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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