By Peter Loftus
The high price of new hepatitis C drugs is keeping them out of
reach of many prison inmates, limiting the ability to cure the
disease in one of the nation's largest infected populations.
Two treatments introduced late last year have steep price tags:
Gilead Sciences Inc.'s Sovaldi has a list price of $84,000 per
patient for a standard 12-week treatment, while Johnson &
Johnson's Olysio costs $66,000 for the same duration.
The drugs promise faster treatment and a better chance of a cure
than older drugs do, but some prisons aren't providing them because
of budget constraints. Others are rationing them to inmates with
the most serious cases. Some prisons have asked state lawmakers for
funding to help pay for the drugs, so far without success.
The Federal Bureau of Prisons, which houses about 9% of the
nation's inmates, gets a 44% discount on Sovaldi and Olysio through
a U.S. Department of Veterans Affairs program, making the drugs a
bit more affordable.
State prison systems, which house 58% of U.S. inmates, generally
don't have access to these discounts, though some are exploring
other ways to get price breaks.
Hepatitis C treatment usually isn't offered in local jails and
prisons because inmates often are incarcerated less than a year,
which isn't enough time to treat patients using the older
drugs.
The virus is transmitted via contact with infected blood,
including sharing needles for injected drugs, sharing personal
items such as razors and sexual contact.
Many prisoners with hepatitis C became infected before they were
incarcerated. Chronic infection with the virus can take years to
progress, but if left untreated it can cause cirrhosis or liver
cancer and require a liver transplant.
Public-health and prisoner advocates say the cost burden of the
drugs could hamper an otherwise strong opportunity to tackle
hepatitis C. Prison life is often well-suited to treatment because
the staff can monitor inmates to make sure they take their
pills.
Curing prisoners also could help reduce transmission of the
virus in the general population after inmates are released.
"Close to 95% of these men and women will be back out in the
community," said Michael Ninburg, executive director of the
Seattle-based Hepatitis Education Project, which provides classes
about hepatitis C to inmates in the Washington State Department of
Corrections. "It's really a missed opportunity if we're not
addressing hepatitis C in the correctional setting."
Some 12% to 35% of the 2.3 million inmates in the U.S. are
estimated to be infected with hepatitis C, versus 1% to 1.5% of the
general population, according to the Centers for Disease Control
and Prevention.
Gilead says its pricing for Sovaldi reflects the drug's
potential to cure hepatitis C and ward off more costly health-care
services down the line.
J&J said it is having discussions with prison systems to
negotiate a price for Olysio that ensures prisoners have access to
it.
Spending on hepatitis C already had been on the rise in some
prisons due to the 2011 introduction of two drugs that added about
$50,000 in costs per patient. The drugs, known as protease
inhibitors and sold by Merck & Co. and Vertex Pharmaceuticals
Inc., generally improved cure rates to a range of 66% to 79% for
people with the most common type of hepatitis C, from 40% to 45%
for older drugs.
Sovaldi, when added to two older drugs, can shorten treatment
duration to as little as 12 weeks from 48 weeks for the older
drugs, while improving cure rates to about 90% for the most common
type of hepatitis C. Olysio, which is typically given for 12 weeks
combined with at least 24 weeks of the two older drugs, has shown a
cure rate of about 80% for the most common type of the disease.
The Federal Bureau of Prisons saw spending on hepatitis C drugs
more than double to $4.4 million in 2012 from 2011, partly because
of the cost of protease inhibitors, a spokesman said. The bureau
started making Sovaldi and Olysio available to inmates in
February.
Meanwhile, state prison systems have taken different tacks with
these two drugs.
In New York, nearly 60 inmates with the most serious cases of
hepatitis C have begun using them, a spokesman said. California's
system isn't yet offering the treatments but is revising its
policies to incorporate them, said a spokeswoman for the
court-appointed federal receiver that oversees health care in the
system.
Elsewhere, Utah hasn't yet begun using the drugs in its prisons,
the Illinois Department of Corrections recently approved their use,
and Washington state and Wisconsin are dispensing them in a limited
number of cases.
"Because these are so expensive and there's a limited budget,
we're having to be even more selective about how to use our medical
dollars wisely," said Robert Striker, an infectious-disease
specialist at the University of Wisconsin who treats inmates in
that state's system as a consultant.
Write to Peter Loftus at peter.loftus@wsj.com
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