OBJECTIVES: Direct-acting antivirals (DAA) are an effective treatment for hepatitis C. We hypothesized state Medicaid programs varied in DAA utilization, and relaxation of policy restrictions resulted in increased utilization. To test these hypotheses, we examined variation in DAA utilization across state Medicaid programs, and the relationship between DAA utilization and policy change.

METHODS: We used several data source to estimate DAA utilization across Medicaid programs between 2014 and 2016. Drug dispensing by state-level Medicaid was accessed from the Centers for Medicaid Medicare Services. Medicaid enrollment was procured from the Statistical Enrollment Data System and state coverage policies was obtained from published literature. Population data as from the Census Bureau and hepatitis C prevalence from published data. At the state level, we calculated prescriptions filled relative to our estimates of hepatitis C prevalence in the Medicaid population. Changes in the number of dispensed prescriptions were compared among states with lessening versus stable restrictions overtime.

RESULTS: Approximately 665,000 DAA prescriptions were dispensed across all 50 Medicaid programs between 2014 and 2016. There was variation in drug restriction policies across the states. In 2014, 26 states required a minimum liver fibrosis score of F3 or higher before a DAA would be covered, one required an F1, two required an F2, four states required an F4, and 14 states had missing data. By 2016, 14 states relaxed their restrictions, while 16 maintained their restrictions. States that relaxed restrictions dispensed DAAs to cover 6.1% of their estimated Medicaid hepatitis C population in 2104 and 39.2% in 2016. States with stable restrictions covered 4.4% in 2014 and 17% in 2016.

CONCLUSIONS: DAA utilization varied widely across states. By 2016, states that relaxed their restrictions had a greater increase in DAA utilization relative to stable states. Policymakers should remove restrictions to allow patients better access to treatment.