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Justification for a Needle Exchange Program as a HCV and HIV Prevention Strategy The cost of drug therapy for treating the Hepatitis C virus (HCV) and HIV/AIDS significantly impacts the North Carolina Medicaid budget, and continues to grow due to increased incidence of both diseases and cost of new drugs being introduced to the market. Drug therapy cost for HCV and HIV/AIDS represents the top two specialty drug classes by per member per year (PMPY) spend in 2014 for North Carolina Medicaid as well as all other state Medicaid programs. Because both are preventable diseases, prevention must be a strategy used to mitigate the budgetary impact of these drug therapies. An estimated 3.2 million Americans are chronically infected with HCV and deaths attributed to HCV far exceed those due to HIV/AIDS. Because the majority of HCV infections are asymptomatic, 65-75% of infected individuals are unaware of their status and more likely to spread the infection to others. Furthermore, between 15-20% of untreated persons with chronic HCV infections will develop chronic liver disease, including liver cirrhosis and hepatocellular carcinoma. In North Carolina, acute HCV is reportable and there has been an increase in the number of acute HCV cases throughout the state during the last five years (Figure 1). According to the Centers for Disease Control, Viral Hepatitis Surveillance Report End-of-year 2014 report, in 2014 North Carolina’s acute HCV rate exceeded that of the US (Figure 2). Injection drug use was by far the greatest risk factor for HCV acquisition. Data released by the North Carolina Injury and Violence Prevention Branch observed a 402% increase in heroin deaths in the state since 2010 (Figure 3). At this time, chronic HCV infection is not reportable in North Carolina. Therefore, the true burden of this epidemic on the state remains unknown. However, using a conservative national HCV prevalence estimate of 1.6%, an estimated 160,000 North Carolinians have been infected with HCV with at least 120,000 of those individuals representing chronic infections. This estimate is more than four times higher than the number of persons living with HIV/AIDS in the state. Due to significant morbidity associated with blood borne pathogens (such as HCV, HIV and HBV) as well as the exorbitant cost of treating these chronic diseases, preventing infection should be a public health priority. In addition to risk reduction counseling, referral to mental health and substance abuse services; needle and syringe exchange programs have proven to be effective in decreasing the transmission of HCV, HIV and HBV. The common practice of sharing syringe, and drug preparation equipment (such as cookers, cotton filters and water used to rinse the syringes) contributes greatly to disease transmission. Therefore, a Hepatitis C Medications Medicaid 2013 2014 Paid Amount $8,068,113 $50,840,276 HIV/AIDS Medications Medicaid 2013 2014 Paid Amount $65,612,098 $70,016,283 AIDS Drug Assistance Program (ADAP) 2013 2014 Paid Amount $40,454,317 $47,059,921