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Strategies for Improving Hepatitis C Treatment Access in the United States

State Officials Address High Drug Prices, Stigma, and Building Treatment Capacity

Kapadia, Shashi N., MD, MS; Johnston, Carrie D., MD; Marks, Kristen M., MD; Schackman, Bruce R., PhD; Martin, Erika G., PhD, MPH

Journal of Public Health Management and Practice: May/June 2019 - Volume 25 - Issue 3 - p 245–252
doi: 10.1097/PHH.0000000000000829
Research Reports: Research Full Report

Context: Curative treatments for hepatitis C virus (HCV) can alter the course of a devastating epidemic, but high drug prices have contributed to restrictions on HCV treatment access.

Objective: We aimed to learn how state health agencies have responded to the challenges of treatment access for HCV.

Design: Qualitative study using semistructured key informant interviews focused on aspects of HCV treatment access between June 2016 and March 2017. Content analysis was used to identify dominant themes.

Setting: United States.

Participants: Eighteen health officials and treatment advocates across 6 states selected using purposive sampling.

Results: Drug pricing is the most important barrier to access, encouraging restrictive authorization criteria from payers that in turn discourage providers from offering treatment. However, payers have not experienced the budget impact that was initially feared. Although authorization criteria are being lifted for fee-for-service Medicaid programs, ensuring that managed care organizations follow suit remains a challenge. The effect of stigma, a shortage of treating providers, and lack of political motivation are additional challenges to expanding treatment. The response to the human immunodeficiency virus epidemic can augment or inform strategies for HCV treatment delivery, but this is limited by the absence of dedicated funding.

Conclusions: While treatment eligibility criteria for HCV treatment are improving, many other barriers remain to achieving the scale-up needed to end the epidemic. Political disinterest, stigma, and a lack of specialty providers are continued barriers in some jurisdictions. States may need to invest in strategies to overcome these barriers, such as engaging in public and provider education and ensuring that treatment by primary care providers is reimbursed. Despite uncertainty about how federal policy changes to Medicaid may affect states' ability to respond, states can identify opportunities to improve access.

Division of Infectious Diseases (Drs Kapadia, Johnston, and Marks) and Department of Healthcare Policy and Research (Dr Schackman), Weill Cornell Medicine, New York, New York; and Department of Public Administration and Policy, University at Albany-SUNY, Albany, New York (Dr Martin).

Correspondence: Shashi N. Kapadia, MD, MS, Division of Infectious Diseases, Weill Cornell Medicine, 1300 York Ave, A-421, New York, NY 10065 (

The authors acknowledge all study participants, who provided invaluable perspectives on hepatitis C treatment access. They also acknowledge Drs Denis Nash, Kendall Smith, Pedro Mateu-Gelabert, and Brandon Aden for their helpful review of earlier drafts.

This work was supported by the National Center for Advancing Translational Sciences (UL1TR000457 to S.N.K.) and the National Institute on Drug Abuse (P30DA040500 to B.R.S.). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies.

Dr Marks has received research grant funding paid to Weill Cornell from Gilead, Merck and BMS for hepatitis C virus–related clinical trials. All other authors decline conflicts of interest.

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