescription date. Cirrhotic status was assigned based on physician-reported fibrosis scores.

RESULTS: Of the total HCV Medicaid subjects in the cohort, 3802/5493 (69%) had access to treatment. In the 27 States evaluated, 9 States had 2-year access rates <50%, 10 had rates of 50%-70%, and 8 had rates >70%. In 11 States with sufficient cirrhotic (F4) and non-cirrhotic samples (F0-3), access rates were higher in each State for patients with cirrhosis. The greatest disparities between F0-3 and F4 were observed for Idaho (56% access F0-3 vs. 84% access F4) and California (60% access F0-3 vs. 83% access F4). Smallest differences between F0-3 and F4 were observed for Washington (93% access F0-3 vs. 95% access F4) and Connecticut (96% access F0-3 vs. 100% access F4). Year over year changes were assessed for 18 States: access rates increased in 15 States, decreased in 2 States, and remained flat for 1 State.

CONCLUSIONS: Despite a decrease in the price of HCV medications, access to HCV treatment remains a barrier to reducing HCV-associated morbidity and mortality. Prioritization of care appears to remain, with many States displaying higher access rates for patients with cirrhosis compared to non-cirrhotic patients.