Due to the strongly fragmented reality of HCV treatment in the various Regions of Italy, effectiveness of access to treatment is difficult to gather. The aim of this paper was to analyze regional differences in healthcare governance models regarding HCV, in order to understand the ability of each Region to give access to HCV diagnosed patients. The analysis was performed by comparing treatment ratios (TR) across all Regions (treated patients/diagnosed patients). Furthermore, the study provides insight to regional regulatory environment and to all HCV treatments entering the market in each Region. Sicily has the highest TR value (73%), whereas Friuli Venezia Giulia has the lowest (5%). Overall, Regions where a technical document on HCV clinical pathways has been implemented, result in a higher number of treated patients.