Recent research published in JAMA highlights an important shift in how hepatitis C is being treated across the United States. Over the past decade, direct acting antivirals have revolutionized care, yet new findings suggest that progress toward eliminating the disease is slowing. This blog breaks down the latest trends, explains what they mean for patients and providers, and explores what needs to happen next.
Since their introduction in 2013, direct acting antivirals, often called DAAs, have dramatically improved hepatitis C treatment outcomes. These medications are highly effective, curing more than 95 percent of patients while being far easier to tolerate than older therapies.
This breakthrough led to a rapid increase in treatment uptake during the early years. By 2015, prescriptions reached their highest level, reflecting strong demand and growing awareness among healthcare providers.
However, despite these advances, hepatitis C remains a major public health concern. Millions of people in the United States are still living with chronic infection, and new cases have continued to rise over the past decade.
The research analyzed prescription data from 2013 through 2025 to better understand how DAA use has evolved. Several important trends emerged.
The number of DAA treatment courses climbed quickly after their introduction, peaking in 2015. After that, prescriptions steadily declined, reaching significantly lower levels by 2025.
This drop is concerning because treatment rates are now far below what is needed to eliminate hepatitis C nationwide. Experts estimate that around 260,000 treatments per year are required to meet elimination goals, yet recent numbers are closer to 70,000 annually.
In the early years, most prescriptions were covered by Medicare and private insurance. Over time, Medicaid became the dominant payer.
This change reflects policy adjustments. Initially, many Medicaid programs restricted access to patients with severe liver disease. As these restrictions eased, more patients gained access through public insurance programs.
Specialists such as gastroenterologists and infectious disease physicians once prescribed the majority of DAAs. Over time, primary care providers have taken on a larger role.
This shift suggests that hepatitis C treatment is becoming more integrated into general healthcare settings, which could improve access, especially in underserved areas.
Earlier in the decade, most treated patients were older adults. By 2025, a growing share of prescriptions went to individuals under 40.
This trend likely reflects rising infection rates among younger populations, particularly linked to injection drug use. It also indicates improved awareness and screening in these groups.
Initially, treatment rates were higher in metropolitan areas. Since 2018, nonmetropolitan or rural counties have seen higher treatment rates.
This change may be due to expanded outreach efforts, telehealth services, and broader prescribing by primary care clinicians.
Despite better medications and broader access, fewer people are being treated each year. Several factors may explain this trend.
Screening efforts have improved, but many patients do not start treatment after being diagnosed. In some studies, fewer than 20 percent of diagnosed individuals received therapy.
Barriers include lack of access to care, stigma, and challenges navigating the healthcare system.
The pandemic disrupted routine healthcare services, including hepatitis C treatment. Reduced clinic visits and delayed care likely contributed to the decline in prescriptions after 2020.
Even with expanded coverage, issues such as prior authorization requirements, provider availability, and cost concerns can delay or prevent treatment.
The findings raise concerns about the United States' ability to eliminate hepatitis C as a public health threat.
Although current treatment levels roughly match the number of new infections each year, they are not sufficient to reduce overall prevalence. In fact, some data suggest that total cases may be increasing again.
Without a significant boost in treatment rates, national elimination goals may remain out of reach.
To reverse these trends and accelerate progress, several strategies are being discussed.
Screening alone is not enough. Systems must ensure that patients who test positive are quickly connected to treatment. This could include same day diagnosis and therapy initiation.
Reducing administrative barriers and simplifying prescribing processes can help more patients start therapy. Expanding the role of primary care providers is also key.
Telemedicine and mobile outreach programs can reach populations that have limited access to traditional healthcare settings, including rural communities and people who inject drugs.
Proposals such as subscription based payment systems aim to make hepatitis C treatment more affordable and scalable. One example is the Cure Hepatitis C Act of 2025, which seeks to expand access through innovative financing.
The introduction of direct acting antivirals marked a turning point in hepatitis C care. However, the latest data show that initial momentum has slowed.
To achieve elimination, the healthcare system must move beyond innovation in medication and focus on improving delivery. That means making treatment easier to access, reducing barriers, and ensuring that every diagnosed patient has a clear path to cure.
With coordinated efforts across public health, clinical care, and policy, it is still possible to eliminate hepatitis C. But the window to act effectively may be narrowing.
Kishore S, Hayden M, Johnson M, et al. National Prescribing Trends of Direct Acting Antivirals for Hepatitis C. JAMA. Published online March 25, 2026. doi:10.1001/jama.2026.3328
This blog is intended for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for guidance regarding any medical condition or treatment decisions.
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