Chino State Prison. (Kevork Djansezian/Getty Images)
Chino State Prison. (Kevork Djansezian/Getty Images)

By George Lauer, California Healthline

It’s the drug that can cure most people with hepatitis C in 12 weeks — but comes at a high cost: $1,000 a pill. Now, California Correctional Health Care Services, which oversees clinical care and drug prescriptions for 125,000 inmates at 34 prisons across the state, began using Sovaldi last month.

Made by Gilead Sciences of Foster City, Sovaldi has become part of the “community standard” for medical professionals treating patients with hepatitis C, according to prison officials. A full course of treatment runs about $84,000.

Hepatitis C, a viral infection that can lead to liver failure, cancer or other health problems, is often associated with intravenous drug use. Many of the estimated 3.2 million Americans living with hepatitis C in the U.S. are poor, imprisoned, elderly or all of the above, giving public systems a disproportionate share of hepatitis C patients.

‘A Tax on All Americans’

study released last month by Express Scripts Lab predicted state governments could spend more than $55 billion on hepatitis C medications.

“There is no doubt that Sovaldi is a breakthrough therapy,” the authors of the study wrote, “but unfortunately, it is also likely to break state budgets. Since health care for so many hepatitis C patients is funded by state programs, each citizen will be shouldering the unprecedented cost burden. The unsustainable pricing of this medication has essentially become a tax on all Americans.”

About 93,000 Californians in Medi-Cal and in the state prison system have chronic hepatitis C. If the state covers Sovaldi treatments for all of them, the bill would be about $6.6 billion, according to the study.

Impact Especially Felt in Prisons

While the high cost of Sovaldi could significantly increase spending in Medicare and Medicaid — as well as by private insurers — the impact could be especially felt in prison systems.

State Medicaid programs — Medi-Cal in California — are entitled by federal law to negotiate drug discounts, but state prison systems usually pay full retail prices. And because prisons typically have a larger percentage of hepatitis C patients than the general population, Sovaldi’s high price could have a significant influence on prison system budgets.

The use of expensive — but effective — treatments takes on added significance in California where the state prison medical system is operated by a federal receiver. A federal judge in 2006 determined the state’s prisoners were not getting adequate care and named a federal receiver to oversee and improve medical care.

An important tool in the measuring of effective health care in prisons is comparing care behind bars to the care received in the general population. If a treatment becomes a community standard on the outside, it will probably eventually become a standard in prisons. That process may be happening especially quickly in California where prison medical care is under so much scrutiny.

“It’s a pretty extensive process and it does take some time,” said Liz Gransee, public information officer for the California Department of Corrections. Sovaldi went through that process and emerged as a “community standard” last month, Gransee said.

Treating hepatitis C is not inexpensive, no matter what drugs clinicians try. The cost of one course of hepatitis C treatment in the California prison system last year ranged from $13,500 to $88,800, according to California Correctional Health Care Services officials.

Depending on the patient’s situation, expensive treatments such as Sovaldi can end up saving money in the long run, state officials said.

“Even though treatment using this drug is expensive, it is more cost effective than caring for a patient with end-stage liver disease who is dying, treating a patient who develops liver cancer, or providing a liver transplant for a patient. For these reasons, the judicious and carefully monitored use of the newly available drug makes sense, both from a medical and cost effective standpoint,” California Correctional Health Care Services wrote in an email response to questions about Sovaldi.

The overall cost to treat hepatitis C patients in California prisons was about $12.4 million last year, up from $9 million in 2012.

The prevalence of hepatitis C infection among prisoners is “substantially higher than that of the general U.S. population,” according to CDC. In the general population, 1 to 1.5 percent of people are infected, compared with 16 to 41 percent among prisoners.

High-Priced Drug Sovaldi Coming to California Prisoners with Hepatitis C 26 August,2014State of Health

  • Glenn Backes

    This is great! Treated prisoners will not infect others, nor will they develop expensive and deadly liver cancer or other late-stage conditions. In the end, not only ethical and humane, but a big savings for taxpayers.

    • Wayne-o

      What about all the NON felons who should be getting treated before convicted felons. If you can’t get treated by your insurance company, commit a felony, and sign up for a life saving treatment. That makes sense, right? Probably 80% of homeless people have Hep C.

  • normsrevenge

    Where do I sign up?
    What a country!
    Full of compassion for felonious inmates..
    while their victims&taxpayers can just wait in line until the price drops.

    • Andrew Reynolds

      We do not have much compassion for “felonious inmates”. We have the largest prison system in the world, and while the medical conditions vary from prison to prison and jail to jail, they are not the same standard as the community. Far more people are treated for HCV outside of prison than inside. That said, the Supreme Court has said that to not provide adequate care and treatment to prisoners amounts to cruel and unusual punishment and is therefore unconstitutional. We should have compassion for prisoners…ideally before they become prisoners. Better access to drug treatment, mental health services and economic opportunities will keep people out. But once in, we are morally and legally obligated to take care of them. As Dostoevsky states: “The degree of civilization in a society can be judged by entering its prisons.”

      • impoundguy

        Everything is “cruel and unusual” in California….the death penalty is cruel and unusual…having them in the prison cells is cruel and unusual…and now not providing a $1,000 per pill is cruel and unusual…the fact that they raped, murdered and harmed innocent others is CRUEL AND UNUSUAL punishment to their victims…did they care about them…NO…and neither do I or the majority of others who do not have the “bleeding heart syndrome” like yourself, care for their well being….they made their own poor choices by committing offenses that put them where they are….sometimes poor choices have consequences.

  • impoundguy

    A $1,000 per pill….seriously. You could probably buy it at CVS for $2….must be nice to be in prison and get better medical care then your victims probably did!!

  • Lorenzo

    So how does this work? If someone has insurance, does the insurance cover the full price? If not, what is the co-pay? So, here is the next question. Say you have insurance, but the copay is too high. If you cannot afford the copay, and thereby not get the medicine, it sounds like it is better to break the law to get into prison so you can get treated. Considering that Hep C is a life-threatening disease, it sounds like this is the only way one could get cured? If not, could someone explain how to obtain the drug otherwise. It is like having Type 1 diabetes and being priced out of being able to get insulin. You might as well just steal a loaf of bread, wait for the cops, go to jail and get what you need to survive. Crazy country we live in.

    • G.B.

      All drug companies have financial assistance programs that help with high co pays or give free drug to those that have no insurance.

  • Crazy Republicans will object to this one. Just remember that Hep C is contagious to medical staff who moonlight in hospitals and nursing homes, as well as to guards and inmates. Eventually prisoners will get out, most of them, and lowering this infection rate can only benefit us all. Anything costing $1k a pill is rip-off, the manufacturer needs to be called out for doing this overpricing.

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