Any national campaign to eliminate hepatitis C, an insidious virus that kills tens of thousands of Americans a year, would almost certainly involve prisons.
One in seven state inmates are believed to be infected, and the regimented environment of a prison has its advantages when it comes to screening and treatment.
The problem is, the drugs that effectively cure the disease are priced in the tens of thousands of dollars — far more than prisons can pay. In 2015, state corrections departments were treating less than 1 percent of those inmates known to be infected, a survey found.
Now courts have begun ordering states to provide the drugs regardless of cost, prompting an unusual showdown over how pharmaceutical companies set prices for the treatments.
In at least nine states, prisoners have filed lawsuits arguing that withholding drugs constitutes deliberate indifference to their dire medical needs, violating a constitutional ban on cruel and unusual punishment.
Last week, Massachusetts settled a lawsuit by agreeing to give all prisoners in advanced stages of the disease access to drugs.
In November, a federal district judge in Florida was the first to order a state prison to begin treating sick inmates. The state must now provide drugs to all inmates with severe liver damage by the end of this year and those with significant damage in 2019.
“This Court will not tolerate further foot dragging,” Judge Mark E. Walker wrote. “One can only wonder how long Defendant would have kicked the can down the road had Plaintiffs not filed this case.”
Dr. Anne Spaulding, an associate professor of public health at Emory University and the former medical director of the Rhode Island Department of Corrections, called the order an unfunded mandate. “It’s an impossible situation that the prison administrators are put in,” she said. “You can’t buy something you don’t have any money for.”
Prisons would be a logical linchpin in a campaign to eliminate hepatitis C: some studies suggest that one in three Americans with the disease pass through a correctional facility in any given year.
Delaying treatment has grave consequences. A leading cause of cirrhosis and end-stage liver disease, hepatitis C wreaks irreversible but invisible damage for years; when symptoms become apparent, it is too late to treat. The disease is blood-borne and usually acquired from unsafe transfusions or injection drug use, but perhaps only half of those infected know they have it. It can also be transmitted through tattooing using nonsterile equipment.
Early therapies for hepatitis C induced fatigue and depression in many patients and cleared the infection in less than half of them. But four years ago drugmakers began to introduce new medicines that do not have the same debilitating side effects and cure nearly all patients, revolutionizing treatment.
In return, the companies demanded high prices — Gilead Science debuted the first of the new class of hepatitis C drugs, Sovaldi, at $84,000 per course of therapy — and private insurers proved willing to pay.