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Robert Greenwald, Phillip Waters & Sarah Cayer, Enforcement of Legal Remedies to Secure Hepatitis C Virus Treatment With Direct-Acting Antiviral Therapies in Correctional Facilities and Medicaid Programs, 135 Pub. Health Rep. 44S (2020).

Abstract: Hepatitis C virus (HCV) infection is a communicable disease that affected approximately 3.5 million persons in the United States as of 2017.1 Despite the introduction of new, highly effective treatments in 2011,2 HCV infection rates in the United States tripled from 850 in 2010 to 2436 in 2015.1 This increase was largely a result of the opioid epidemic, with injection drug use the most common method of new HCV transmissions.3 In addition, the lack of enforcement of laws that entitle persons to life-saving, medically necessary care such as HCV treatment is a missed opportunity to reverse this trend. New treatments for HCV infection with direct-acting antiviral (DAA) therapies are curative for patients and eliminate their ability to spread the virus. However, US health systems have not responded to the potential of new treatments by promoting access to them. Instead, because of high initial list prices,4 state Medicaid programs and correctional health facilities have created rationing. They have limited access to HCV treatment by instituting restrictions that are based on disease severity, as measured by damage to the liver (ie, treating only persons with advanced-stage HCV infection) and prescriber specialty. In addition, despite the syndemic between the opioid crisis and increasing use of injection drugs, periods of sobriety from drugs and/or alcohol are required before treatment.5 These restrictions contradict leading medical guidance recommending treatment of virtually all persons with chronic HCV infection and hinder our ability to reduce HCV incidence, let alone end the HCV epidemic.3 Despite the tension created between scarce resources and public health concerns, the initial budgetary fears cited as justifications for restrictions were less severe than anticipated and have diminished over time, in part because increased competition has led to decreased prices.