Analysis of Claims Data Reveals Clinical and Social Factors Associated With Hepatitis C Direct-Acting Antiviral Prescriptions in Maine

Introduction: There are now several curative options for chronic viral hepatitis C (HCV). We sought to investigate factors associated with prescriptions for direct-acting antiviral therapy in the hopes of informing improved HCV treatment access. Methods: We conducted a cross-sectional analysis of all-payer claims data for the state of Maine to identify patients with chronic HCV diagnosis codes. Prescription claims were analyzed to determine which patients were prescribed a direct-acting antiviral for HCV treatment. Univariate analysis identified factors associated with prescription status, which were incorporated into a multivariable logistic regression model to Identify factors associated with direct-acting antiviral (DAA) prescribing. Results: Insurance status was significantly associated with DAA prescribing status, with Maine Medicaid recipients more likely to be prescribed, while those on Medicare or dually eligible less likely. Male sex was was associated with a DAA prescription, while patients with a diagnosis of HIV coinfection were less likely to have a prescription. Discussion: In light of studies conducted in other states and over different time frames, we see that DAA prescribing rates are subject to changes in reimbursement rates over time, and that access to DAAs is likely state dependent, reflecting a patchwork of availability across the United States. DAA prescribing rates in the setting of different comorbidities may reflect a preference to prescribe DAAs in those with more advanced liver disease. Conclusions: Our study suggests that there are likely many avenues for increasing access to DAAs from the health systems level to the level of the individual prescriber.