Chart Review: Treating Hepatits C In Federal Prisons

Josee Farmer, Health Care Policy Intern

One in three individuals in jails or prisons have hepatitis C. According to a recent Department of Justice report, the Federal Bureau of Prisons (BOP) has increased its spending on hepatitis C treatment from $4.4 million in 2014 to $25 million in 2018—accounting for only 5 percent of the BOP’s total prescription drug expenditures in 2014 and rising to 20 percent by 2018. When the first cure for hepatitis C, Sovaldi, came to market in 2013, it had a list price of $84,000 per patient, but as competing treatments entered the market in the following four years, the average price per treatment decreased significantly, falling to $21,598 in 2018. While the BOP stated that its goal is to administer drugs that cure the disease whenever possible, the BOP’s hepatitis C spending only could have provided treatment for 65 inmates in 2013. The number of inmates who received treatment increased in the following years as the cost of treatment decreased, and in 2017 the BOP formally determined that cost would no longer be a factor in deciding who would receive treatment—explaining the jump from 600 treated inmates in 2016 to roughly 1,200 in 2017. Nevertheless, the need still remains high among inmates. The standard for determining who receives priority treatment, based on the severity of liver fibrosis, remained consistent from 2013 to 2018, meaning the need likely was not changing even as the number of provided treatments rose.

Cost data obtained from Medicaid Drug Spending Dashboard
Note: BOP is assumed to pay drug prices comparable to Medicaid pricing; Medicaid “Best Price” Rule (23.1 percent rebate) is accounted for.

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