$210.5m is One Hard Pill to Swallow

A couple of years ago, Florida TaxWatch published a report, “Florida’s Aging Prisoner Problem,” that discussed the disproportionately high cost brought on by elderly inmates in the Department of Corrections, largely for healthcare expenses.  In this report, we did a case study on an expensive antiviral drug treatment for hepatitis C with a 95 percent cure rate that Illinois had approved for use in its state correctional facilities.  Recently, a Federal court has ordered the Pennsylvania Department of Corrections to administer this drug, Sovaldi, or a similar drug, Harvoni, to one of its death row inmates in a preliminary injunction ruling.

Many advocates are praising the decision, which will open the door for other inmates who are in dire need of better healthcare services; and the effectiveness of the drug will drastically improve the quality of life for many inmates with hepatitis C.  It’s important to remember, however, that inmates have a constitutional right to healthcare services; unlike members of the general population. So, if the decision is ratified, it will become the new standard. When combining this possibility with the drug’s “$1,000 a pill” price tag and the fact that inmates make up almost a third of all U.S. hepatitis C cases, it becomes clear that the constitutional obligation to make this drug available to all inmates could bankrupt state corrections departments as well as take valuable resources away from other critical public services.

For a full course of treatment, it can cost states $61,000 to $122,000 per inmate, depending on the severity of the illness and the inmate’s length of stay.  No matter what your opinion on the court’s decision to make the drug accessible to inmates, that is an undeniably hefty cost.  Assuming the estimated national average for hepatitis C prevalence in prisons (17.4 percent) applies Florida, the cost to treat them with this new drug could go as high as $210.5 million—more than half of the entire DOC healthcare budget.  When applying the highest reported prevalence rate (New Mexico - 41.1 percent), that number increases to almost $5 billion—6.5 percent of the entire state budget.

States that have already made the drug available have had to make some pretty drastic moves to offset newly incurred costs. This is especially true for states already in a budget crunch.  Illinois, for example, was already facing budget challenges when it began making the drug available to inmates.  The state's proposed solutions to mitigate the fiscal burden of the drug ranged from releasing over 15,000 prisoners to making temporary tax hikes permanent.  

While a price tag should never outweigh constitutional requirements to provide the best health services possible to individuals in state care, requiring expensive treatments like Sovaldi/Harvoni will undoubtedly have an effect on the community at large. Going forward, Florida must plan for the possibility that this drug may soon become a requirement, and ensure that it will not have a severe impact on taxpayers or other critical services provided by the state.