Relaxed Medicaid Regulations Are Giving More Individuals Access to Hepatitis C Treatment

Medicaid programs around the country are relaxing restrictions on who qualifies for hepatitis C drugs, and in a new study, researchers have found that this is leading to a significant rise in the number of individuals accessing treatment.

Hepatitis C (HCV) is a blood-borne virus that causes liver infection and is most often spread through the sharing of needles for drug injection. Symptoms of the virus typically appear 6 to 7 weeks after infection but may take as long as 6 months to appear. While 70-80% of those with acute HCV infections have no symptoms, those who do may experience fatigue, fever, nausea, abdominal pain, dark urine, or joint pain. Individuals with chronic HCV go on to develop liver damage; in fact, the virus is currently the leading cause of cirrhosis and liver cancer in the United States. In 2014, there were 30,500 cases of acute HCV reported in the United States, and the Centers for Disease Control and Prevention (CDC) estimates that 2.7 million to 3.9 million individuals in the country have a chronic form of the disease. In addition, about 19,000 individuals in the United States die each year from liver disease caused by HCV.

While about 25% of those with acute cases of HCV see their infections clear without treatment, today chronic and acute infections that don’t pass on their own can be treated successfully with direct-acting antivirals (DAA). In a new study published in the journal Clinical Infectious Diseases, researchers from Weill Cornell Institute in New York studied the effects of expanded access to DAA drugs for Medicaid enrollees with HCV. The authors note that the virus is more prevalent among Medicaid enrollees than among individuals who are commercially ensured, but Medicaid programs have typically had strict criteria for accessing treatment that included costly DAAs. Those requirements have included advanced liver fibrosis, abstinence from substance use, and consultation with a specialist medical provider. In recent years, Medicaid programs have begun relaxing those requirements, thereby expanding access to DAAs for those with HCV.

The new study looked at 273,158 DAA prescriptions dispensed in 49 states and the District of Columbia over a 2.5-year study period from 2014 to 2016. They found that while the number of DAA prescriptions declined from 21,061 in the second quarter of 2014 to 13,555 in the fourth quarter of that year, they rose to 40,546 by the third quarter of 2016. Most of those new prescriptions were for the drug sofosbuvir, an effective but expensive drug that had only been available with strict criteria to Medicaid recipients when it was first introduced in 2014. The increase in prescriptions, the authors noted, followed an easing of restrictions by states as well as Medicaid expansion made available by the Affordable Care Act.

“In conclusion, relaxation of Medicaid DAA treatment eligibility requirements in terms of disease severity and substance use abstinence may have contributed to increased treatment access for HCV-infected Medicaid enrollees,” the authors write. “Despite the obvious implications for Medicaid program cost, this expansion is necessary to significantly reduce the burden of HCV related mortality.”