In the United States, an estimated 2.4 million persons have chronic hepatitis C virus (HCV) infection , and the number of deaths from HCV-related mortality is greater than those from HIV and TB combined . Treatment of HCV with direct acting antivirals (DAAs) can cure over 95% of patients with HCV, and cure has been shown to greatly reduce liver-related as well as all-cause mortality [3, 4]. The medical benefits of early treatment of treatment of HCV, before any liver fibrosis has occurred, further improves medical outcomes for HCV patients . However, access to treatment has been limited, often due to treatment criteria that are at least partially attributable to the cost of drugs .
American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV related mortality, making access to treatment among this population a priority . Surveillance data from the Indian Health Service (IHS), the federal agency that provides direct medical care to AI/AN communities, documented approximately 30,000 unique patients with HCV, with significant differences in HCV burden by region .
The overall Indian health care system is comprised of federal (IHS), tribal, and urban Indian facilities. It is the largest health system provider to AI/AN communities, serving approximately 2.6 million persons in 37 states. State Medicaid programs are a key public insurer for an important proportion of patients in this health network. However, state Medicaid programs vary greatly in HCV treatment eligibility criteria, with some states requiring late stage liver fibrosis, specialist consultation, documented periods of sobriety and other qualifications prior to HCV treatment approval . These eligibility requirements for treatment of a confirmed diagnosis of an infectious disease are thought to be unique to HCV, and are not in alignment with clinical recommendations .
We examined prescription data to determine if state Medicaid policy correlated with significant differences for facilities of the Indian health care system.