The Oklahoma Department of Corrections has made strides in hepatitis C treatment, but only a small number of prisoners with the virus have received drugs that could cure it.
The agency reported there were 3,118 inmates with hepatitis C in September. But since July 1, only 243 people — or about 8 percent — have received drugs that could cure the disease, according to data provided by DOC. Only those with the most severe infections are prioritized for treatment.
The problem, agency leaders say, is the high cost of the potentially life saving drugs, which are priced in the tens of thousands of dollars. DOC cannot afford to treat everyone who has the virus, officials say.
Hepatitis C treatment costs DOC between $13,200 to $62,000 for just one patient, according to data from the agency. From FY 2016 to FY 2019, DOC spent more than $2.5 million on the drugs.
Oklahoma ranks second in the nation for the prevalence of the virus, only behind Washington D.C.
DOC spokesman Matt Elliott said treating people in prisons would offer the state its best chance at eradicating the disease. DOC, along with lawmakers and other state agencies, is exploring solutions to the costly problem ahead of the 2020 legislative session.
“Although hepatitis C treatment is expensive, the costs of end-stage liver disease, cirrhosis and other medical conditions associated with it can be more expensive in the long run in prison or the general public,” he said in an email.
Hepatitis C is a blood-borne viral infection that can go undetected for several years, silently inflicting permanent damage on the liver until symptoms eventually start to show. Maybe more than half of the people with hepatitis C don’t know they have it, according to the Centers for Disease Control and Prevention.
The virus is most commonly spread through injected drug use and unsafe blood transfusions. It can also be transmitted through unsanitary piercing or tattoo needles. The infection is usually curable.
About one in 12 inmates is suspected of having hepatitis C, data from DOC shows. The Department of Corrections requested $91 million for hepatitis C treatment in its fiscal year 2020 budget, but the state Legislature only approved about $12 million for treatment.
Those funds will cover the cost of treatment for 450 to 550 patients, Elliott estimated. The agency is making progress on tackling hepatitis C, he said. DOC has treated more patients since July than it did over the previous three years combined.
Failing to treat the virus early has severe consequences, health care and criminal justice experts say. The more hepatitis C progresses, the more costly it is to treat, and any movement to rid the state of the virus would have to address prison populations.
Hepatitis C in prisons
DOC’s policy, which is modeled after the Federal Bureau of Prisons, prioritizes who gets hepatitis C treatment based on the severity of their infection and complications stemming from it, such as cirrhosis.
The agency does not yet have an opt-out policy for hepatitis C screening, which would require all people entering DOC custody to be tested for the virus unless they declined. Opt-out testing is recommended by the U.S. Preventive Services Task Force and the World Health Organization.
Instead, the agency tests for hepatitis C upon a doctor’s recommendation, Elliott said. Doctors look for symptoms indicating an inmate might have the virus, such as liver abnormalities on lab results, or proof of injected drug use or tattooing.
Oklahoma is not alone in its search for cheaper hepatitis C drugs. Across the U.S, prisons are failing to treat inmates with hepatitis C. Many states, such as Texas, Missouri and Florida have faced lawsuits.
Mandy Altman, director of the National Hepatitis Corrections Network, said of all the people who have hepatitis C, about one-third of them will pass through a correctional facility.
“So if you want to cure or eradicate hepatitis C, you have to look to the prison population. It would be an essential piece of that,” Altman said.
Altman said treating people while they are in prison is a good opportunity to reach groups that otherwise would be hard to engage in the healthcare system.
“Prison health is public health,” Altman said. “The prisoners are people in your community, They’re going to get released. It’s (treatment is) protecting you. It’s protecting your community. It’s a no-brainer.”
Damion Shade, a criminal justice policy analyst at the Oklahoma Policy Institute, a non-partisan think tank, described the hepatitis C problem in Oklahoma’s prisons as an “expensive time bomb.”
The number of incarcerated people with hepatitis C has nearly doubled since 2013. As that number continues to grow, so will the cost to treat the disease, he said. The cost of treatment will also increase as treatment is delayed and the infection causes cirrhosis or liver cancer.
“It’s not only terrible, inhumane suffering for those people,” Shade said, “it’s also a profoundly more expensive problem for taxpayers in the state of Oklahoma.”
State agencies, lawmakers studying solutions
State agencies and lawmakers are exploring ways to treat and prevent hepatitis C ahead of the next legislative session. At an interim study at the state Capitol last week, lawmakers and health care workers delved into the issue.
Clint Castleberry, director of health services for DOC, said the agency obtains its hepatitis C drugs from a wholesaler, but leaders are studying more affordable options. He pointed out public health concerns and potential lawsuits from prisoners not receiving treatment as an incentive to find solutions.
DOC is working with the Oklahoma Health Care Authority to monitor how other states contract with drug companies, he said. The agency is also looking to states, such as Louisiana, that have adopted a “Netflix” model to reduce the cost of the expensive drugs, Castleberry said.
Sally Bouse is the administrative programs manager of prevention and intervention for the Sexual Health and Harm Reduction Service division at the state health department.
She said because Oklahoma has the second highest uninsured rate in the nation and is one of 14 states that chose not to expand its Medicaid program, people have been allowed to “fall through the cracks” when it comes to treatment.
The health department is pushing initiatives to try to stop the spread of hepatitis C and HIV, such as preventing people from getting infected and increase treatment.
Bouse said one way to stop the transmission of the virus is through clean needle exchange programs that provide syringes and ways to safely dispose of the products. Studies have shown that programs such as those can reduce the spread of HIV and hepatitis C.
Those types of programs are illegal under state paraphernalia laws, Bouse said, but the health department is working with several lawmakers and groups on the initiative.
“We have very high hepatitis C numbers,” she said at the interim study. “So if we just look at prisons and jails, they house one-third of the hepatitis C epidemic.
“Treatment in DOC is cost-effective for society as a whole. It’s both helping our inmates and helping our general population.