HMN 2026: How Dramatic reduction in prescribing of hepatitis C antivirals may leave many curable patients untreated

Direct-acting antivirals (DAAs) can cure hepatitis C (HCV) in more than 95% of individuals treated. But only 1 in 3 people with HCV in the U.S. receive treatment within a year of diagnosis. A new study by investigators from Mass General Brigham and University of Virginia School of Medicine has analyzed a large national prescription database to estimate hepatitis C treatment courses over time and trends by patient and prescriber characteristics from 2013–2025.

In the study, researchers found that prescriptions rose rapidly after DAAs first became available, peaking in 2015, but then declined sharply through 2025. Results are published in JAMA.

The team found that initially DAA treatment was concentrated among older adults and those with Medicare or commercial insurance, but over time, treatment has shifted toward younger patients and Medicaid beneficiaries. Specialist prescribing peaked in 2015 and then declined through 2025.

“Treatment levels being too low may help explain why hepatitis C prevalence hasn’t fallen (and may have even increased) in recent years,” said senior author Benjamin Rome, MD, MPH, a faculty member in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Mass General Brigham Department of Medicine. “Elimination will require system-level changes, not just better screening.”

“Hepatitis C is a curable disease, but current treatment levels are substantially below what’s needed to achieve national elimination targets,” said lead author Sanjay Kishore, MD, a faculty member at the University of Virginia School of Medicine and a former resident at Brigham and Women’s Hospital.

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