For individuals with hepatitis C virus (HCV) enrolled in Medicaid, the implementation of a subscription-based payment model (SBPM) was associated with a significant increase in prescription fills of Medicaid-covered HCV medications among those residing in Louisiana, but not among those in Washington, according to study results published in JAMA Health Forum.  

In a cross-sectional study, researchers sought to assess the impact of SBPMs on prescription fills for HCV medications among individuals with HCV in Louisiana and Washington who were enrolled in Medicaid between January 2017 and June 2020. A synthetic control approach was used to compare changes in prescriptions fills for HCV medications between US states that did and did not implement SBPMs. To determine the number of prescription fills in all 50 US states and the District of Columbia, the researchers analyzed Medicaid State Drug Utilization Data files from the Centers for Medicare and Medicaid Services. The primary outcome was the rate of HCV prescription fills per 100,000 individuals enrolled in Medicaid per state-quarter.  

Prior to SBPM implementation, the mean rate of quarterly HCV prescription fills per 100,000 individuals enrolled in Medicaid was 43.1 (standard deviation [SD], 8.6) and 50.1 (SD, 4.1) in Louisiana and Washington, respectively. . After SBPM implementation, the rate of quarterly HCV prescription fills among individuals enrolled in Medicaid significantly increased among those in Louisiana (206 per 100,000; SD, 51.2) compared with those in Washington (53.9 per 100,000; SD, 11.0). Results of synthetic control models showed that the rate of quarterly prescription fills significantly increased among individuals enrolled in Medicaid in Louisiana (173.5 per 100,000; 95% CI, 74.3-265.3), with a relative increase of 534.5% (95% CI, 228.7%-1125.0%); HCV prescription fills among individuals enrolled in Medicaid in Washington did not significantly increase nor  after SBPM implementation.

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The study was limited by its observational design, and the lack of access to individual data on the prevalence of individuals with HCV enrolled in Medicaid. In addition, the study results were not generalizable to rural US states due to the inability to access records of States with fewer than 11 HPC prescription fills per quarter.

The researchers concluded, “SBPMs may enable states to facilitate access to effective but costly [HCV] medications, which may both improve the health of [individuals with HCV] and potentially [decrease] downstream spending on complications from untreated HCV.”


Auty AG, Shafer PR, Griffith K N. Medicaid subscription-based payment models and implications for access to hepatitis C medications. JAMA. Published online August 27, 2021. doi:10.1001/jamahealthforum.2021.2291