I have to chime in too.  I too work for corrections.  I work at the county jail part time, and full time at a forensic psychiatric center.  A few patients have asked if they would be treated with sorosbuvir at the facility. They were told the cost is very expensive.  The patients feel to weigh their lives against the cost of treating them, should not matter.  Not sure what "our" facility is going to do yet, but I will let you know if I hear of one of them being treated. I am open minded and am on the fence with this topic.  Although, I know it is expensive, my fear is that they would start the treatment in jail or prison, etc, and get released, and won't be able to complete it. That would be a total waste.   We are praying my husband Tom will  be able to get the new treatment. I beleive his insurance company would cover it....(we only hope) as he  is still taking nexavar to prevent his liver cancer from returning. I know each patient has to be of certain criteria, and I think he reaches all of it.  We are hoping to have him start it this fall if possible.   

A link people on this thread might like to see. Drugs been approved for prisoners in Ill.

http://www.cbsnews.com/news/1000-a-day-hepatitis-c-drug-approved-to-treat-prison-inmates-in-illinois/

So much too ponder on.  So many ideas, and all good.

Rachel

Matt Chris wrote:

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Interesting topic, with all the new treatment choices coming on board in the next year or two I would guess that one of the Big Pharma companies will negotiate a fixed price with a either Federal or State government Agency which will likely take a law change on how Drug companies deal with State and Federal Agencies.

The company that gets that contract will be a big winner.

 

        __________________________________________________________________________________________________________

Very astute, Matt.  Seems likely to me.   

The government is not likely to alter the free market system we capitalists enjoy.  They will find a way to make it work where the rich get richer.

Under the 8th amendment's prohibition against cruel and unusual punishment inmates have a constitutionally protected right to adequate health care.  That generally means health care that is equivalent to what a free person who is receiving government subsidized health care would receive.  I expect inmates will be subject to the same priority system (based on medical need) as that set in the free population assuming it comes to that.

States may try to get around providing expensive hep c tx to inmates but state legislation will be subject to both their state's and the federal constitution's standards. Obviously, any federal legislation will also have to pass constitutional muster.

The objective should not be to decide who needs to be thrown off the life boat, but rather, how to keep everyone afloat.  It is highly doable if we set some limits on greed and use some sense with government spending.

Keep in mind that most inmates will return to free society.  Sending them back out with infectious diseases is a public health issue.

Hi Rachel,

Let me tell you how sorry I am to hear about the violent crime carried out against you. That happened to me many years ago and the a-hole walked on a technicality. I feel your anger, trust me. I also agree that they should be at the end of the line and the qualifications to stand in that line would be extensive and difficult. The cost of incarceration here in the States is obscene and it seems the needs of the prison population are always in the news here. The incidence of HCV and HIV in the prison system is extremely high, so I know that something has to be done. Perhaps they need to use up the stores of Interferon, Riba and Incivek on them before trying the gold standards available to the law abiding citizens. It's a very contentious subject, rightly so...

Tig

I am new to this forum and most likely this topic is not going on.  But this subject hit a nerve.   I live in Quebec.  The provinice just put the drug sovaldi on it drug review board.  So who knows when it will get to the provincial health plan.  But if you can afford it, you can obtain the drug at a Federal level.  I can not afford the drug for I am on Victims Compensation which does not pay for any drugs which are  not related to the crime. 

I use to have a very prestige profession, paid well, great health insurance, and was studying at night to obtain another degree (masters).  I lost everything to a violent crime. The person who did this to me, received the "Dangerous Offenders Act", meaning life in prison.  This man did so much damage to me physically, psychologically, socially, mentally and financially.  Now, when I heard about Federal prisoners getting new hepatitis c drug in Canada - it really hit a nerve.  Victims on compensation do not even get medication paid.  No dental, no free education......they receive the basics to put food on the table.

I had to really put up a fight with the Provincial and Federal Health care system.  The provinicial and federal Victims compensation have no power or funding for victims.  Money is being put into prisons for their health, education, dental etc.  It should be that the victims come first before prisoners who commit violent crimes and destroy lifes. 

I am lucky that I am a determined person.  I fought tooth and nails the Gouvernement.  And the only reason why I received the drug is because I am on my last stage, cirrohosis and very sick.  But what about the other people who are suffering.  Some victims do not have the strength to fight.  So they give up.

Rachel

-- Edited by Rachsavagesam on Thursday 17th of April 2014 05:18:55 AM

Hey  Jill

Interesting topic, with all the new treatment choices coming on board in the next year or two I would guess that one of the Big Pharma companies will negotiate a fixed price with a either Federal or State government Agency which will likely take a law change on how Drug companies deal with State and Federal Agencies.

The company that gets that contract will be a big winner.

Yes, the prison population should be treated if they pass a drug test and are trying to reform themselves.

matt     

Hi Jill,

You have opened a 'can of worms' (Sorry!). As Tim said, this will be postponed until the cost issue is resolved.  Abbvie may have the sense to put a reasonable price on their drugs, once approved. Poor old Merck will     probably have the best cut-price option. At the moment, Sovaldi has all the attention. SVR figures for Abbvie and Merck will probably be just as good, and those who pay for this stuff will question whether Sovaldi is worth it. This time next year, we'll have some idea. Cheers.

Hi Tim, I was hoping you`d come in on this as I know you have experience of the prison service, so thanks for your comments.

There`s no easy answer to this question and when resources are stretched I think stigma plays it`s part too as far as prison inmates with Hep C are concerned, and that certainly applies over here in the UK too.

Hi Jill,

This a such a relevant topic, one that will be easier(and less expensive) to talk about than for the public and governmental agencies to agree on, for a proper solution.   In 2012 just before I retired from the Sheriff's Dept. the medical staff were in a debate as to how best to deal with treating the approximately 40% of the inmate population that are HCV infected.   Compounding the problem is that the state has 'dumped' thousands of inmates back onto the local cities/counties, in order to avoid budget busting healthcare costs.       Here in the U.S. everyone wants all the public services(roads, streetlights, ERs etc) and of course strict criminal laws and public safety.  But, nobody wants to PAY for all of that, as in increased taxes.    Public healthcare for the 'law abiding' citizens is still a political hot potato, so I expect that HCV treatment for prisoners will be postponed off into the future...

This was an issue faced by H.I.V drugs in the past. The needs of long term care will be assessed and addressed eventually. I think the pressure will be placed and change will be fast...

Hi Wayne, thanks for your comments and I agree with everything you`ve said.  These new drugs are such huge advance in Hep C treatment, which is what we`ve all been waiting for, but the enormous cost has to be met somehow and that has opened up new questions and dilemmas.  We all understand that the drug companies want to recoup the the expenses involved in getting these drugs through the development processes and to market, and Gilead of course needs to recoup the $11 billion it paid out to acquire Pharmasset, but the bottom line is that at some point the drug companies will surely be obliged to compromise on profits and make these drugs more affordable to more people. 

Hep C is such massive global public health issue and it seems morally wrong that so many peoples` lives are at stake when effective treatments exist.  A work in progress, indeed.

Interesting dilemma, isn't it? The estimates of the number of people living with chronic HCV in the US (~2.7-3.2 million) are based on numbers provided by the National Health and Nutrition Examination Survey (NHANES), which does not include the incarcerated, homeless, nursing home residents, hospitalized persons, or those on active military duty. Expanded to include these people, prevalence estimates are well north of 5 million. So we have a serious national health problem that is much worse than generally advertised. If all of the HCV infected seek treatment at the same time, it clearly bankrupts the payer systems currently in place. If treating only the sickest first and those with more generous health plans, then everyone else is placed on the back burner awaiting treatment while their condition worsens, which of course only adds to the financial burden further down the road.

The only solution I can see are more affordable drugs. But we all know what the Gilead, et al., arguments will be when asked to explain the high cost of their meds. Much uncertainty in the air right now, and at a time when there's also so much hope. A work in progress, methinks.

wayne 

An interesting article which raises many questions of cost/health benefits and moral obligation to prisoners and the wider community.  Here are some quotes from the article, to read it in full follow the link...

`If used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States.  But the high price of the drugs might prevent their use in prisons, which house as many as one-third of those who are infected.`

`The new drugs, simeprevir (marketed as Olysio by Janssen Therapeutics, a division of Johnson & Johnson) and sofosbuvir (sold as Sovaldi by Gilead Sciences), have a cure rate of  95 percent or better in some clinical studies, compared to 45 percent for previous medications. Unlike the alternatives, simeprevir and sofosbuvir cause only mild side effects, and can be taken orally.  Furthermore, patients only have to take them for12 to 24 weeks, compared to at least 48 weeks for the previous treatments.`

`Yet at approximately $1,000 per pill, the cost is likely to prove a challenge for the entire health care system, including Medicaid, Medicare and private insurance companies.  The difference is that prisons are constitutionally bound to provide adequate health care to prisoners.`

`States and municipalities typically pay for prisoner health care out of their corrections budgets.  When effective HIV treatments emerged in the late 1990s, those budgets grew to accommodate the cost of the drugs, said Edward Harrison, president of National Commission on Correctional Health Care, which sets standards for prisoner health care.`

`But the new hepatitis C medications present a much bigger challenge. "The prevalence of HCV [hepatitis C) is 10 times greater than HIV and the cost of treatment is probably 10 times greater than a year`s worth of treating HIV," said Anne Spaulding of Emory University, one of the leading researchers on hepatitis C in prisons.`

http://www.pewstates.org/projects/stateline/headlines/should-prisoners-get-expensive-hepatitis-c-drugs-85899542574