August 7, 2025
It wasn’t so long ago that hepatitis C was a silent killer lurking beneath the surface of public health; today it’s a mostly curable condition. Decades of pharmaceutical innovation and public health vigilance have flipped the script on this once-grim diagnosis. Patients are now routinely surviving, and life insurers can confidently adapt their underwriting guidelines to cover risks in this cohort. But there are distinct clues to look for in the data when assessing applicants with hepatitis C.
Hepatitis C treatment has come a long way
In the 1990s, treatment options for hepatitis C were limited and largely ineffective. Interferon-based therapies offered modest success, with sustained virologic response (SVR)—the benchmark for cure—achieved in as few as 6% of patients. Fast forward to today, and direct-acting antivirals (DAAs) like Harvoni, Epclusa, and Mavyret have revolutionized care. These oral medications boast SVR rates exceeding 95%, with treatment durations as short as 8 to 12 weeks.
Mortality data reflects treatment progress
This medical breakthrough has had a measurable impact on mortality. Our own mortality research shows that relative mortality risk for individuals undergoing hepatitis C treatment has dropped significantly—from nearly 300% in the early 2010s to around 200% by 2021. We expect to see further declines in our continued studies that reflect the growing effectiveness and accessibility of curative therapies.
The shift demands a recalibration of risk models
Underwriting hepatitis C is no longer a binary decision of decline or high rating. Instead, it requires a nuanced assessment of treatment history, SVR confirmation, liver function, and comorbidities. Applicants who have achieved SVR and show no signs of liver damage—confirmed through tools like FibroScan—may now qualify for standard or near-standard rates. On the other hand, red flags such as intravenous drug use, co-infections (e.g., HIV or hepatitis B), or advanced liver fibrosis still warrant caution.
The underwriting process must also adapt to the realities of disclosure. Many applicants remain unaware of their infection, and reflex testing for elevated liver enzymes often uncovers undiagnosed cases. Electronic health records (EHRs) and prescription histories are becoming indispensable tools for verifying treatment success and long-term outcomes.
You can confidently underwrite applicants with hepatitis C
Hepatitis C is no longer the underwriting pariah it once was. With the right data and clinical context, insurers can confidently offer coverage to a growing population of cured individuals—turning what was once a chronic liability into a manageable, and often negligible, risk.
Watch our webinar series, From uninsurable to opportunity: The evolving mortality of hepatitis C, HIV, and cystic fibrosis, to learn more.
Derek Cole, PharmD, is a senior clinical consultant at Milliman IntelliScript.
