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 analyzed a large national prescription database to estimate hepatitis C treatment courses over time and trends by patient and prescriber characteristics from 2013–2025. 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.

Researchers 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 Viriginia School of Medicine and a former resident at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system.

Authorship: In addition to Kishore and Rome, co-authors include Margaret Hayden, Micah Johnson, and Aaron S. Kesselheim.

Disclosures: Kishore and Hayden reported consulting for the Equal Justice Initiative. Kishore, Hayden, and Johnson reported being unpaid cofounders of EqualCure. Kesselheim reported serving as an expert witness in cases against Gilead, Johnson & Johnson, generic manufacturers, and pharmacy benefits managers and serving as a consultant for Alosa Health. Rome reported receiving grants from Humana, Elevance Health Public Policy Institute, and PCMA Foundation and personal fees from Alosa Health.

Funding: Kesselheim and Rome were supported by a grant from Arnold Venture.

Paper cited: Kishore S et al. “National Prescribing Trends of Direct-Acting Antivirals for Hepatitis C” JAMA DOI: 10.1001/jama.2026.3328