Hepatitis C can be cured in more than 95 percent of treated patients with an eight-to-twelve-week course of pills. National prescribing of those pills peaked in 2015 and has declined sharply since, according to an analysis of a large national prescription database covering 2013 through 2025.
The gap this produces is measurable. Only about one in three people with hepatitis C in the United States receives treatment within a year of diagnosis.
That is not a technology problem. The medicines work, are taken orally, have minimal side effects, and their prices have fallen dramatically from the roughly $84,000 that early treatment courses commanded.
The Shape of the Decline
Researchers from Mass General Brigham and the University of Virginia School of Medicine examined prescribing trends for direct-acting antivirals by patient and prescriber characteristics. Their findings were published in JAMA earlier this year.
Early treatment was concentrated among older adults and people with Medicare or commercial insurance, reflecting who could obtain coverage authorization when the drugs were new and expensive. Over time, treatment shifted toward younger patients and Medicaid beneficiaries, tracking the epidemiology of newer infections.
The prescriber pattern moved too. Specialist prescribing peaked in 2015 and then declined through 2025, meaning the physicians who once drove the treatment wave largely stopped writing these prescriptions without primary care fully absorbing the work.
Senior author Benjamin Rome noted in the study announcement that low treatment levels may help explain why hepatitis C prevalence has not fallen and may have even increased in recent years, adding that "elimination will require system-level changes, not just better screening." Lead author Sanjay Kishore said that current treatment levels are substantially below those required by national elimination targets.
The Reasons a Curable Infection Stays Untreated
Hepatitis C progresses silently over years, causing liver scarring, cirrhosis, and eventually liver cancer. People feel fine for most of that time, which removes the urgency that drives treatment for symptomatic illness.
The delivery obstacles are structural rather than clinical. Diagnosis and treatment often happen in different places and at different visits, requiring people to return. Prior authorization requirements, sobriety restrictions in some payer policies, and specialist referral bottlenecks each remove people between the positive test and the first pill.
Hepatitis C in the United States is concentrated among people who inject drugs, people who are incarcerated or recently released, and people with unstable housing, all groups for whom a multi-visit treatment pathway is hard to complete.
Disclosure context belongs here. The work was supported by a grant from Arnold Ventures. Two authors reported consulting for the Equal Justice Initiative; three reported being unpaid co-founders of EqualCure, a group that facilitates hepatitis C treatment; one reported serving as an expert witness in cases against drug manufacturers and pharmacy benefit managers; and the senior author reported grants from Humana and other organizations.
The Federal Effort and Its Funding
Congressional action remains pending. Senators Bill Cassidy and Chris Van Hollen introduced the Cure Hepatitis C Act in June 2025, which would direct the federal government to enter a five-year purchasing contract with manufacturers so that eligible people could receive the drugs without cost-sharing, including those on Medicaid, in correctional facilities, uninsured, or served by the Indian Health Service.
Representatives Mariannette Miller-Meeks, Diana DeGette, Hank Johnson, and Don Bacon introduced a House companion in July of this year. Neither has passed, and the Senate bill has not received a hearing. Sponsors project $6.6 billion in federal savings.
MedicalDaily previously reported on how federal public health funding reductions have affected elimination programs. The prescribing analysis adds a distinct point: the decline in treatment began years before those reductions rather than resulting from them.
Steps for Anyone Who Has Been Diagnosed
The CDC recommends hepatitis C screening at least once for all adults 18 and older, and during each pregnancy. A single test is enough for most people, and many have never had it.
Anyone who has tested positive and never started treatment can ask a primary care clinician directly about direct-acting antivirals. A specialist referral is often unnecessary for uncomplicated cases, and many primary care practices now treat hepatitis C.
People facing coverage obstacles have several routes. State Medicaid programs have removed many prior authorization and sobriety restrictions in recent years, manufacturer patient assistance programs exist, and federally qualified health centers frequently offer treatment on a sliding scale.
Anyone who completed treatment should confirm a cure with a follow-up test roughly twelve weeks after finishing, since that test documents that the virus is gone.
Reinfection is possible after cure for people with ongoing exposure risk, so repeat testing is appropriate rather than assuming one cure is permanent.
Key Questions Answered
How effective is hepatitis C treatment? Direct-acting antivirals cure more than 95 percent of treated patients with an eight-to-twelve-week oral course and minimal side effects.
What did the analysis find? National prescribing rose rapidly after these drugs became available, peaked in 2015, then declined sharply through 2025, with specialist prescribing falling over the same period.
How many diagnosed people get treated? Only about one in three people with hepatitis C in the United States receive treatment within a year of diagnosis.
Why do people go untreated? The infection remains silent for years, and structural obstacles, including multi-visit pathways, prior authorization, and referral bottlenecks, keep people from moving from diagnosis to treatment.
Who should be tested? The CDC recommends screening at least once for all adults 18 and older, and during each pregnancy. Many people have never been tested.
Is treatment affordable? Prices have fallen substantially from early levels. Medicaid programs have removed many restrictions, manufacturer assistance programs exist, and community health centers often treat on a sliding scale.
What happens after treatment? A follow-up test about twelve weeks after finishing confirms the cure. Reinfection remains possible for people with ongoing exposure, so repeat testing is appropriate.
