Why Aren’t Prison Inmates With Hepatitis C Being Treated?

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Why Aren’t Prison Inmates With Hepatitis C Being Treated?

As a matter of general health policy, states should aggressively treat hepatitis C in prisons.

The launches of the first hepatitis C cures from Gilead (Sovaldi) and AbbVie (Viekira Pak) were met with great controversy. While welcomed as medical breakthroughs, these drugs had list prices of $84,000 per course of treatment – a price that outraged many. While various economic analyses demonstrated that, even at this high price, curing hepatitis C made economic sense in terms of preventing the long term consequences of the disease such as liver cancer, liver transplants, etc., many felt that the companies were putting profits ahead of patients.

Things, however, have changed over the last five years. Thanks to the availability of multiple hepatitis C drugs and hard bargaining on the part of payers like Express Scripts and CVS Health, the prices of these drugs are less than half of the original list prices. As a result, the U.S. prices for hepatitis C drugs are lower than in places like Germany and the U.K. – countries that negotiate prices with the manufacturers. With these drugs now more affordable, efforts are being made to eradicate this disease in large populations. For example, Australia with roughly 230,000 hepatitis C patients has committed $1 billion to cure this disease by 2026. In the U.S., the Department of Veteran’s Affairs (VA) announced that, by the end of the year, 59,200 veterans with hepatitis C will be cured of their infections. The VA was able to achieve this by working with the manufacturers to receive a reduced price. The VA estimates that the drugs will cost $748.8 million or roughly $25,300/soldier – an enormous difference from 2013 and a relatively reasonable price to cure this disease.

Given this progress, it was surprising to see a report from Kaiser Health News proclaiming “State Prisons Fail To Offer Cure To 144,000 Inmates With Deadly Hepatitis C.” This article reported the results of a survey conducted at Columbia University’s School of Journalism.  Forty-nine states responded to the survey and the data provided indicated that about 97% of inmates with hepatitis C are not getting the treatment needed to cure hepatitis. The reason for treatment being denied is blamed on the high cost of these drugs.

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