Getting what some scientists have called revolutionary treatment into the hands of Hepatitis C patients under confinement has been a struggle. But if two prisoners have their way, the Massachusetts Department of Corrections will have to administer the full range of the newest medicines to thousands of infected inmates in the state correctional system.
With the help of the National Lawyers and Prisoners’ Legal Services, inmates Emilian Paszko and Jeffrey Fowler have sued the Massachusetts Department of Corrections, alleging that it has withheld Hepatitis C medication from nearly 1,500 inmates. According to legal documents, the duo said that only three inmates in the facility have received treatment.
“The Department of Corrections and its health care contractor knew before 2011, when triple therapy arrived, that they needed to bring a large number of prisoners who were previously ineligible for treatments — particularly non-responders and relapsers — back into the treatment protocol, but ordering pre-treatment tests and staging them,” the lawsuit argues. “They failed to do so then, and defendants are failing to do so now.”
The U.S. Surgeon designated Hepatitis C as a “silent epidemic” at the turn of the century. Today, nearly 2.7 million people carry the virus, with more than 29,000 cases reported within a year. Hepatitis C often spreads via the bloodstream when infected people share needles and other injectable devices, putting those in the prison system at a significant risk. If left untreated, Hepatitis C can cause chronic liver disease and other long-term health problems, and even result in death. Such is the case for the more than 75 percent of people who reach this dire stage of the illness.
Experts say that Hepatitis C treatment has vastly improved in the last couple of years, particularly with the Food and Drug Administration’s approval of Sovaldi and Olysio. Getting the newest treatment — which often costs up to up to nearly $90,000 — to the between 12 and 35 percent of inmates in Massachusetts infected with Hepatitis C has been a challenge. In lieu of budget constraints in the state’s prison system, officials have always prioritized expensive treatment for inmates who have the most serious form of illnesses, the Wall Street Journal said.
These budget constraints haven’t only affected inmates in Massachusetts. Other state correctional facilities have faced similar difficulties in providing timely, consistent Hepatitis C treatment.
Last month, two prisoners sued the Minnesota Department of Corrections as part of an effort to access treatments that researchers say carry a 95 percent success rate for more than 1,300 inmates at risk of contracting Hepatitis C. California Governor Jerry Brown raised eyebrows earlier this year when he proposed $300 million in healthcare spending for new hepatitis drugs, a figure that eclipsed that of state parks and emergency drought response.
These price increases didn’t happen without warning. Members of the medical community have foreseen such spikes in Hepatitis C drug prices as with other drugs. In April, researchers in Rhode Island predicted that treating prisoners for Hepatitis C would cost nearly twice as much as the entire correctional health budget, even if only the sickest inmates received treatment.
“The big problem is, even if you just take the most advanced disease, you can’t afford it with the current correctional budget,” Dr. Brian Montague, assistant professor medicine and public health at Brown University and a physician in the Division of Infectious Diseases at The Miriam Hospital, who led the study, said in a press statement.
“There was an option to defer treatment before because the [prior] treatments were significantly more toxic and the risks often outweighed the benefits. Now, with safe and highly effective treatments, morally and ethically there’s no option to not treat, particularly for those with more advanced disease,” Montague added.
However, the issue may be more financial than moral for states struggling to meet the needs of residents, regardless of whether they’re serving time behind bars. Federal figures show that Medicare outlays for the newest Hepatitis C medication surpassed $4.5 billion last year, more than 15 times what officials spent the previous year on older treatments. Sovaldi also accounted for more than 75 percent of the new spending, causing doctors to worry, especially since expenditures for the Part D program under which Hepatitis C treatment stands has slowed down in recent years Medicaid have been affected too, with some programs along with private insurance companies, restricting access to pills to those with advanced liver disease.
Hepatitis C drug manufacturers have cited the new drugs’ high success rate and low occurrence of side effects in their justification of its high price tag. However, not everyone has bought into that logic.
A recent study published in the Annals of Internal Medicine suggested that circumventing hospitalization and other treatment options would lower total costs by only a quarter — far less than what supporters have contended. The high-cost drugs have also strained the budgets of foreign countries. So much so that activists in Brazil, China, Russia, and Ukraine have collectively challenged Sovaldi’s patent status: a move that would allow foreign pharmaceutical firms to produce cheaper versions of the tablet in more than 90 developing countries.
Even with recent developments, allocations for inmates’ Hepatitis C treatment have been on the decline long before the new drugs entered the market. Infectious disease specialist Dr. Camilla Graham told The Boston Globe that the state spent more than $1 million on Hepatitis C medication for the entire prison population. This year, the system would spend less than half that amount. That neglect, advocates say, caused a patient backlog and ultimately an increase in the number of inmates in need of treatment.
“As is the case with many of our clients, they’ll get a response that’s not a response — ‘You’ll have an appointment soon. We’re putting in a request for you to see,’ ” Joel Thompson, the prisoners’ attorney, told The Boston Globe. “They’ll put you in the next step of the process, but the process seems unending.”