OBJECTIVES:: Until recently, treatment of chronic hepatitis C (HCV) relied on dual therapy of peg-interferon combined with ribavirin, or triple therapy, with the addition of boceprevir/telaprevir, offering low cure rates and severe side effects. In the last two years new agents became available in Latin America, offering high cure rates and minimal side effects. In this study, we analyze patients’ access to new generation direct-acting antivirals in Argentina, Brazil, Colombia and Mexico. METHODS:: Approximately 200 specialists involved in treating chronic HCV were surveyed regarding access to new generation treatments for chronic HCV on their countries between 2016-2017. Additionally, 12 payers who influence patient access to treatments at an institutional, regional or national level were also interviewed. RESULTS:: Surveyed physicians indicate their current prescribing practices are driven by payers’ policies rather than their treatment preferences. As a result, up to 70% of patients fails to access treatments for which they are clinically eligible, receiving treatment with older agents, or no treatment at all. In Brazil, for example, and despite coverage, 26% and 25% of public patients fails to receive sofosbuvir and daclatasvir, respectively. Among the most commonly cited reasons for lack of access are budget restrictions (10-50%), lack of coverage (10-70%) and failure to fully meet criteria defined in clinical guidelines (5-60%). According to interviewed payers, the cost of drugs limits formulary inclusion, and justifies the use of strict guidelines to prioritize certain patient populations. CONCLUSIONS:: Prescribing of drugs for chronic HCV is shaped by payers’ policies and the high cost of treatments. As a result, access to more effective therapies is limited, resulting in a high percentage of patients that are not treated or that receive cheaper but less effective, instead of physicians’ preferred treatments. Moreover, future uptake of emerging therapies may also be constrained by these factors.