Spending to Save: The Subscription Model for Eradicating Hepatitis C in Louisiana

How should payers balance fiscal sustainability with access to transformative medical technology? We study Louisiana’s 2019 Medicaid subscription model for hepatitis C (HCV), the first example of a U.S. state employing a two-part tariff to secure unlimited access to curative medicines. Using a differences-in-differences design comparing spending on beneficiaries with HCV to those with diabetes or HIV, we find that treatment volume tripled, medical spending fell, and new HCV diagnoses declined 23 percent. The state’s $37 million in incremental spending on antivirals generated $266 million in five-year savings. Innovative financing models can generate health benefits and near-term savings for payers.