Hepatitis C Treatment Rates Reveal Care Disparities in Public, Private Coverage

Treatment initiation rates for hepatitis C indicate care disparities for individuals who are not White as well as those who are younger and male individuals, a report from the Centers for Disease Control and Prevention (CDC) found.

The researchers used data from an administrative claims database called HealthVerity from January 30, 2019 to October 31, 2020. Claims data was gleaned from individuals who had been enrolled in health insurance 60 days or more before their diagnoses with hepatitis C and who remained enrolled 360 days or longer after their diagnoses.

The results revealed disparities in hepatitis C treatment and low rates of timely direct-acting antiviral (DAA) treatment.

Beneficiaries who identified as Black or African American were less likely to pursue treatment than beneficiaries who identified as White. 

In Medicaid programs, individuals who identified their race as “other” or who did not identify their races were least likely to pursue treatment. When researchers performed an adjusted analysis, Black beneficiaries and those who identified as an “other” race had lower rates of treatment than White beneficiaries.

While private insurance health plans had higher rates of treatment initiation across racial categories, individuals who chose not to disclose their racial identities had the least likelihood of progressing to receive treatment. Less than a third of all employee enrollees who did not disclose their racial identities pursued treatment.

In Medicare, individuals who identified as Asian were more likely to initiate DAA treatment than White beneficiaries.

Medicaid and Medicare beneficiaries had lower rates of treatment initiation compared to private insurance health plan enrollees. Medicaid beneficiaries were less likely to pursue treatment in states that had Medicaid treatment restrictions.

In Medicaid, 23 percent of individuals diagnosed with hepatitis C pursued treatment while, in Medicare, 28 percent of those diagnosed with the virus received treatment. Of those who received treatment, 75 percent of Medicaid beneficiaries and 77 percent of Medicare beneficiaries started their treatment processes within half a year of being diagnosed. 

In contrast, more than a third of all private insurance health plan enrollees who were diagnosed with hepatitis C pursued DAA treatment (35 percent). Over eight in ten private insurance health plan members who tested positive for hepatitis C and received treatment started their treatments within six months of the positive test date (84 percent).

Younger adults had lower rates of treatment initiation. Additionally, male beneficiaries and members were less likely to start treatment than their female counterparts.

These results have crucial implications, not only for the health of the individuals diagnosed with hepatitis C but also for those that they may infect. Timely diagnosis and fast treatment can reduce the spread of hepatitis C, the report stated. But late diagnoses and delayed treatment can perpetuate the virus’s prevalence.

“Few insured persons with diagnosed hepatitis C receive timely DAA treatment, and disparities in treatment exist. Unrestricted access to timely DAA treatment is critical to reducing viral hepatitis-related mortality, disparities, and transmission,” the researchers concluded.

“Treatment saves lives, prevents transmission, and is cost saving.”

Payers have tried many approaches to reimbursing for hepatitis C treatment. Some states have attempted to implement subscription-based payment models to cover the treatment, but these have produced mixed results. Others introduced step therapy protocols, but more than half of all states' step therapy protocols have been deemed too strict.

Still, national hepatitis C screening rates remained low prior to the coronavirus pandemic in 2020.