Untreated hepatitis C (HCV) can lead to liver cancer, cirrhosis and death. Lifesaving medications, known as direct-acting antivirals (DAAs), can cure HCV in more than 95% of cases. However, despite the fact that Medi-Cal, California’s Medicaid program, covers DAAs, fewer people in the states received the medications in recent years.
By eliminating the need for prior authorization, for example, Medi-Cal has helped reduce barriers to HCV treatment. Yet, the number of Medi-Cal patients receiving this medication annually fell by more than 40% between 2018 and 2019 and 2020 and 2021, according to data from the California Department of Health Care Services. In 2022, the number of people taking DAAs remained stable, at around 5,500, but seems to be increasing this year.
While it is unclear how many Medi-Cal patients are without treatment, it has been estimated that more than 300,000 people in California are living with hepatitis C. Additionally, more than 35,000 cases of chronic hepatitis C were reported in 2018.
“We’re just not treating enough people,” Christian Ramers, MD, MPH, an infectious disease specialist and chief of population health at Family Health Centers of San Diego, told the LA Times. “There has just not been a real, concerted effort to make hepatitis C treatment an easily accessible part of primary care.”
Ramers points to issues such as limited clinicians providing care and gaps in testing and linking people to treatment. Other experts say people put off seeking care and treatment due to COVID-19 lockdown restrictions and have not been contacted by health care providers since such restrictions were eased.
Anne Donnelly, cochair of the California Hepatitis Alliance, said people who use drugs or share needles can be challenging to reach due to limited resources. She added that hepatitis C is a slow-moving but deadly virus, and, therefore, people often do not treat it as an emergency, “in spite of how horrific it is and how much cost it has to the health care system and how many lives it ruins and how many people it kills.”
In an effort to boost the number of people getting treatment for HCV, a clinic at UCLA Health that’s part of a study, seeks to determine the effectiveness of a one-stop facility to connect people who inject drugs to health care, including HCV treatment.
A joint effort between the University of Southern California and the LA County Department of Public Health plans to deliver treatment directly to patients— via mail, Uber or in-person drop-off wherever they may be staying—within the coming year.