[Pnews] Hepatitis C Drugs Save Lives, but Sick Prisoners Aren’t Getting Them

Prisoner News ppnews at freedomarchives.org
Fri Mar 16 10:29:45 EDT 2018


https://www.nytimes.com/2018/03/15/us/hepatitis-c-drugs-prisons.html


  Hepatitis C Drugs Save Lives, but Sick Prisoners Aren’t Getting Them

Ted Alcorn - MARCH 15, 2018
------------------------------------------------------------------------

Any national campaign to eliminate hepatitis C, an insidious virus that 
kills tens of thousands of Americans a year, would almost certainly 
involve prisons.

One in seven <https://www.ncbi.nlm.nih.gov/pubmed/28926560> state 
inmates are believed to be infected, and the regimented environment of a 
prison has its advantages when it comes to screening and treatment.

The problem is, the drugs that effectively cure the disease are priced 
in the tens of thousands of dollars — far more than prisons can pay. In 
2015, state corrections departments were treating less than 1 percent of 
those inmates known to be infected, a 
<https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0296>survey 
found <https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0296>.

Now courts have begun ordering states to provide the drugs regardless of 
cost, prompting an unusual showdown over how pharmaceutical companies 
set prices for the treatments.

In at least nine states, prisoners have filed lawsuits arguing that 
withholding drugs constitutes deliberate indifference to their dire 
medical needs, violating a constitutional ban on cruel and unusual 
punishment.

Last week, Massachusetts settled a lawsuit by agreeing to give all 
prisoners in advanced stages of the disease access to drugs.

In November, a federal district judge in Florida was the first to order 
a state prison to begin treating sick inmates. The state must now 
provide drugs to all inmates with severe liver damage by the end of this 
year and those with significant damage in 2019.

“This Court will not tolerate further foot dragging,” Judge Mark E. 
Walker wrote. “One can only wonder how long Defendant would have kicked 
the can down the road had Plaintiffs not filed this case.”

Dr. Anne Spaulding, an associate professor of public health at Emory 
University and the former medical director of the Rhode Island 
Department of Corrections, called the order an unfunded mandate. “It’s 
an impossible situation that the prison administrators are put in,” she 
said. “You can’t buy something you don’t have any money for.”

Prisons would be a logical linchpin in a campaign to eliminate hepatitis 
C: some studies <https://www.ncbi.nlm.nih.gov/pubmed/24587554> suggest 
that one in three Americans with the disease pass through a correctional 
facility in any given year.

Delaying treatment has grave consequences. A leading cause of cirrhosis 
and end-stage liver disease, hepatitis C wreaks irreversible but 
invisible damage for years; when symptoms become apparent, it is too 
late to treat. The disease is blood-borne and usually acquired from 
unsafe transfusions or injection drug use, but perhaps only half of 
those infected know they have it. It can also be transmitted through 
tattooing using nonsterile equipment.

Early therapies for hepatitis C induced fatigue and depression in many 
patients and cleared the infection in less than half of them. But four 
years ago drugmakers began to introduce new medicines that do not have 
the same debilitating side effects and cure nearly all patients, 
revolutionizing treatment.

In return, the companies demanded high prices — Gilead Science debuted 
the first of the new class of hepatitis C drugs, Sovaldi, at $84,000 per 
course of therapy — and private insurers proved willing to pay.

Competitors have driven down the price. The latest entrant, AbbVie’s 
Mavyret, was introduced in August 2017 at $26,400. But the treatments 
remain highly profitable. Manufactured for just dollars per course of 
treatment, Gilead’s hepatitis C drugs 
<https://www.nytimes.com/2015/02/04/business/sales-of-sovaldi-new-gilead-hepatitis-c-drug-soar-to-10-3-billion.html> 
have brought in more than $55 billion in revenue since 2014.

Drugmakers have long defended their high prices, arguing that their 
business model for developing new drugs depends on being able to reap a 
profit from existing ones. In the case of hepatitis C, this system has 
yielded drugs that the most affected populations have no way to afford.

“We are harming millions of people because of allegiance to a model of 
innovation that constrains delivering that innovation,” said Peter Bach, 
a drug pricing expert who directs the Center for Health Policy and 
Outcomes at the Memorial Sloan Kettering Cancer Center. “That model — 
the central dogma of pharmaceutical development — is broken.”

As people with private insurance gained access to hepatitis C treatment, 
it became less defensible to withhold it from prisoners. Florida had 
treated just 13 inmates when the federal court intervened. More than 
5,000 inmates there have been diagnosed with chronic hepatitis C, but 
the corrections department does not conduct proactive screening, so 
officials concede there are likely closer to 20,000.

The Florida Legislature has allocated $36 million to fund treatment 
through June 30, 2019, in a budget bill that awaits the governor’s 
signature. State Senator Jeff Brandes, chairman of the Appropriations 
Subcommittee on Criminal and Civil Justice, believes that amount will be 
sufficient to satisfy the court’s order to treat the sickest inmates, 
but it will leave thousands of others infected.

“You kind of feel like Sisyphus pushing the rock up the hill,” he said.

Left untreated, prisoners will suffer irreparable liver damage and may 
transmit the infection to others. While state prisons that withhold 
drugs may protect their own budgets, the cost will likely still fall on 
taxpayers once the prisoners are released and seek care through Medicaid 
or other avenues, said Dr. Harish Moorjani, an infectious disease 
specialist who oversees care for prisoners in New York State.

“You may take a short-term view, whether you are a governor or a state 
legislature or whatever budget authority you are, but there is a price 
to be paid for that,” Dr. Moorjani said.

New York has taken a longer view, approving 2,009 inmates for treatment 
between 2014 and 2017 at a cost of about $140 million.

Some states have tried to obtain drugs at lower prices by banding 
together for greater bargaining power and by enrolling prisoners as 
patients in hospitals that already get discounted drugs. These tactics 
have moderately reduced prices, but corrections officials say they would 
need to be vastly cheaper to even consider treating all eligible prisoners.

Lower prices are available — in Egypt. Once the country with the highest 
rate of hepatitis C in the world, it may become the first to eliminate 
it 
<https://www.nytimes.com/2015/12/16/health/hepatitis-c-treatment-egypt.html>. 
Gilead allows manufacturers there to license its drugs, and the price of 
treatment is just $80 per patient. The country has already cured 1.6 
million cases.

Gregg Alton, an executive vice president at Gilead, defended the prices 
the company charges in the United States. Like other drugmakers, Gilead 
promises its best price to state Medicaid programs, the Department of 
Veterans Affairs, and certain hospitals. If the company lowered the 
price for prisons, Mr. Alton said, it would have to further reduce it 
for these other entities. Giving prison health systems access to the 
same discounted price would require an act of Congress.

“I would love to see all the poor people in the United States have 
unlimited access to hepatitis C medication,” Mr. Alton said. But, he 
argued, states must pay for it. “They have to be accountable for 
providing a reasonable budget.”

Some experts worry that drug companies will become even more reluctant 
to reduce their prices as courts order states to treat their inmates, 
since it effectively prevents them from leaving the negotiating table.

In an attempt to break the impasse, the National Governors Association 
recently convened representatives from states and drugmakers. Louisiana 
brought up a little-used section of patent law that would allow the 
federal government to manufacture the drugs for the public interest, 
paying only reasonable compensation.

Participants also broached the idea of a Netflix-type model, in which 
states would license bulk use of drugs rather than pay per patient. They 
reason that drug companies might vie for the large, untapped market of 
state prison inmates.

Whether the idea becomes a reality is up to the drugmakers. Asked about 
the company’s position, a Gilead spokesman wrote in an email, “We’re 
open to discussing all innovative access solutions that can help 
patients access important therapies.”

-- 
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