Treating prisoners for hepatitis C virus (HCV) can be a costly nightmare, straining prisons’ pharmacy and health care budgets.

Prisoners are entitled to adequate medical care under the 8th amendment, as “deliberate indifference” to medical needs can be considered cruel and unusual punishment.

Last October, the FDA approved Gilead’s HCV treatment Harvoni, which combines the previously approved sofosbuvir (Sovaldi) with ledipasvir. While Harvoni delivers high HCV cure rates, it’s a tough pill to swallow in terms of costs. The price of 1 pill is $1125, so a 12-week course of treatment would total $94,500. 

A new study published in The Journal of Urban Health examined projected costs for Rhode Island prisons to treat HCV infections, which can range from mild to severe, lifelong illnesses.

The researchers found treating prisoners with at least 6 months left to serve of their sentences would cost around $34 million—13 times the pharmacy budget and almost twice the overall health care budget.

“The big problem is, even if you just take the most advanced disease, you can’t afford it with the current correctional budget,” said lead study author Brian Montague, assistant professor medicine and public health at Brown University and a physician in the Division of Infectious Diseases at The Miriam Hospital, in a press release. “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.”

About 17% of those incarcerated in the Rhode Island Department of Corrections (DOC) have chronic HCV, the researchers found. This percentage mirrors 2006 estimates of HCV among national state prisoner populations, as well.

The researchers posited there were 3 potential treatment strategies: treating all chronically infected inmates, treating only patients with demonstrated fibrosis, or treating only the sickest inmates with advanced fibrosis. If the Rhode Island DOC chose the last strategy, treatment would cost about $15 million.

Even if the DOC could obtain a 50% discount on drug prices, it would still need to spend 3 times the system’s budget on drugs and more than 40% of its total health care budget to treat its sickest inmates, according to the researchers.

They suggested the projected costs for HCV treatment would make it unlikely for correctional facilities to afford the drugs on their own, with their current budgets, for all their HCV-infected inmates. Outside programs offering alternative payment strategies may need to be tapped in order to treat the incarcerated.

“In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable,” the researchers concluded.
The researchers noted the prison population is disproportionally affected by HCV, which can be spread via injection drug use.

Beyond Rhode Island, treating California’s Medicaid and prison population with Harvoni would add $3 billion to the state’s total drug spending, according to the California Technology Assessment Forum’s January 2015 report.