OBJECTIVES: Hepatitis C Virus (HCV) is a significant global health issue that persists despite the availability of curative treatment options with Direct Acting Antivirals (DAAs). The objective of this study is to describe and analyze the utilization, reimbursement, and price trends of HCV medications in the Medicaid-covered population.

METHODS: The primary data source was the state Medicaid drug utilization pharmacy claim files collected by the Centers for Medicaid and Medicare Services (CMS) from 2001 to 2021. A longitudinal retrospective and descriptive study was conducted to examine the annual secular trends of HCV medication utilization, reimbursement, and cost per prescription (proxy of price). The study evaluated all medications authorized for HCV treatment in the US, such as ribavirin (RBV), pegylated interferon alfa-2a (PEG-INFA2a), and DAA brand and generics (e.g., Boceprevir, Telaprevir, Simeprevir, Sofosbuvir, Ledipasvir/Sofosbuvir, Elbasvir/Grazoprevir, Daclatasvir, Sofosbuvir/Velpatasvir, and Glecaprevir/Pibrentasvir). The annual total numbers were calculated for number of prescriptions, reimbursements, and prices for each medication.

RESULTS: The utilization of conventional PEG-INFA2a and RBV reduced as the newer DAAs were introduced. In 2011, the total number of prescriptions for RBV, PEG-INFA2a, and DAAs were 103,358, 192,529, and 12,074, respectively; while in 2021, they were 1,600, 1,215, and 119,496, respectively. New DAAs agents led to the discontinuation of several DAAs agents due to market competition and lower utilization. The overall cost of PEG-INFA2a and RBV was much lower than DAAs, averaging around $2,945, $797, and $16,725, respectively, resulting in a much higher reimbursement for DAAs. The DAAs agent with the highest total annual reimbursement is Harvoni, with over $2 billion in both 2014 and 2015.

CONCLUSIONS: Despite the introduction of multiple DAAs agents, the drug prices remained high and unchanged during the study period. The increase in HCV incidence cases in recent years indicates accessibility issues for costly and effective DAAs medications.