In the New England Journal of Medicine, Dr. Joshua Liao and Dr. Michael Fischer of Brigham and Women's Hospital offer an analysis of states' Medicaid programs spending on sofosbuvir to treat hepatitis C. The cost made up 6.73% of Medicaid drug spending in New York, or $354 million, the highest amount in the U.S. In N.Y., 36.9% of hepatitis C prescriptions were for sofosbuvir. The state's rate of acute hepatitis C cases was 0.5% per 100,000 population. Overall spending ranged from N.Y.'s $354 million to New Mexico's $593,000. The figures did not account for manufacturer's rebates and the states may have prescribed other drugs to Medicaid enrollees. Rates of acute hepatitis C infection were highest in Kentucky at 4.1 cases per 100,000 population, West Virginia at three cases, and Oklahoma at 2.1 cases, The main finding, the authors noted, was that "in the first year after the approval of sofosbuvir by the FDA, there was a rapid, widespread increase in Medicaid spending on sofosbuvir, but with substantial variation across the states." The results "underscore the need to identify effective strategies to guide policy and reimbursement in order to ensure parity and appropriateness in the use of sofosbuvir among the Medicaid population and other high-need populations."