Only one in three Americans who have hepatitis C virus (HCV) infection receive curative antiviral drugs, according to a research letter published yesterday in JAMA.
Researchers from the University of Virginia and Brigham and Women’s Hospital analyzed data from the Symphony Health Metys database, which estimates US prescription counts by county and month using a large sample of retail, mail-order, and specialty pharmacy data, from January 2013 to December 2025.
The study authors noted that, since becoming available in 2013, direct-acting antivirals (DAAs) have transformed the treatment of hepatitis C. The drugs are well tolerated and result in a cure in more than 95% of patients.
“However, only about a third of people in the US with HCV infection receive treatment within a year of diagnosis, an estimated 2.5 million to 4 million remain chronically infected, and incident cases of HCV have increased during the last decade,” they wrote.
Prescribing far below that needed for elimination
About 1.3 million DAA courses were dispensed from 2013 to 2025. The annual volume peaked in 2015, at 185,677 courses, falling to 68,523 in 2025. Prescribing reached its maximum of courses before newer regimens that can be used to treat all genotypes of HCV became available in 2016.
We observed that DAA prescribing among Medicaid beneficiaries increased from 2016 through 2019 and then began decreasing, possibly due to interrupted access during the COVID-19 pandemic.
Most prescriptions were covered by either Medicare or commercial insurance (36.8% and 44.7%, respectively), while Medicaid accounted for the largest proportion in 2025, at 48.7%. Specialist prescribing dropped from a peak of 66.1% of DAA courses in 2015 to 28.3% in 2025.
The age distribution of patients prescribed DAAs shifted over time, with adults older than 61 making up 41.8% of treated patients in 2015, compared with 26.0% in 2025, while the proportion of adults younger than 40 prescribed the drugs rose from 5.4% in 2015 to 28.9% in 2025. Treatment rates were at first higher in metropolitan counties, but since 2018 they have been higher in nonmetropolitan counties.
“We observed that DAA prescribing among Medicaid beneficiaries increased from 2016 through 2019 and then began decreasing, possibly due to interrupted access during the COVID-19 pandemic,” the researchers wrote.
Since 2020, the annual treatment volume (roughly 69,000 courses) was similar to the estimated number of new US HCV infections but is substantially below the estimated 260,000 annual treatment courses needed to achieve national elimination targets.
May explain lack of progress against infection
“Treatment levels being too low may help explain why hepatitis C prevalence hasn’t fallen (and may have even increased) in recent years,” senior author Benjamin Rome, MD, MPH, of Mass General Brigham (MGB), said in an MGB news release.
