US state prisons fail to treat at least 144,000 inmates with hepatitis C, a curable but potentially fatal liver disease, according to a recent poll and subsequent interviews with state judicial authorities.
Many of the 49 states that responded to questions about prisoners with hepatitis C cited high drug prices as the reason for refusing treatment. The medications can cost up to $ 90,000 for a treatment.
Nationwide, about 97 percent of inmates with hepatitis C receive no cure, says the study, which was conducted for a master's project at the Toni Stable Center for Investigative Journalism Columbia University Graduate School of Journalism.
Proponents say this ignores a Supreme Court ruling of 1
"There is no point in waiting for us to have the effective cure," Dr. Raymond Chung, director of the Hepatology and Liver Center at the Massachusetts General Hospital. Chung was a former co-chair of the American Association for the Study of Lever Diseases and the Infectious Diseases of the Americas HCV Guidance Panel, which recommends access to the cure for anyone with chronic hepatitis C.
Corrections Departments in all 50 states and the District of Columbia were asked how many prisoners have hepatitis C, how many are being treated, what drugs are used for treatment, and what policies exist for inmates with the virus. Almost all states have responded with some or all of the requested information. South Carolina and DC refused the demands.
With more than 1.3 million inmates, state prisons house the largest group of detained people in the country – people at higher risk of transmitting virus-transmitted blood through needles, razors, or toothbrushes. The infection rate is much higher among detainees than in the general population, partly because nearly one-sixth of state detainees serve for drug offenses
The enormous under-treatment comes at a time when the infection rate for hepatitis C or HCV has increased in part due to the opioid epidemic.
Some prisons ignore their own standards of care. According to Florida Department of Corrections, at least 181 inmates who meet the criteria for treatment have experienced no cure in Florida. The department has a 13-page policy stating that inmates are approved for HCV therapy when the disease reaches Phase 2, when the liver shows mild to moderate fibrosis or scarring.
"The Department Commits to Serving All Prisoners We are in charge of medically necessary treatments that are in line with national standards and our constitutional responsibilities," Ashley Cook, spokesman for the Florida prison system, said in an e-mail ,
Since the end of 2013, new hepatitis C drugs with a success rate of more than 95 percent are available. But they come with sticker prices of $ 40,000 to $ 90,000 for the daily tablet rule of eight to 12 weeks. These drugs replaced previous therapies, which cost around $ 70,000 for 48 weeks of treatment and have a significantly lower cure rate.
The Minnesota Department of Corrections treated 58 prisoners from 2014 to 2016. David Paulson, medical director of the Minnesota Prison System, said his department can not afford to do more.
"We must act within our means and treat the [prisoners] the most advanced first," he said in an interview. "When prices go down, we will treat more people."
In California civil servants provided $ 106 million next year for the treatment of prisoners with hepatitis C.
Gilead, one of the companies that manufacture the drugs, including the popular brands Sovaldi and Harvoni, says patient access is one of its top priorities.
"Gilead offers substantial discounts to public and private payers and is committed to working with individual state departments for corrections. Patients receive the treatments they need," wrote Mark Snyder, director of public relations, in an email.
In 2016, Gilead said in a statement to the BMJ medical research journal that he "behind the die" "antiviral drugs" would pay off long-term, compared with "the long-term costs associated with the treatment of chronic
Another pharmaceutical company, AbbVie, said the company's latest HCV drug, Mayret, is significantly cheaper than any medications that came before it could gain access.
"We continue to work with payers , Plan Benefit Manager and Vendors, to ensure patients access to the appropriate HCV therapy, "said Raquel Powers, AbbVie's Public Affairs Director
The HCV drugs in 2016 cost more than $ 50,000 per treatment course per prisoner With some discount, according to Brandon Sis, senior pharmacist for corrections at the Minnesota Multistate Contracting Alliance for Pharmacy, the drug discounts for various agent All over the country negotiated including 15 correction departments. Sis said that the reduced price of HCV drugs available to state prisons has been cut by about half since the end of 2017 to about $ 25,000 per treatment cycle.
"This is a treatable condition and no one should die from HCV," said Michael Ninburg, President of the World Hepatitis Alliance and executive director of the Hepatitis Education Project, an interest group for people affected by the disease.
Barry Michaelson, a former Minnesota prisoner, and Terry Riggleman, a current detainee in Virginia, were among the untreated, though they made several applications for healing.
During their prison sentences, both felt healthier and were increasingly exhausted. Michaelson said he had frequent headaches and white spots and hard bumps on his skin. Riggleman said he was in constant pain in the abdomen and joints. These symptoms are common as the disease progresses.
"We are ill and they do not object," Michaelson said.
In Minnesota, where Michaelson was imprisoned, only 22 prisoners had received treatment. In the first ten months of 2017, the survey revealed
"If we all treated with hepatitis C, this would be the entire drug budget for everything else exceed and there would not be enough budget left to treat patients with other diseases ". Paulson said. "We have to do what brings the greatest benefit to the largest number of people."
According to Paulson, 15 percent of prisoners or about 1,500 in Minnesota prisons in 2017 were HCV-infected. If the Department Should Do That If every prisoner were treated, it would have cost more than $ 75 million and far exceeded its $ 27 million health care budget.
"We need to look at the whole picture, the goal, at least my goal, is a treatment based on the risk of the side effects of hepatitis C," said Paulson, who published a book in . about hepatitis C. "Ideally, we would treat everyone if it's $ 50 per pop."
The constitutional argument about treatment revolves around the eighth amendment prohibition on "cruel and unusual punishments." Prisoners can not turn to health care anywhere else. States restrict or prohibit any private or external medical care.
"I'm in a position where I can not help myself," Riggleman said in an interview at the Augusta Correctional Center in Virginia.
"The cost is not a quarrel," Michaelson said, "once you've arrested people, you need to take care of them."
Michaelson and Riggleman filed separate class action lawsuits against their states' prison systems because they were not prisoners an external lawyer treated with hepatitis C was the country's first lawsuit and Riggleman was one of the last.
"The law is clear that we have the right to medical care," Michaelson said, "so you have to treat us. No excuses. "
Litigation is ongoing in Minnesota and Virginia, as well as at least seven other states, including Alabama, California, Colorado, Florida, Missouri, South Carolina, and Tennessee.
About 640,000 prisoners are released nationwide each year, and that means that potentially more than 75,000 people infected with HCV could enter the general population annually, and those who were not tested or treated during detention would increase the risk of new infections
"It is very unfortunate that any person who may be Chung said in an interview, "It is even more regrettable that we can not treat people who are at high risk of passing the virus on to others."
"From a public health perspective this is a disaster, "Paulson said." If the court decrees that the department must treat everyone, it must it comes from the Diet. That would be the money spent on roads, bridges, schools and child protection services. "
Michaelson was released from his Minnesota jail in March 2017, with no treatment for hepatitis C, nearly seven years after his diagnosis, and while imprisoned lost 20 pounds, leaving his old clothes hanging loosely from his body He left the jail with two boxes full of papers from his legal research and, as he was no longer imprisoned, his name was dropped from the lawsuit and a trial is expected to begin in September.
Riggleman, who was diagnosed 14 years ago and is not awaiting treatment for another 10 years.
"I have no life sentence. I have people who are important to me, and I want to fix things. I want to live. I was not sentenced to death. Do not let me die in here.
Thanthong-Knight reported this story as part of his master's project for the Toni Stable Center for Investigative Journalism at Columbia University's Graduate School of Journalism.
KHN's coverage of the development of prescription drugs Medicines, costs and prices are partially supported by the Laura and John Arnold Foundation.