• Olivia K Sugarman, Brendan Saloner, Samantha J Harris, Risha Irvin, Vivian Flanagan, and Sachini Bandara.
• Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. osugarm1@jh.edu.
• J Gen Intern Med. 2025 Jan 21.

BackgroundHepatitis 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.ObjectiveTo examine receipt of direct-acting antivirals (DAAs) for patients living with HCV-OUD and received any vs. no medications for opioid use disorder (MOUD).DesignWe conducted a cross-sectional study using a proprietary dataset from HealthVerity of health claims between 1/1/2020 and 12/31/2021.PatientsKentucky Medicaid beneficiaries aged ≥ 18 with concurrent chronic HCV-OUD diagnoses.Main MeasuresMultivariable 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 ResultsOf 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.ConclusionsGaps 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.© 2025. The Author(s), under exclusive licence to Society of General Internal Medicine.

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