$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.