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Iowa Prisons Use Sovaldi
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Iowa prisons use drug called Sovaldi that costs $1K per pill to treat hepatitis C
ASSOCIATED PRESS
September 08, 2014
DES MOINES, Iowa - The state Corrections Department has started limited use of a hepatitis drug that costs $1,000 per pill.
Supporters of Solvadi's use argue that it cures more than 90 percent of people who take it, depending on which virus strain they have, The Des Moines Register reported (http://dmreg.co/1uestSa ). They say it also has fewer side effects than older drugs used to treat hepatitis C, a virus most commonly spread by sharing infected needles.
According to the corrections department's medical director Harbans Deol, more than 10 percent of the prison system's inmates have the virus.
In order to qualify for the drug, inmates must show signs of illness. They have to be in prison for 18 months and must be willing to participate in alcohol- or drug-addiction treatment. The drugs are not given to the inmate if he or she is allergic or pregnant or has heart problems, bleeding disorders or liver problems.
Deol said prison medical staff screen all incoming inmates for the virus, but they do not aggressively treat every inmate who has it. Usually, they will prescribe medications for prisoners who show signs of becoming seriously ill. The blood-borne virus can cause liver disease and chronic health problems, but it doesn't always.
"You could have hepatitis C and never even know it," Deol said. "You could live 20 or 30 years with it without any problem."
Inmates who were ill with hepatitis C were treated before with daily shots of interferon and the drug Ribavirin for about 11 months. Deol said that treatment costs about $30,000 and has been used in around six to seven cases each year. The corrections department spent $206,000 on that treatment for inmates last year.
Two inmates have recently opted to take Sovaldi. Deol said the total cost to treat them is expected to reach about $147,000.
The prison system has budgeted about $1.5 million for the new medication for the current fiscal year, he said.
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[Iowa] State paying for pricey pill to treat hepatitis C
September 8, 2014
The state of Iowa has started paying $1,000 per pill for a new drug targeting hepatitis C, but officials don't plan to buy the medication for every person who carries the virus and qualifies for public health care.
The issue could be particularly acute for the state prison system, because more than 10 percent of its inmates are infected with hepatitis C.
The prison system recently started paying to treat two inmates with the new drug, called Sovaldi. The total cost to treat them is expected to hit $147,000, said Dr. Harbans Deol, the corrections department's medical director.
Deol said about 830 of Iowa's 8,200 inmates carry the hepatitis C virus. That level is more than 10 times the rate in the general population, mainly because many prisoners have a history of using intravenous drugs. The most common way to spread the virus is by sharing needles.
Prison medical staff screen all incoming prisoners for the virus, but they don't aggressively treat every inmate who is carrying it, Deol said. Instead, they prescribe medications for prisoners who show signs of becoming seriously ill.
"You could have hepatitis C and never even know it," Deol said. "You could live 20 or 30 years with it without any problem."
Sovaldi went on the market late last year. Proponents say that it cures more than 90 percent of people who take it, depending on which strain of the virus they have. The drug also reportedly has fewer side effects than older drugs. But critics, including U.S. Sen. Chuck Grassley of Iowa, have questioned how the manufacturer can justify such a high cost.
Deol said the prison system has budgeted about $1.5 million for the new medication for the current fiscal year, which runs through next June.
In order to qualify for the treatment, inmates must show signs of active illness, they must be scheduled to remain in the prison system for 18 months and they must be willing to participate in alcohol- or drug-addiction treatment. They are not given the medications if they're allergic to them, or if they are pregnant or have heart problems, bleeding disorders or liver issues besides hepatitis.
A leading civil-rights advocate said prison officials are required to provide needed medical treatment to inmates.
The legal test includes the question of whether a prisoner needs medication "to treat or prevent serious harm to his or her health," said Rita Bettis, legal director for the Iowa chapter of the American Civil Liberties Union.
"Cases make clear that when a reasonable doctor would recognize that a medical condition needs treatment, or when the failure to treat the condition could result in further injury, harm to health, loss of some function, or unnecessary suffering, prison officials may be liable for failure to provide that care," Bet-tis wrote in an email to the Register. Prison authorities may not rely on "non-medical factors" in deciding on treatment, she wrote.
2 inmates recently began taking drug
Deol said the Iowa prison system is following national guidelines in handling the issue. In recent years, Iowa inmates who became ill with hepatitis C were treated with daily shots of interferon and the drug Ribavirin for 48 weeks. That treatment costs about $30,000, and has been used in about six or seven cases per year, Deol said. The department spent $206,000 on such treatment last year.
Deol said some prisoners have declined the standard type of hepatitis treatment because they don't like shots and because the medications often cause flu-like symptoms that can last for months. More prisoners might be interested in taking the Sovaldi pills, he said.
The first Iowa inmate to receive Sovaldi was a woman who had obtained the pills via the manufacturer's charitable program before entering the prison at Mitchellville, Deol said. Two more inmates began taking Sovaldi at the prison system's expense in recent weeks, he said.
The state Medicaid program also could face a heavy bill for Sovaldi prescriptions. Administrators estimate that more than 5,000 of the 333,000 Iowans on Medicaid or related programs have the virus, though many don't know it yet.
Spokeswoman Amy Lorentzen McCoy said the program is paying for the medication if it's prescribed by an appropriate medical specialist and if patients meet a list of criteria. The criteria include that the patient shows signs of disease, is not pregnant and can pass three months of urine tests for drug and alcohol use.
Iowa's Medicaid program, which is financed by the federal and state governments, expects to spend $7.4 million on the pills this fiscal year and $12.7 million for the next year, McCoy said.
Dr. Donald Hillebrand, a Des Moines hepatitis specialist who works for UnityPoint Health, said Medicaid's rules seem overly strict.
The drug is most effective in people who aren't yet seriously ill, he said.
Hillebrand said recent hepatitis drugs represent enormous progress. When he started treating the disease 20 years ago, the available medications had severe side effects and only cured 5 to 10 percent of patients. "We've really flipped the script" with cure rates over 90 percent and few side effects, he said.
Hillebrand has been paid for speaking to other doctors about Sovaldi and other hepatitis drugs, but said his overriding interest is the welfare of his patients. He said the cost of the new medications should be weighed against the cost of years of treatment for people who aren't cured of the virus. Complications can include cirrhosis and liver cancer, which can require multiple hospitalizations, expensive medications or even organ transplants.
Hillebrand added that the per-pill prices might come down as more new medications hit the market, providing competition for Sovaldi.
Wellmark will cover cost of drug
Iowa's main private health insurance company, Wellmark Blue Cross & Blue Shield, is covering Sovaldi if doctors prescribe it appropriately, even if a patient has not yet become ill from hepatitis. Matt Hosford, who is Wellmark's chief pharmacy officer, said the company has spent about $14 million on Sovaldi so far this year. About 155 of its 1.3 million members in Iowa and South Dakota have taken the drug, he said.
Hosford said Wellmark is in a relatively fortunate position, because hepatitis C levels are low among its customer base. The virus is more common among people who live in big cities and in people who qualify for Medicaid, he said.
Hosford said Wellmark sees use of the drug as an investment, because it can cure most people of a virus that can cause chronic and expensive illnesses. Part of the reason drugs like Sovaldi are so expensive is because they have no real alternative so insurers have little ability to negotiate for discounts, he said.
"The manufacturer really has a stranglehold. They set the price," he said.
More hepatitis drugs are expected to hit the market in the coming months and years. Some could be taken along with Sovaldi, which could have a mixed effect on costs. Insurers would have to pay for another type of pill, but the course of treatment could be shortened from the standard 12 weeks.
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