A new hepatitis C treatment that costs $1,000 a pill will soon be given to some Michigan prison inmates.
The same drug isn’t available to most Michiganians, whose insurance companies won’t pay for it. It may become broadly available to people on Medicaid.
The Department of Corrections 2015 budget, which totals roughly $2 billion and takes effect Oct. 1, includes $4.4 million for sovaldi, a drug with a high success rate in treating the disease without the debilitating side effects associated with standard treatments.
The Detroit News contacted several prison-related national groups Wednesday, but none was able to say whether Michigan will be the first state to offer Sovaldi to inmates. Illinois passed a law specifically prohibiting its use for prisoners.
States mostly are dealing with whether to provide the treatment option to non-convict Medicaid patients — and that debate likely will be coming here soon. New York, Oklahoma and Colorado have approved the drug, which was approved by the U.S. Food and Drug Administration in December, for their citizens who are covered by Medicaid. Louisiana did as well, but limited the treatment course to 12 weeks.
More than 2 million Michiganians are covered by Medicaid; the health care program for people with low incomes was expanded April 1 and more than 330,000 have enrolled since then.
The Michigan Department of Community Health already is providing the drug on a “case by case” basis to non-inmate Medicaid patients, spokeswoman Angela Minicuci said. She was unable to say Wednesday how many that is.
The prospect of providing sovaldi to large numbers of people on Medicaid alarms the Michigan Association of Health Plans, which represents private insurers including health maintenance organizations that serve people on Medicaid.
The Association of Health Plans estimates that first-year costs of providing sovaldi to Medicaid patients will total $400 million — 11 times the combined $36 million profits earned by Michigan’s Medicaid HMOs in 2013, according to a letter the group sent in July to the state health department’s Pharmacy and Therapeutics Committee. It has asked the state to delay any move to add sovaldi to the list of drugs Michigan’s Medicaid program will cover without special authorization.
“Given the magnitude of folks on Medicaid plans ... the money involved will rival dollars that are advocated for roads,” said Rick Murdock, executive director of the health plan association.
Among the rest of Michiganians — those not in prison or on Medicaid — Murdock said “some” of their insurers cover the drug, “some not yet.”
“In the future,” he said, “all of them are going to have to deal with this one way or another.”
Murdock was unable to name an insurance company that pays for sovaldi.
Up to $100K cost per patient
According to the federal Centers for Disease Control and Prevention, about 1 percent of Americans, or roughly 3 million people, are infected with the hepatitis C virus, which is spread primarily by blood, sex and intravenous drug paraphernalia. Estimates weren’t available on the number infected in Michigan. The CDC recommends that baby boomers get tested because 81 percent of people infected were born between 1945 and 1965.
Murdock describes the prospect of an $84,000-per-patient treatment for each patient — up to $100,000 when combined with other drugs — as an out-of-control train barreling toward the insurance industry. He notes that most Medicare Part D prescription plans are expected to cover sovaldi, resulting in higher costs for the federal government and health insurers, as well as higher premiums for Medicare patients.
“You have a sole producer of the drug charging $1,000 a pill, you have the Centers for Disease Control urging everyone be tested, you’ve got the federal government covering it under Medicare, and now states have to deal with it relative to the prison population,” Murdock said. “Once you turn than on, how do you turn that off?”
Concerns about spread of disease
According to some experts, the eye-popping cost of sovaldi has detracted attention from its potential savings. The progression of hepatitis C leads to years, even decades of medical care, followed by serious liver damage, costly dialysis treatments and liver transplants — destruction that might be stopped in its tracks with a 12-week course of the drug.
“From the research and the tests, it does a better job curing some of these cases,” said Russ Marlan, spokesman for the state Corrections Department. “Certainly the medication is expensive, and it’s new. (But) the alternative can be pretty expensive, too.”
According to Marlan, the pills will be “targeted to the serious cases where the traditional hepatitis C drugs have been ineffective.”
“As the condition gets worse for some, for the prisoners that are on the more serious side with extreme liver issues, these are the ones that we’re targeting,” he said.
Emery University College of Law professor Polly Price, a specialist in public health law, said prisons are “petri dishes” for diseases, and the public has an interest in containing diseases such as HIV/AIDS, tuberculosis and hepatitis C.
“It would be better if we could treat everybody, but if you have the opportunity to try to control the disease, you should take it,” said Price, who advises the U.S.-Mexico Border Health Commission on how to contain TB brought into the country by immigrants, who often are housed in jails and prisons.
“You don’t want to create this inferno inside a prison when the population is going to be moving out into the public at some point.”
Mel Grieshaber, executive director Michigan Corrections Organization, the union that represents Michigan’s 6,300 corrections officers, said he supports the measure if it will protect prison guards.
“There’s biting, scratching — they might be cutting themselves,” Grieshaber said of the prisoners. “We are constantly concerned about the transmission of all communicable diseases and hepatitis C is one of them.
“Not to minimize the cost, but $4 million in the scheme of a $2 billion budget is not a lot of money, and the officers are constantly concerned about the exposure to contagious diseases in there.”
Michael LaFaive, director of fiscal policy for the Mackinac Center, a free-market research institute, said the state has a constitutional responsibility to provide health care for prisoners as long as the state is fiscally responsible for the overall budget.
“If the marginal benefits of these pills exceed the marginal costs, I think you could made a case for the expenditure,” LaFaive said. “If the expenditure exceeds the benefits, I think there are plenty of ways to cut costs in the prison system — such as contracting out for the management of just one prison.”