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

Kevin Callison; Rena M. Conti; Jonathan Gruber; Jacob Wallace

doi:10.3386/w35583

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

Kevin Callison, Rena M. Conti, Jonathan Gruber & Jacob Wallace

Working Paper 35583

DOI 10.3386/w35583

Issue Date August 2026

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.

The authors would like to thank Grant Kovel for providing excellent research assistance and seminar participants at the BU-Harvard-MIT Health Economics seminar, the Highland Health Economics Symposium, the Murphy Institute Health Policy Working Group seminar, Fiona Scott Morton, David Bradford, Liran Einav, Luca Maini, Mark Shepard, Anirban Basu, Bob Rebitzer and Jim Rebitzer, and Rebekah Gee for helpful comments. The authors thank Murray Aitken and the Iqvia Institute for Human Data Science for access to National Sales Perspective (NSP) and Longitudinal Prescription Claims (LRx) data. This content is the sole responsibility of the authors and does not represent the official views of the Louisiana Department of Health, the Iqvia Institute for Human Data Science, or the National Bureau of Economic Research.

Jacob Wallace
Jacob Wallace receives financial support from the Yale School of Public Health (salary) and he or his team receive grant funding from Arnold Ventures, the National Heart, Lung, and Blood Institute, the National Institute of Drug Abuse, the Commonwealth Fund, the Robert Wood Johnson Foundation, and the Connecticut Project. He received consulting fees from KPMG to serve on an academic advisor group for California Medicaid and is an unpaid member of the New York State Department of Health’s Evidence-Based Benefit Review and Advisory Committee.
Copy Citation

Kevin Callison, Rena M. Conti, Jonathan Gruber, and Jacob Wallace, "Spending to Save: The Subscription Model for Eradicating Hepatitis C in Louisiana," NBER Working Paper 35583 (2026), https://doi.org/10.3386/w35583.

Download Citation

MARC RIS BibTeΧ

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

Related

Topics

Programs

More from the NBER