This study measured direct-acting antiviral (DAA) initiation among Medicaid recipients diagnosed with hepatitis C in one US state, 2015-2022. Surveillance records were matched to Medicaid claims; initiation meant a DAA claim within 6 months of diagnosis. Yearly initiation rose from 1% for 2015 diagnoses to a peak of 23% for 2020 diagnoses. Compared with the fully restricted period, adjusted initiation was 2.8 times higher once specialist and disease-severity rules ended in 2017. It was 3.7 times higher after sobriety rules ended in 2019, and 5.6 times after prior authorisation ended in 2020. Modified Poisson models adjusted for sex, race, ethnicity and birth cohort, but cannot attribute these changes to the policies themselves.
Why it is interesting: Removing prior authorisation, sobriety and specialist rules coincided with more than fivefold higher treatment initiation. Yet fewer than a quarter of newly diagnosed Medicaid recipients started treatment in any year.
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