• William V Padula, Jonathan S Levin, Joy Lee, and Gerard F Anderson.
• Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way (VPD), Los Angeles, CA 90089. Email: padula@healthpolicy.usc.edu.
• Am J Manag Care. 2021 May 1; 27 (5): e171-e177.

ObjectivesMost Medicaid beneficiaries with hepatitis C virus (HCV) are not treated with direct-acting agents because of budget constraints, but they experience costly complications after becoming Medicare eligible. Maryland's "total coverage" proposal could receive a credit from Medicare to offset Medicaid investments in treatments that could lead to Medicare savings. This study analyzes the cost-effectiveness and budget impact of total coverage for HCV treatments sponsored by state Medicare and Medicaid.Study DesignA Markov model simulated patients going through the care continuum of HCV. The model simulated 3 pathways: standard coverage with a 50% probability of screening for HCV and 20% probability of treatment; risk-stratified total coverage with assumed 80% probability of screening and 60% treatment rate; and total coverage with assumed 80% probability of screening and 100% treatment rate.MethodsThe model calculated US$ and quality-adjusted life-years (QALYs) to produce an incremental cost-effectiveness ratio evaluated at a willingness-to-pay threshold of $100,000/QALY. The budget impact for the state of Maryland was calculated in terms of per member per year.ResultsTotal coverage and risk-stratified coverage saved $158 per patient and $178 per patient, respectively, compared with standard care at an increased effectiveness of 0.05 and 0.02 QALYs over 25 years. Total coverage and risk-stratified total coverage would save $1.0 billion and $1.1 billion, respectively, after 25 years.ConclusionsMedicare-Medicaid partnerships to pay for all HCV treatments today represent good value and a low budget impact. States with trouble covering HCV treatments should consider using this model to plan coverage decisions.

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