Hepatitis C Treatment in Kentucky Medicaid Recipients with Concurrent Opioid Use Disorder: A Cross-Sectional Study

Background: Hepatitis C virus (HCV) infections and injection drug use have concurrently increased in the last decade. Evidence supports simultaneously treating chronic HCV and opioid use disorder (OUD) with medication. Kentucky is a hard-hit state for both conditions that has undertaken policy and practice efforts to increase access to both types of medications. Objective: To examine receipt of direct-acting antivirals (DAAs) for patients living with HCV-OUD and received any vs. no medications for opioid use disorder (MOUD). Design: We conducted a cross-sectional study using a proprietary dataset from HealthVerity of health claims between 1/1/2020 and 12/31/2021. Patients: Kentucky Medicaid beneficiaries aged ≥ 18 with concurrent chronic HCV-OUD diagnoses. Main Measures: Multivariable logistic regression models were used to calculate adjusted proportions of HCV DAA receipt based on receipt of MOUD, adjusting for patient characteristics and region. Key Results: Of 2149 patients, 36% (n = 780) received HCV DAAs; 84% (n = 1804) received any MOUD during the study period. Buprenorphine was the most common MOUD type used (n = 1414, 66%). Adjusting for covariates, HCV DAA receipt was lower among people who received any vs. no MOUD (33% vs. 46%, p < 0.0001). Methadone (vs. no MOUD, 29% vs. 46%, p = 0.0002) had the greatest difference in odds of HCV DAA receipt. Conclusions: Gaps in HCV treatment among Kentucky Medicaid recipients with OUD were pervasive. Despite evidence supporting HCV-OUD co-treatment, patients receiving MOUD were significantly less likely to receive curative HCV treatment.