Annual hepatitis C virus (HCV) treatment volume in the United States has dropped by nearly two-thirds since its peak in 2015, according to a national cross-sectional analysis of prescribing trends for direct-acting antivirals (DAAs). The decline raises concerns about the feasibility of achieving HCV elimination goals, as current treatment rates remain insufficient to outpace new infections.
Data from a study published in JAMA Network Open show that DAA prescriptions for HCV treatment peaked in 2015 and have since declined steadily. By 2025, annual treatment volume was well below the approximately 260,000 courses per year needed to meet the World Health Organization’s elimination targets. Instead, the number of people treated annually now closely matches the estimated number of new HCV infections each year, suggesting the U.S. Is merely maintaining status quo rather than reducing the overall disease burden.
“We’re roughly treating the same number of people each year as We find new infections,” said Sanjay Kishore, MD, assistant professor at the University of Virginia School of Medicine, in an interview with Healio. “We’re essentially just replacing those who are cured with new cases, making no net progress toward elimination.”
The findings underscore a growing gap between public health ambitions and real-world prescribing patterns. While DAAs revolutionized HCV treatment upon their introduction—offering cure rates exceeding 95% with minimal side effects—access and uptake have not kept pace with the scale of the epidemic, particularly among underserved populations.
Understanding the Decline in HCV Treatment
Several interconnected factors contribute to the downward trend in DAA prescribing. Initial enthusiasm following the 2013–2015 launch of sofosbuvir-based regimens led to a surge in prescriptions, driven by heightened awareness and aggressive marketing. However, as the pool of easily diagnosable and treatable patients diminished, structural barriers began to limit further expansion.
These barriers include inconsistent screening practices, gaps in linkage to care, insurance restrictions, and stigmatization of people who use drugs—a group disproportionately affected by HCV. Many individuals remain unaware of their infection status due to inadequate routine testing in primary care and community settings.
Public health experts emphasize that eliminating HCV requires more than effective medication; it demands coordinated efforts to increase testing, simplify treatment delivery, and address social determinants of health. Without such interventions, the U.S. Risks falling short of its 2030 elimination goal endorsed by the National Academies of Sciences, Engineering, and Medicine.
Implications for Public Health Policy
The stagnation in treatment volume has direct implications for disease prevalence and long-term healthcare costs. Untreated HCV can lead to cirrhosis, liver cancer, and the need for transplantation—conditions that impose significant burdens on individuals and the healthcare system. Mathematical models suggest that sustaining current treatment rates will result in preventable morbidity and mortality over the coming decades.
Policy responses have varied across states. Some jurisdictions have implemented Medicaid reforms to remove sobriety requirements and prior authorization hurdles, while others have launched mobile testing units and telehealth initiatives to reach rural and marginalized communities. However, fragmentation in healthcare delivery and inconsistent state-level policies hinder nationwide progress.
Federal agencies, including the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA), continue to support HCV elimination through funding for surveillance, prevention programs, and integration of HCV care into substance use treatment settings. Yet, advocates argue that more aggressive national strategies—such as universal adult hepatitis C screening and treatment-as-prevention models—are needed to reverse the current trend.
Global Context and Lessons Learned
The U.S. Experience contrasts with progress seen in certain high-income countries that have adopted nationwide elimination strategies. For example, Australia’s public health approach—which combines broad access to DAAs through its Pharmaceutical Benefits Scheme with targeted outreach to priority populations—has resulted in sustained declines in HCV prevalence and liver-related mortality.
Similarly, countries like Iceland and Switzerland have reported being on track to eliminate HCV as a public health threat by leveraging universal healthcare access, robust surveillance, and low-threshold treatment models. These examples highlight the importance of political will, equitable access, and integrated care systems in achieving elimination goals.
In low- and middle-income countries, challenges remain more pronounced due to limited healthcare infrastructure and higher drug costs, while generic versions of DAAs have improved affordability in recent years. International efforts led by the World Health Organization and UNAIDS continue to support national planning and capacity building in these regions.
The Path Forward
Experts agree that rekindling progress toward HCV elimination will require renewed focus on several key areas: expanding point-of-care testing, decentralizing treatment to primary care and harm reduction settings, enforcing parity in insurance coverage, and engaging communities most affected by the epidemic.
Innovative models such as hepatitis C microelimination initiatives—targeting specific settings like prisons, syringe service programs, and HIV clinics—have shown promise in demonstrating feasibility and building momentum. Scaling these approaches, coupled with real-time monitoring of treatment gaps, could help align U.S. Efforts with global elimination benchmarks.
As of April 2026, the CDC recommends that all adults aged 18 and older be screened for HCV at least once in their lifetime, with periodic testing for individuals with ongoing risk factors. Updated guidance and resources are available through the CDC’s Division of Viral Hepatitis website.
For individuals seeking testing or treatment, local health departments, community health centers, and organizations such as the Harm Reduction Coalition and the National Viral Hepatitis Roundtable offer directories and support services. Patients are encouraged to discuss screening options with their healthcare providers, particularly if they have a history of injection drug use, received a blood transfusion before 1992, or are living with HIV.
The next major milestone in national HCV tracking is the anticipated release of the CDC’s annual surveillance report for 2025, expected in mid-2026. This report will provide updated estimates of new infections, treatment uptake, and mortality trends, offering a critical benchmark for assessing progress toward elimination goals.
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