The Cure Hepatitis C Act of 2026 Bets on a National Drug Contract. The Design Could Narrow Access.

On July 14, 2026, Representatives Mariannette Miller-Meeks (R-IA), Diana DeGette (D-CO), Hank Johnson (D-GA), and Don Bacon (R-NE) introduced the Cure Hepatitis C Act of 2026, the House companion to the Senate bill carried by Senators Bill Cassidy (R-LA) and Chris Van Hollen (D-MD). The medicines that cure hepatitis C reached the market more than a decade ago and clear the virus in roughly 95 percent of the people who take them. Ten years on, only one-third of people diagnosed start treatment within a year. The cure exists. The system that should carry it to people does not. This bill sets out to build that system. The design choice at its center, how the federal government buys the cure, will decide whether it widens access or narrows it.

What the Bill Puts on the Table

The legislation commits serious money. It appropriates $5.5 billion to purchase antiviral treatments and $4.283 billion for the elimination program and public health grants, with $25 million directed to the Bureau of Prisons and up to $20 million for point-of-care test development. The purchased treatments would reach people enrolled in participating state Medicaid programs, people who are uninsured, people held in participating correctional systems, and people who receive care through the Indian Health Service, all without cost-sharing. The House referred the measure to the Energy and Commerce Committee, and more than 100 organizations back it, among them the American Liver Foundation and the American Pharmacists Association. Sponsors project $6.6 billion in federal savings over ten years from the liver disease, cancer, and transplants that treatment prevents, a figure the Congressional Budget Office (CBO) has not yet scored. As Representative DeGette put it, "We have the tools to stop this epidemic and curb the human and financial costs of this disease going untreated."

The Scale of the Problem

The case for federal action rests on numbers that have moved slowly. Between 2.5 and 4 million people live with chronic hepatitis C, and about half are unaware they carry it. The Centers for Disease Control and Prevention (CDC) recorded 11,194 hepatitis C-related deaths in 2023, with the age-adjusted death rate down 13 percent from 2022 and new acute cases holding steady since 2021. The trend shows the medicines work when people reach them. It also shows a plateau that voluntary, piecemeal effort will not clear. Access stays uneven by design: people covered by Medicaid are 46 percent less likely to receive treatment than people with private insurance, and Native American and Alaska Native communities carry the highest rates of any group. All of this despite access initiatives gaining ground and eliminating utilization management and prior authorization barriers states have previously implemented.

What Louisiana and Washington Proved

The bill's centerpiece is a subscription model; two states have already successfully run one. Under the House design, the Department of Health and Human Services would use competitive bids to select one manufacturer to supply the entire covered population, or split the award 70/30 between the two best bids, on a five-year contract, and the drugs would reach patients without cost-sharing. 

Louisiana signed a competitive, exclusive deal with Asegua Therapeutics, a subsidiary of Gilead Sciences, in 2019 for unrestricted access to a generic cure at a fixed annual price, and it built the most comprehensive state program in the country. In 2018, before the agreement, fewer than 3 percent of the state's Medicaid and incarcerated residents with hepatitis C could reach direct-acting antivirals, even as Louisiana spent more than $30 million. Prescriptions then rose 260 percent in 2019 and 560 percent in 2020 over the prior baseline, and by its fourth year the program had treated more than 30,000 people. The economists who studied it concluded the model "more than pays for itself." A competitive contract drove lower prices and more treatment at once.

What slowed was the last stretch. Louisiana ran into diminishing returns as it worked through the people easiest to reach and struggled to engage the ones who are not. The state did not finish the job, and the reason matters for the federal design: the work gets harder and the cost per patient climbs as a program nears the end. The people left are the ones existing barriers already made hard to reach, and reaching them takes screening, provider capacity, and engagement the drug deal alone did not fund.

Washington ran its own competitive deal in 2019, selecting AbbVie from three bidders for a five-year term at what the state called near "a penny a pill." The price fell. The build-out lagged: planned emergency-room screening, mobile testing units, and expanded clinic hours stalled under budget shortfalls and the pandemic. Between them, the two states mapped the terrain. A competitive contract can control the cost of the cure and open the door to treatment. Finishing the work takes a delivery system funded for the long, expensive endgame.

Competition or Coercion

The federal bill departs from the state model in the way that matters most to patients. Louisiana and Washington each ran a competitive process and signed a contract inside their own borders. The House bill would run a single national procurement and bind the entire covered population to the winner's product for five years. The competition happens once, at the bid. After that, the manufacturers that did not win are shut out of the covered population for the length of the deal. That works more like administered pricing than an open market.

The design carries three potential harms for development and patient access. It can freeze out newer therapies. In June 2025, while advocates debated this approach, the Food and Drug Administration approved AbbVie's Mavyret as the first treatment for acute hepatitis C, the first expansion of the curative toolkit in years. A national contract locked before that approval would have left the covered population without it. The design also narrows choice. Hepatitis C treatments are not interchangeable for every patient, and a single-product award removes the room a patient and a provider need to match a regimen to a person. And it concentrates supply. Routing the full national demand through one manufacturer, or two, tests whether any single maker can meet it.

A competitive procurement built on the state experience would keep price discipline without these concerns. Contracting closer to Louisiana and Washington, including state-level awards granted through waivers, would spread access more evenly across states and leave room for new therapies and patient choice as the market moves. The aim is a cure delivered to the people who need it, in coordination with the providers who treat them. An open, competitive, state-by-state process protects that better than a national contract that locks the market for five years.

Building What the States Could Not

On delivery, the 2026 bill improves on its predecessors. It directs about $4.3 billion to the work the state deals underfunded: outreach, provider training, point-of-care testing, wrap-around services, and grants to community health centers, opioid treatment programs, tribal health programs, correctional systems, and a Ryan White clinic pilot of up to 25 sites. This is the money that reaches the harder patients, the screening and navigation that find the undiagnosed and hold people through a course of treatment.

The gaps that money has to close are national and documented. Only 23 percent of primary care providers prescribe these treatments compared with 94 percent of specialists, and a single prior authorization consumes about 35 minutes of staff time. Grants can pay for training and outreach, but they cannot by themselves place providers in the counties that lack them or make public health wages competitive. That is the part of the work the states never finished, and the part the federal program will live or die on.

The bill’s goals would be well-supported by leveraging the Affordable Care Act’s Essential Health Benefits standards and incentivizing providers, by way of reimbursement policies, to better screen and treat, with appropriate viral clearance follow up.

Two structural weak points carry into the federal bill. The Bureau of Prisons and the Indian Health Service must participate, but states and local correctional systems choose whether to opt in, and the states with the heaviest burden and the most restrictive histories are the least likely to join. Dropping blanket restrictions has not ended the friction, either. Every state Medicaid program has removed fibrosis and sobriety prerequisites, yet some are rebuilding barriers through step therapy and non-preferred drug status, as Maryland and New Hampshire did in 2025.

The 340B Question

The bill carries a provision CANN's readers will study closely. Section 4 prohibits providers and pharmacies from using 340B, or any other federal discount, on hepatitis C treatments bought through the subscription program. As an anti-duplication rule the logic holds. The federal government pays for the course, and a second discount on the same unit would be a duplicate the program is right to block. The harder questions sit on either side of that rule.

340B has grown far past its origin as a targeted discount for safety-net providers. On July 15, 2026, the day after the House bill was introduced, the Health Resources and Services Administration reported that 340B purchases reached at least $100 billion in 2025, up 23 percent from $81.4 billion in 2024. Disproportionate share hospitals accounted for $79.2 billion of that total, while the federal grantees at the center of hepatitis C care drew a fraction of it: $5.9 billion for health center programs and $3.1 billion for Ryan White HIV programs. The program's growth has run through hospital consolidation and contract pharmacy arrangements, which CBO counted rising from about 2,000 in 2010 to nearly 130,000 in 2021. Manufacturers that placed claims-data conditions on hepatitis C drugs were answering duplicate discounts and diversion inside that growth, not inventing a grievance.

Two Chambers, Two Texts

The House and Senate versions already diverge in ways that matter for patients. The Senate bill limits treatment funds to citizens and a defined set of lawfully present immigrant categories. The House text carries no such restriction. House Democrats called the Senate language a nonstarter, noting that hepatitis C spreads regardless of immigration status, which makes exclusion a public health problem as much as an equity one. Infectious diseases disregard for citizenship status and priority on proximity and residency is one that has been well-reflected in previous public health policy. The chambers also differ on Medicare. The Senate ends cost-sharing for these treatments beginning in plan year 2027; the House starts a year later, in 2028. Both provisions expire in 2032.

A Cliff in 2032

The sponsors intend to attach the bill to a year-end spending package, and the Senate version has not yet received a hearing or a committee vote. The timing is unusual. DeGette and Cassidy are both leaving Congress after primary losses, and Miller-Meeks holds a seat rated a toss-up, which concentrates the push into this session. The alternative on offer shows the ceiling of half-measures: in July 2025 the Substance Abuse and Mental Health Services Administration (SAMHSA) opened a $100 million pilot, roughly one percent of the nearly $10 billion this bill commits and discretionary rather than mandatory.

The bill pairs durable goals with temporary machinery. The drug appropriation and delivery grants expire in 2033. Medicare cost-sharing relief expires in 2032. State participation is optional. Louisiana showed the trap: reaching the last and hardest patients costs more per person, not less, which makes a funding cliff in 2033 a mismatch for the arithmetic of elimination. Read together, these choices set a cliff in 2032 and 2033, a point where the money stops, the grantee margin is gone, and a workforce built on grant dollars has nothing beneath it, at the very moment the work turns most expensive. For the populations the program will have gathered into its care, the sickest and least reached, that cliff is its own harm. Language adjustment to ease continuing appropriations, dependent upon program success, would help to insulate the program from partisan bickering in the budget process.

The bill's goal is right, and its delivery investment is overdue. The mechanism at its center needs to change. Congress should replace the single national procurement with a competitive, state-by-state process modeled on Louisiana and Washington, so price discipline does not come at the expense of new therapies and patient choice. The Energy and Commerce Committee should move the bill through markup with that revision. Appropriators should preserve the provisions that remove cost-sharing and prior authorization for the covered population, reject the Senate's immigration carve-out in any reconciled text, and ensure language sufficient to not knee-cap the program just as it is making progress. States should commit to opt in eagerly and early. Hepatitis C elimination in the United States is within reach, and the people counting on it cannot afford a cure they cannot choose or a program that collapses in 2033.