{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T09:38:06Z","timestamp":1793957886594,"version":"4.8.0"},"reference-count":52,"publisher":"Duke University Press","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>State payers may face financial incentives to restrict use of high-cost medications. Yet, restrictions on access to high-value medications may have deleterious effects on population health. Direct-acting antivirals (DAAs), available since 2013, can cure chronic infection with hepatitis C virus (HCV). With prices upward of $90,000 for a treatment course, states have struggled to ensure access to DAAs for Medicaid beneficiaries and the incarcerated, populations with a disproportionate share of HCV. Advance purchase commitments (APCs), wherein a payer commits to purchase a certain quantity of medications at lower prices, offer payers incentives to increase access to high-value medications while also offering companies guaranteed revenue. This article discusses the use of subscription models, a type of APC, to support increased access to high-value DAAs for treating HCV. First, the authors provide background information about HCV, its treatment, and state financing of prescription medications. They then review the implementation of HCV subscription models in two states, Louisiana and Washington, and the early evidence of their impact. The article discusses challenges to evaluating state-sponsored subscription models, and it concludes by discussing implications of subscription models that target DAAs and other high-value, high-cost medicines.<\/jats:p>","DOI":"10.1215\/03616878-10041121","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T16:16:35Z","timestamp":1658506595000},"page":"691-708","source":"Crossref","is-referenced-by-count":15,"title":["Improving Access to High-Value, High-Cost Medicines: The Use of Subscription Models to Treat Hepatitis C Using Direct-Acting Antivirals in the United States"],"prefix":"10.1215","volume":"47","author":[{"given":"Samantha G.","family":"Auty","sequence":"first","affiliation":[{"name":"Boston University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin N.","family":"Griffith","sequence":"additional","affiliation":[{"name":"Vanderbilt University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Shafer","sequence":"additional","affiliation":[{"name":"Boston University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah E.","family":"Gee","sequence":"additional","affiliation":[{"name":"Louisiana State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena M.","family":"Conti","sequence":"additional","affiliation":[{"name":"Boston University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"73","published-online":{"date-parts":[[2022,7,14]]},"reference":[{"key":"2022122223040392600_jhppl10041121C1","unstructured":"AASLD\u2013IDSA (American Association for the Study of Liver Diseases and the Infectious Diseases Society of America). 2021. \u201cHCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C.\u201d September21. https:\/\/www.hcvguidelines.org\/sites\/default\/files\/full-guidance-pdf\/AASLD-IDSA_HCVGuidance_September_29_2021.pdf."},{"issue":"4","key":"2022122223040392600_jhppl10041121C2","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1111\/1468-0009.12521","article-title":"Beyond Causality: Additional Benefits of Randomized Controlled Trials for Improving Health Care Delivery.\u201d","volume":"99","author":"Alsan","year":"2021","journal-title":"Milbank Quarterly"},{"issue":"1","key":"2022122223040392600_jhppl10041121C3","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1146\/annurev-publhealth-031816-044208","article-title":"Evaluating the Health Impact of Large-Scale Public Policy Changes: Classical and Novel Approaches.\u201d","volume":"38","author":"Basu","year":"2017","journal-title":"Annual Review of Public Health"},{"issue":"1","key":"2022122223040392600_jhppl10041121C4","doi-asserted-by":"crossref","first-page":"34S","DOI":"10.1177\/0033354919841593","article-title":"Principles to Guide National Data Collection on the Health of Persons in the Criminal Justice System","volume":"134","author":"Binswanger","year":"2019","journal-title":"Public Health Reports"},{"issue":"9","key":"2022122223040392600_jhppl10041121C5","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1093\/cid\/ciz008","article-title":"The Effects of Hepatitis C Treatment Eligibility Criteria on All-Cause Mortality among People with Human Immunodeficiency Virus","volume":"69","author":"Breskin","year":"2019","journal-title":"Clinical Infectious Diseases"},{"key":"2022122223040392600_jhppl10041121C6","unstructured":"Bruen\n              Brian\n            \n          , BrantleyErin, ThompsonVictoria, SteinmetzErika, and HelmchenLorens. 2017. \u201cHigh-Cost Hepatitis C Drugs in Medicaid: Final Report.\u201d Medicaid and CHIP Payment and Access Commission, January. https:\/\/www.macpac.gov\/wp-content\/uploads\/2017\/03\/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf."},{"issue":"5","key":"2022122223040392600_jhppl10041121C7","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1093\/cid\/ciy697","article-title":"Trends in Treatment Uptake and Provider Specialty for Hepatitis C Virus (HCV) Infection in the Veterans Affairs Healthcare System: Results from the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES)","volume":"68","author":"Butt","year":"2019","journal-title":"Clinical Infectious Diseases"},{"issue":"3","key":"2022122223040392600_jhppl10041121C8","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/jcph.830","article-title":"Reinventing HCV Treatment: Past and Future Perspectives","volume":"57","author":"Carter","year":"2017","journal-title":"Journal of Clinical Pharmacology"},{"issue":"6","key":"2022122223040392600_jhppl10041121C9","doi-asserted-by":"crossref","first-page":"397","DOI":"10.7326\/M14-1336","article-title":"Cost-Effectiveness and Budget Impact of Hepatitis C Virus Treatment with Sofosbuvir and Ledipasvir in the United States","volume":"162","author":"Chhatwal","year":"2015","journal-title":"Annals of Internal Medicine"},{"key":"2022122223040392600_jhppl10041121C10","unstructured":"CHLPI (Center for Health Law and Policy Innovation). 2017. \u201cHepatitis C: The State of Medicaid Access.\u201d October23. https:\/\/stateofhepc.org\/report\/."},{"issue":"3","key":"2022122223040392600_jhppl10041121C11","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1377\/hlthaff.2019.01432","article-title":"How The ACA Reframed the Prescription Drug Market and Set the Stage for Current Reform Efforts: A Look Back at the ACA's Successes and Missed Opportunities at Improving Prescription Drug Affordability","volume":"39","author":"Conti","year":"2020","journal-title":"Health Affairs"},{"issue":"10","key":"2022122223040392600_jhppl10041121C12","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1097\/MLR.0b013e31805371bf","article-title":"Studying Prescription Drug Use and Outcomes with Medicaid Claims Data: Strengths, Limitations, and Strategies","volume":"45","author":"Crystal","year":"2007","journal-title":"Medical Care"},{"key":"2022122223040392600_jhppl10041121C13","unstructured":"DHHS (US Department of Health and Human Services). 2018. \u201cOverdose Prevention Strategy.\u201d https:\/\/www.hhs.gov\/opioids\/sites\/default\/files\/2018-09\/opioid-fivepoint-strategy-20180917-508compliant.pdf (accessed June14, 2022)."},{"key":"2022122223040392600_jhppl10041121C14","unstructured":"DHHS (US Department of Health and Human Services). 2020. \u201cEliminating Hepatitis C in Louisiana: An Innovative Payment and Outreach Model Case Study.\u201d May. 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(Institute for Clinical and Economic Review). 2015. \u201cThe Comparative Clinical Effectiveness and Value of Novel Combination Therapies for the Treatment of Patients with Genotype 1 Chronic Hepatitis C Infection: A Technology Assessment.\u201d January30. https:\/\/icer.org\/wp-content\/uploads\/2020\/10\/CTAF_HCV2_Final_Report_013015.pdf."},{"key":"2022122223040392600_jhppl10041121C20","unstructured":"Kaiser Family Foundation. 2020. \u201cStatus of State Action on the Medicaid Expansion Decision: Interactive Map.\u201d https:\/\/www.kff.org\/medicaid\/issue-brief\/status-of-state-medicaid-expansion-decisions-interactive-map\/ (accessed June15, 2022)."},{"issue":"10","key":"2022122223040392600_jhppl10041121C21","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1093\/cid\/cix1062","article-title":"State Medicaid Hepatitis C Treatment Eligibility Criteria and Use of Direct-Acting Antivirals","volume":"66","author":"Kapadia","year":"2018","journal-title":"Clinical Infectious 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https:\/\/www.propublica.org\/article\/cost-of-a-cure-medicare-spent-4.5-billion-on-hepatitis-c-drugs-last-year#:\u223c:text=The%20drugs%20cure%20the%20disease%2C%20but%20taxpayers%20are%20footing%20the%20bill.&text=Medicare%20spent%20%244.5%20billion%20last,previously%20undisclosed%20federal%20data%20shows."},{"issue":"2","key":"2022122223040392600_jhppl10041121C34","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s11904-018-0390-3","article-title":"The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions","volume":"15","author":"Perlman","year":"2018","journal-title":"Current HIV\/AIDS Reports"},{"issue":"8","key":"2022122223040392600_jhppl10041121C35","doi-asserted-by":"crossref","first-page":"e186371","DOI":"10.1001\/jamanetworkopen.2018.6371","article-title":"Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016","volume":"1","author":"Rosenberg","year":"2018","journal-title":"JAMA 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