A cure for a disease is only useful if it’s accessible to those who need it.
For people with chronic hepatitis C, that cure can cost up to $90,000 and may not be fully covered by their insurance.
For prisoners in the U.S. correctional system, that cure is even further out of reach.
State prisons are failing to treat at least 144,000 incarcerated patients with hepatitis C, according to a recent story published by Kaiser Health News.
Nationwide, about 97 percent of incarcerated patients with hepatitis C aren’t getting the treatment they need.
Officials quoted in the story say price is a major barrier, although advocates cite a 1976 Supreme Court ruling determined an inmate’s medical care is covered by the U.S. Constitution.
Siraphob Thanthong-Knight, a recent masters graduate from the Toni Stabile Center for Investigative Journalism at Columbia University Graduate School of Journalism who wrote the Kaiser story, told Healthline that some inmates have to exhaust all other options before they’ll receive the antiviral medications that can cure their infections.
“I found the problem isn’t just paying for the drugs,” he said. “For some prisoners, when they request the drugs in the late stages, they get the treatment.”
That, too often, involves taking the state to court, involving long and expensive legal battles while a patient’s health is in jeopardy.
The costly cure
The Centers for Disease Control and Prevention estimate there are 3.5 million people in the United States with chronic hepatitis C.
Hepatitis C is spread more easily in the prison population because it’s transferred by blood, such as through needle sharing and contaminated tattooing equipment.
Left untreated, hepatitis C infections can be deadly. It’s currently the most common reason for liver transplants in the United States.
For years, hepatitis C was treated with a combination of medications — ribavirin and interferon — to boost a person’s immune system in an attempt to kill the virus. In the past decade, more effective drugs that directly attack the virus hit the market.
In 2013, the U.S. Food and Drug Administration approved two drugs, Sovaldi and Olysio, that could cure — not just merely treat — hepatitis C infections by blocking proteins so the virus can’t replicate.
But the 12-week treatments that cured people of the virus with a 95 percent effective rate came with hefty price tags.
While it can vary from state to state depending on agreements between the drug makers and insurance providers, the treatments cost tens of thousands of dollars. Typically, it ranges from $40,000 to $90,000, according to various news outlets.
While a $300 alternative is currently being tested, the large price tag for drugs that can cure hepatitis C is a major hindrance for many patients, especially those currently incarcerated.
Many states and their departments of corrections have cited this high cost for denying or delaying hepatitis C treatments to inmates.
In some cases, treating prisoners with hepatitis C would deplete a state prison system’s healthcare budget, leaving no room to treat incarcerated patients with other health problems.
For example, the state of Minnesota treated 58 inmates with hepatitis C from 2014 to 2016. Dr. David Paulson, medical director of the Minnesota state prison system, told Kaiser Health News that his department can’t afford to do more.
“We have to operate within our means and treat the [prisoners] that are the most advanced first,” he said. “When prices go down, we’ll treat more people.”
“When you incarcerate people, you take away their right to get their own care,” he told Healthline. “With hepatitis C, the standard of care has changed. Things are evolving. These antiviral drugs are the latest in treating hepatitis C.”
What’s worse is that the burden of paying for the treatment shouldn’t fall on prisoners, who, on average, make 50 cents an hour.
“While the cost of treatment is expensive, the cost of nontreatment, which not only results in prisoner deaths but also in the spread of the disease both within prisons and outside, is also expensive,” Friedmann said.
Seeking legal remedies
The most effective way prisoners are getting hepatitis C treatments is by suing the states that are incarcerating them.
In November, a judge ruled in favor of a lawsuit brought by three Florida inmates who were being denied care. The state may now have to pay for the treatment for 20,000 inmates infected with hepatitis C.
In March, Massachusetts prisoners won a class-action lawsuit so that those with the most severe infections will be treated within a year.
Some of these cases were fought on behalf of individual patients, but the American Civil Liberties Union (ACLU) has aided in some class-action lawsuits in Colorado, Massachusetts, Pennsylvania, Minnesota, Missouri, Tennessee, Florida, Virginia, and North Carolina.
Mark Silverstein, legal director for the ACLU of Colorado, said that despite the availability of a cure, the Colorado Department of Corrections had planned to leave thousands of prisoners untreated and then release them back to the community with a communicable disease.
“Not only is that dangerous for public health, it’s a cruel way to save some money in the short term that may end up costing taxpayers a lot more in the long term,” he said in a statement after filing a class-action lawsuit in Colorado last year.
Too often, the stigma against those in prison makes it difficult for people to get behind the cause. But, Friedmann said, giving prisoners poor healthcare and jeopardizing their lives — especially when their offense isn’t legally punishable by death — is a “pretty ridiculous” deterrent.
“People don’t care about things until it affects them or someone they know,” he said. “Prisoners are no different. They’re someone’s child or have children of their own. Why does the fallout have to come after someone dies?”