Inconsistent Treatment for Prisoners With Hepatitis C Provokes Lawsuits

The rate of inmates infected with the hepatitis C virus (HCV) is estimated at 17.4% across the United States, and can reach as high as 40% in some states. However, many inmates in state prisons are not permitted to receive the the newest and most expensive treatments for the virus, inciting allegations that this violates the Constitution.

The Federal Bureau of Prisons has guidelines for HCV treatment in place that ensure prisoners receive the new drugs like Sovaldi and Harvoni, but the vast majority of inmates in the US reside in state prisons, where these regulations do not apply. According to a Health Affairs study, only 0.89% of state inmates with HCV were being treated with the new direct-acting antiviral medications as of January 2015. Inmates with HCV and their attorneys now say that withholding these treatments is cruel and unusual punishment, which is prohibited by the Eighth Amendment.

One such prisoner is Salvatore Chimenti, an inmate with advanced liver damage who filed a lawsuit against the Pennsylvania Department of Corrections in 2015 when it denied him treatment with the new medication. If Chimenti’s lawsuit is successful, it could force prisons to provide the treatment to prisoners, even though the cost differs greatly by state.

State prisons are omitted from many of the programs that allow federal prisons to receive discounted drugs, and the negotiation process for lower prices is so complicated that only 16 states said they were currently working to receive discounts through that pathway. In the absence of help from these programs, many states are left to negotiate directly with the pharmaceutical companies, leading to wildly varying costs for the treatments.

The state that paid the most for the new drugs actually had a relatively permissive policy towards providing it to inmates, according to the Health Affairs study. As of September 2015, Michigan paid $94,500 per course of Harvoni and $84,000 per course of Sovaldi, but its Department of Corrections decided to cover anyone who would be eligible to receive the drugs through Medicaid if they were not incarcerated, including those with advanced liver scarring. This made about 600 prisoners eligible out of the estimated 4400 inmates with HCV. So far, around 400 have been treated, costing the state $26 million.

Michigan is one of several states that has instituted policies on HCV treatment before a lawsuit like Chimenti’s forces them to. New Mexico, the state with the highest HCV rate among its prison population at 40%, has treated 75 inmates so far at a cost of $80,000 per week for each person treated. The cure rate for these prisoners after treatment is 100%.

Experts said that this high cure rate is why the expensive treatments are actually cost-effective in the long-term, despite the estimated $33 billion cost to treat all US inmates with the virus. The American Association for the Study of Liver Diseases recommends treating nearly everyone with HCV in order to prevent more infections, especially in prisons where many cases are concentrated due to high rates of intravenous drug use, poverty, and mental illness.