Hepatitis C kills far more Americans than any other infectious disease, and it is rampant amongst prison inmates. When new antiviral drugs first promised to cure the disease in 2014, states took one look at the high sticker price and immediately took steps to limit the availability of those treatments for Medicaid beneficiaries and prison inmates. Only about three percent of inmates with hepatitis C serving time in state penitentiaries has received the cure.
However, recent court rulings and settlements have indicated states can no longer withhold the life-saving medication from Medicaid beneficiaries and inmates who have chronic hepatitis C. In the latest ruling, U.S. District Judge Jane Magnus-Stinson, chief judge of the U.S. Southern District of Indiana nominated to her post by President Obama, said that withholding or delaying treatment from hepatitis C-infected inmates was unconstitutional. The judge said that doing so violates the Eighth Amendment and constitutes cruel and unusual punishment. According to the Constitution, state penitentiaries must provide appropriate medical care to prisoners regardless of cost and inmates need to receive the treatment they are promised.
A Florida ruling last year arrived at the same conclusion and settlements have been reached this year in Massachusetts and Colorado, mandating prison systems to provide treatment to all infected inmates. Colorado has set aside $41 million over two years to treat those infected. Similar lawsuits are pending in Pennsylvania, Minnesota, Missouri, and Tennessee.
“Thousands of prisoners who were forced to suffer through needless barriers to treatment now have access to life-saving medication,” said Mark Silverstein, ACLU of Colorado legal director after the decision. “This is a just and humane result that will save dollars in the long run.”
Lawsuits involving Medicaid beneficiaries have also been filed in on behalf of those being denied treatment in Michigan, Missouri, Colorado, and Washington, forcing states to change their policies and make the cure available.
Providing treatments will cost states tens of millions of dollars. However, allowing inmates access to appropriate treatment while providing economic and public health benefits that are well worth the added cost, according to health policy experts. Preventing patients with untreated hepatitis C from having their disease progress to liver failure and cancer will save money in the long run.
“The most important thing to remember about cost-effectiveness is that something that is really expensive can still be cost-effective if it is really, really effective,” said Mark Roberts, chairman of the University of Pittsburgh department of health policy and management. “And these drugs are very, very effective.”
The new antiviral treatment first released in 2014 typically requires 12-week treatment periods, has little to no side effects, and is more than 95 percent effective. It promised those infected a pain free recovery. When the drugs first came to market, however, a single course of treatment cost as much as $84,000.
“States were terrified by their cost exposure,” recalled Matt Salo, executive director of the National Association of Medicaid Directors. “And they had no idea how many people would show up on Day One demanding the cure. Would it be 75 percent? Twenty-five percent? One percent? They had no idea what their exposure was.”
However, it turns out, legal fees and settlements, disease progression, and allowing hepatitis C to spread like wildfire in the prison system is much more expensive. Since the prices have come down over the years, treating symptoms sooner rather than later and stopping it in its tracks only makes sense.