A recent Wall Street Journal article reported that only 3% of patients with Hepatitis C in prisons are receiving the newest medications which have a cure rate over 90%.
This means most are not receiving these medications.
The reason is cost. Each treatment cost up to $1,000/day for a number of weeks. A commitment to treat everyone in prison would break the bank. There would be no money left for buildings, guards, etc. So, treatment is being rationed to those with failing livers or low platelets. This is equivalent to not treating diabetes until patients have retinopathy, renal disease, or need amputations.
But, it’s actually worse. Diabetes is not contagious. Hepatitis C is. If these prisoners regain their freedom, as many will, they will be in the general community. The Hepatitis C will spread – as all infectious diseases do.
I’m aware that pharmaceutical companies take great risk and need to recoup their investment. And they need to make money for their shareholders.
But, the cost of making these medications, once approved, is not significant. The main cost is R and D. So, if the drug was priced at 50% of current pricing, double the number of people could receive it. And the company’s profits would not be significantly different.
These medications are being rationed for prisoners. Some will eventually make the legal argument that the government is responsible for their care and they have a right to seek medical treatment. Do not be surprised if some courts let select prisoners be released early to find a way to get the medication.
And the rest of the population will likely be in the same pickle down the road. Rationing of treatments that are expensive and affect a large number of patients.
A number of years ago, India refused to issue patents for HIV medications. They argued their position will allow more people to have access to life-saving medications.
In the US, the government cannot take property without a compelling need, due process, and fair compensation. It is not a stretch to imagine that, at some point, the government will act – treating intellectual property under eminent domain, making the case that public health depends upon vital medications. The prison population may just be the canary in the coalmine defining how serious this problem could become if large pharmaceutical organizations maintain the status quo.
What do you think?
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It is incredibly difficult situation. My uncle has practiced medicine as a PA in a prison for the last 30 years. They have struggled to treat as many prisoners for hepatitis C as possible. It has broken the budget, and with that, the morale of the entire prison. There’s nothing left for anything else.
This political season should remind us what we should’ve learned a long time ago. There is no limit to the promises that can be made that will fix the problems (with someone else’s money). And the problems continue. And they seem to get bigger.
And just like every physician knows that you don’t treat rheumatoid arthritis with a pain pill. You don’t treat the symptom, you treat the root disease. The real disease of our culture is that we no longer know who we are, we no longer embrace freedom and responsibility.
My guess is the same situation exists with HIV+ inmates too. A few years ago, I stuck myself repositioning a needle while suturing a wound on our HIV+ patient. Thankfully he was using anti-retroviral meds and he had an undetectable viral load. My ID colleague prescribed a month of prophylaxis for me -The fee for Truvada and Isentress at that time was well over $100 per day.
A search on Harvoni revealed –
Harvoni cost in the US – $94,500 per treatment. If you are looking for cheap Harvoni price don’t look at the US. In the United States the price of Harvoni is the highest in the world. With an average cost of $1,125 per Harvoni pill, it is one of the most expensive drugs on the market.