By: Marcus J. Hopkins, Blogger
Here, at HEAL Blog, we frequently speak about issues related to the cost of newer Direct Acting Agents (DAAs) to treat Hepatitis C (HCV). We’ve also covered issues related to HCV treatment in America’s prison system. Our verdict, then, as now, stands – the only U.S. citizens who are Constitutionally guaranteed healthcare are the least likely to receive treatment for HCV.
A recent study published in Health Affairs confirms our observations from earlier this year: inmates who are infected with HCV are not receiving proper treatment, largely because the cost of medications puts the drugs far out of reach. For co-infected patients, the HCV is likelier to kill them, before the HIV ever will.
The finding that is most troubling is that, of the 106,266 inmates known to have HCV (reported by 41 states), only 949 inmates were receiving any form of HCV treatment by January 01, 2015 – 0.89% of reported inmates. This means that fewer than 1% of reported inmates are receiving their Constitutionally guaranteed treatment.
Another finding that’s equally appalling is that numerous state departments of corrections were receiving much smaller discounts than other state agencies. The US Senate Committee of Finance’s 2015 report on the pricing of Sovaldi and Harvoni noted that the Federal Bureau of Prisons, Department of Defense, and Department of Veterans Affairs receive at least a 24% discount on those drugs, Medicaid receives at least a 23% discount, and that the V.A. and Medicaid programs that accepted the conditions of offered rebates may receive more than a 50% discount. In contrast, ten of eighteen state departments of corrections received less than a 10% discount on Sovaldi as of September 30, 2015, with Michigan paying the full $84,000; five of nineteen states received less than a 10% discount on Harvoni.
While this study does not claim to claim to represent an estimate of HCV prevalence in US prison populations, it does admit that this limitation means that there is likely a far greater prevalence of HCV than the 106,266 inmates listed in the report. This has been suspected for some time, and was specifically alleged in a Tennessee inmate’s case against the state for withholding treatment from prisoner. A May 2016 report by the Tennessean also found that many prisons in the state simply do not test incoming prisoners, because doing so might result in a positive HCV result; admitting that the inmates have HCV would require them to treat the inmates.
While Gilead Sciences (makers of Sovaldi, Harvoni, and Epclusa) justifies the price of their medications by comparing the cost of one course of treatment to the cost of multi-year treatment costs for other diseases, state budgets are not made in such a way that accommodates that pricing philosophy, particularly if patients/inmates become re-infected. With prison budgets already strained beyond the breaking point to provide for the basic needs of their inmates, having them pay price much higher than those paid by either Medicaid or the V.A. is simply a recipe for disaster.
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.