title: New Hepatitis C Drugs Are Very Costly And Unavailable To Many State Prisoners.
abstract: Prisoners bear much of the burden of the hepatitis C epidemic in the United States. Yet little is known about the scope and cost of treating hepatitis C in state prisons-particularly since the release of direct-acting antiviral medications. In the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 (0.89 percent) of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively). Numerous corrections departments received smaller discounts than other government agencies did. To reduce the hepatitis C epidemic, state governments should increase funding for treating infected inmates. State departments of corrections should consider collaborating with other government agencies to negotiate discounts with pharmaceutical companies and with qualified health care facilities to provide medications through the federal 340B Drug Discount Program. Helping inmates transition to providers in the community upon release can enhance the gains achieved by treating hepatitis C in prison.
authors.affiliation: Adam L. Beckman was an undergraduate at Yale College and research assistant at the Yale Global Health Justice Partnership, both in New Haven, Connecticut, when completing this work.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Beckman
authors.affiliation: Alyssa Bilinski is a PhD candidate in health policy in the Harvard Graduate School of Arts and Sciences, in Cambridge, Massachusetts.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Bilinski
authors.affiliation: Ryan Boyko is a PhD candidate in the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health, in New Haven, and a fellow at the Yale Global Health Justice Partnership.
authors.forename: Ryan
authors.initials: R
authors.lastname: Boyko
authors.affiliation: George M. Camp is co-executive director of the Association of State Correctional Administrators, in Hagerstown, Maryland.
authors.forename: George M
authors.initials: GM
authors.lastname: Camp
authors.affiliation: A. T. Wall is director of the Rhode Island Department of Corrections, in Cranston.
authors.forename: A T
authors.initials: AT
authors.lastname: Wall
authors.affiliation: Joseph K. Lim is an associate professor of digestive diseases and director of the Yale Viral Hepatitis Program, Yale University School of Medicine, in New Haven.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lim
authors.affiliation: Emily A. Wang is an associate professor of general medicine at Yale University School of Medicine.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Wang
authors.affiliation: R. Douglas Bruce is an associate clinical professor of medicine at Yale University School of Medicine and chief of medicine of the Cornell Scott-Hill Health Center, in New Haven.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Bruce
authors.affiliation: Gregg S. Gonsalves (gregg.gonsalves@yale.edu) is codirector of the Yale Global Health Justice Partnership, a research scholar in law and lecturer in law at Yale Law School, and a PhD candidate in the Department of Epidemiology of Microbial Diseases at Yale School of Public Health.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Gonsalves
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000191:economics* / Q000627:therapeutic use; D006526:Hepatitis C / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009657:North Carolina; D011329:Prisoners; D011330:Prisons / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000069474:Sofosbuvir; D013219:State Government; D014481:United States; D014542:Uridine Monophosphate / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D001562:Benzimidazoles; D005449:Fluorenes; C000595958:ledipasvir, sofosbuvir drug combination; D014542:Uridine Monophosphate; D000069474:Sofosbuvir
keywords: Access To Care; Cost of Health Care; Disparities; Public Health; Special Populations