Plunge in Antiviral Scripts for Hep C Points to Unmet Treatment Needs

Hailed as breakthrough treatments at their 2013 debut, the number of direct-acting antiviral (DAA) prescriptions to treat hepatitis C virus (HCV) infections has plummeted by nearly two-thirds in the last decade, according to a cross-sectional analysis of U.S. prescription data.

After peaking at 185,677 DAA courses in 2015, prescriptions dropped 63% by 2025, to 68,523. The age of patients taking DAAs also shifted over that period; those older than 61 years accounted for 41.8% of DAA-treated patients in 2015, but that percentage shrank to 26% by 2025, reported researchers led by Sanjay Kishore, MD, of the University of Virginia in Charlottesville.

The constellation of primary payers and providers also reconfigured itself during the decade. Medicare and commercial insurance paid for the vast majority of DAA prescriptions in 2015, at 36.8% and 44.7%, respectively. By 2025, expanded Medicaid coverage rules helped push that public payer’s share to 48.7% of all prescriptions. While specialists wrote two-thirds of DAA scripts in 2015 (66.1%), their share fell to 28.3% by 2025, according to the study in JAMA.

“What is most concerning is that estimates suggest the rate of people acquiring new hepatitis C infections is rising — and that between 2.5 million and 4 million Americans still remain infected several years after these cures were available,” Kishore told MedPage Today. “That suggests that we are failing to help people gain access.”

The number of DAA courses in recent years has roughly matched the nation’s estimated number of new HCV infections. But that tally falls far short of the estimated 260,000 treatment courses needed to hit national HCV elimination targets, Kishore noted. That shortfall may help explain why the U.S. HCV prevalence rate from 2017 to 2020 didn’t drop the way it did in prior periods. Underrepresenting the number of people who inject drugs may have actually masked a rise in prevalence during that period.

These are “sobering numbers” that reflect the need for a national HCV elimination plan such as the Cure Hepatitis C Act of 2025, Debika Bhattacharya, MD, of the University of California Los Angeles, told MedPage Today. “We must expand access to DAAs.”

After the debut of DAAs, “we were able to quickly identify and treat patients with HCV who were already connected to care,” Kishore explained. That initial patient cohort included many older baby boomer patients with a known diagnosis of hepatitis C who were likely covered by Medicare or commercial payers.

As Medicaid removed its access restrictions on DAAs, the payer mix shifted — a move accelerated by the makeup of patients with new HCV infections. Younger adults ages 30 to 50 years are driving those new infections, Kishore noted, many of whom have histories of substance use, tend to be lower-income, and are covered by Medicaid rather than commercial insurance. The share of people younger than 40 years who received DAA courses rose from 5.4% in 2015 to 28.9% in 2025.

The decade’s shift from specialty to primary care prescribers is a good thing, Bhattacharya said. Initiatives that involve more primary care physicians and other providers, including advanced practice practitioners, are expanding the pool of HCV treatment providers, she noted. Kishore credited programs such as Project ECHO and similar models that support prescribing by primary care providers, as well as the end to insurance restrictions that limit prescribing to specialists.

The researchers studied prescription counts from the Symphony Health Metys database, which includes retail, mail-order, and specialty pharmacy data. The analysis included prescriptions from January 2013 to December 2025.

Study limitations included a reliance on aggregated claims that didn’t allow the researchers to assess treatment persistence, as well as the exclusion of non-retail prescriptions such as those in correctional facilities.