State Medicaid Hepatitis C Treatment Eligibility Criteria and Use of Direct-Acting Antivirals

Abstract

Medicaid program criteria for accessing hepatitis C treatment are changing. Medicaid drug utilization data from 2014 to 2016 show that programs that have relaxed their criteria have seen significant increases in treatment utilization, as have states with Medicaid expansions.

Figure 1.

Mean number of direct-acting antiviral (DAA) prescriptions per 1000 hepatitis C virus (HCV)–infected nonelderly adult Medicaid enrollees, categorized by fibrosis policy change (A), abstinence policy change (B), and Medicare expansion status (C). A, High restriction is defined as a METAVIR score of F3 or F4; no-to-low restriction, no restriction or a score of F1 or F2; less restrictive, a change from high restriction to no-to-low restriction; and more restrictive, a change in the opposite direction. B, High restriction is defined as any documentation of abstinence from substance use; no-to-low restriction, no documentation needed; less restrictive, a change from high restriction to no-to-low restriction; and more restrictive, a change in the opposite direction. Abbreviations: Q2, quarter 2; Q4, quarter 4.