Lawsuits are piling up against states that withhold hepatitis C cures from prisoners.
In Missouri, a class action lawsuit is under appeal. In Florida, a U.S. District Court judge ordered the Department of Corrections to begin treating infected inmates immediately. And at least six other states, including Virginia and Tennessee, face similar legal challenges.
In each case, advocates argue that prisoners need direct-acting antiviral drugs, which cure hepatitis C 90-95 percent of the time.
The drugs have few side effects but a hefty price tag. Direct-acting antivirals were initially priced upward of $84,000, though market forces soon yielded less expensive options. One recently approved direct-acting antiviral was priced at $26,000. As with many on-patent drugs, prices are then reduced further by rebates and negotiations between the manufacturer and the health plan.
Nevertheless, critics argue that treating prisoners would deplete state coffers. Proponents of treating infected inmates consider the upfront cost an investment, a way to reduce spending on future care. As hepatitis C progresses it can lead to liver cancer, liver failure and the need for liver transplantation, all of which are expensive.
Meanwhile, prisons offer a closed, structured setting – ideal for treatment. In eight-12 weeks, the treatment reduces one’s viral load so that hepatitis C is undetectable. This means the patient no longer experiences symptoms and can’t infect others—in prison or upon release.
Reducing transmission is an important step toward disease eradication and improved public health. So, some states have negotiated discounts on hepatitis C cures to make the strategy work.
But most states are still holding back. In Missouri, only 14 of an estimated 5,000 inmates with hepatitis C received a direct-acting antiviral in 2016.
To learn more about testing and treating prisoners for hepatitis C, read the Institute for Patient Access’ health policy brief on the subject.