State prisons across the U.S. are failing to treat at least 144,000 inmates who have hepatitis C, a curable but potentially fatal liver disease, according to a recent survey and subsequent interviews of state corrections departments.
Many of the 49 states that responded to questions about inmates with hepatitis C cited high drug prices as the reason for denying treatment. The drugs can cost up to $90,000 for a course of treatment.
Nationwide, roughly 97 percent of inmates with hepatitis C are not getting the cure, according to the survey conducted for a master’s project at the Toni Stabile Center for Investigative Journalism at Columbia University’s Graduate School of Journalism.
Advocates say this ignores a 1976 Supreme Court ruling that determined an inmate’s medical care is a constitutional right.
In California, more than 16,000 prisoners — or about 12 percent of the prison population — have tested positive for chronic hepatitis C, according to the state Department of Corrections and Rehabilitation. Between July 2017 and April of this year, 1,580 prisoners with the disease received treatment, the department said.
Since late 2013, new hepatitis C drugs with a success rate of more than 95 percent have become available. But they come with sticker prices of $40,000 to $90,000 for the daily tablet regimen of eight to 12 weeks. These drugs replaced previous therapies that cost around $70,000 for 48 weeks of treatment with a much lower cure rate.
Rates of treatment vary from state to state.
Methodology
The figures in this story came from a survey sent to the departments of corrections in 50 states and the District of Columbia, between October 2017 and March 2018. Some states responded to the survey without FOIA or Open Records requests, and others required a formal request.
The survey asked for: (1) the state prison policy on testing and treating HCV, (2) the HCV drugs in their formulary, (3) the number of inmates with HCV, or the prevalence rate of HCV in the state prisons, and (4) the number of inmates with HCV who were treated in the previous year, or the most recent data available. For states that required records requests, a question about the amount of budget spent on treating inmates with HCV was added to the survey.
Forty-nine states and D.C. responded to the survey in some form; North Carolina did not respond to repeated emails and phone calls. Forty-five states gave complete answers for both the numbers of inmates diagnosed and treated. Arkansas, Hawaii and Missouri responded only to either the prevalence rate or the number of inmates treated. South Carolina and D.C. denied the FOIA requests.
The overall numbers are estimates, and some states provided only estimates. Additionally, not every state prison performed testing during intake or does routine testing. For example, Georgia tested only 4 percent of its inmates but reported that 727 inmates have HCV, meaning that almost 1 in 3 of the people who were tested had the virus.
The policies on testing and treating varies greatly by state; some are more restrictive than others in terms of treatment eligibility, giving access to those in advanced stages of disease. Alaska, Georgia, Maine and South Dakota did not have clear written rules for testing or treating HCV. Mississippi had a policy that dated to 2005, almost a decade before the current drugs were introduced.
The current HCV medications come in at least eight brands. Not every prison system had these treatments in their formularies; physicians prescribing non-formulary HCV drugs need approval from the department of corrections. At least nine states did not include any of the HCV drugs in their prescription lists.
This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
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