MRK Merck and Co Inc

By Peter Loftus 

This article is being republished as part of our daily reproduction of WSJ.com articles that also appeared in the U.S. print edition of The Wall Street Journal (March 10, 2018).

Massachusetts state prison officials agreed to expand treatment for inmates with hepatitis C, in the first settlement among several class-action lawsuits accusing state prison systems of denying many prisoners access to costly drugs.

Drugmakers including Gilead Sciences Inc., AbbVie Inc. and Merck & Co. since 2013 have been selling hepatitis C drugs with higher cure rates than older drugs for the disease. But prices initially were high -- between $54,000 and $95,000 per patient for a standard course of treatment using drugs such as Merck's Zepatier or Gilead's Sovaldi and Harvoni -- leading many state prison systems to restrict their use.

Inmates in Indiana, Pennsylvania, Missouri, Minnesota and Tennessee have filed lawsuits similar to the one in Massachusetts, generally accusing prison officials of violating the U.S. Constitution's Eighth Amendment prohibition on cruel and unusual punishment by denying most infected prisoners access to the new drugs.

Public-health experts say inmates have a higher hepatitis C-infection rate than the general population because many have a history of drug injection, a common route of transmission for the blood-borne virus. The infection can damage the liver and become life-threatening if left untreated.

Prison officials have said treating all infected inmates with the new drugs would wreck their taxpayer-funded health-care budgets. An analysis by The Wall Street Journal in 2016 found that only 3.4% of inmates with hepatitis C in 34 state prison systems had been treated with the new drugs.

Massachusetts has settled a lawsuit filed by two prisoners in 2015 accusing the state prison commissioner and a prison health-care contractor of refusing to provide treatment to most of the more than 1,500 inmates infected with hepatitis C at the time. A judge certified the lawsuit as a class action on behalf of all Massachusetts prisoners who couldn't get access to treatment.

The Massachusetts settlement requires the prison system's health-care contractor to evaluate all infected prisoners and prioritize treatment. It mandates that the sickest patients be treated first with the new class of drugs. It also requires that all new prisoners be tested for hepatitis C when they enter the system.

About 280 Massachusetts prisoners -- those at more advanced stages of disease -- are expected to be treated under the settlement within the next 18 months with more to follow, said Joel Thompson, attorney with Prisoners' Legal Services in Boston, which represented the inmates who sued Massachusetts prison officials. At least 130 inmates were previously treated, Mr. Thompson said. Attorneys filed the settlement Friday in U.S. District Court in Boston seeking approval by a federal judge.

Mr. Thompson said the settlement was a compromise. "We would love to see everyone get treated tomorrow for hep-C, but in the absence of that, what we wanted to see was a much more streamlined system for triaging patients," he said in an interview. "The goal is not to miss anybody, not to let it get to the point where people are getting cirrhosis."

A spokeswoman for Massachusetts Gov. Charlie Baker called the settlement "a fair and equitable resolution" that will improve treatment of infected inmates.

The state's health-care contractor, Massachusetts Partnership for Correctional Healthcare LLC, isn't a party to the settlement, and the plaintiffs have agreed to dismiss the contractor from the lawsuit once the settlement is approved by the judge. The partnership is a division of Centurion, a joint venture of Centene Corp. and MHM Services Inc. A spokesman for Centene, which recently agreed to acquire MHM, couldn't immediately be reached.

Litigation is having an effect elsewhere. In a lawsuit filed by Florida state prisoners last year, a federal judge in November issued a preliminary injunction ordering the state corrections department to substantially expand treatment of the estimated 7,500 inmates who have hepatitis C.

U.S. District Judge Mark Walker wrote in his ruling that Florida inmates were dying because they weren't being treated, and the primary reason for lack of treatment was lack of funding. The judge issued an injunction to ensure inmates receive "medical care in a timely manner consistent with constitutional requirements" and told the state to avoid "further foot-dragging."

The Florida attorney general's office, representing the secretary of the corrections department, said in court papers last year that many prisoners with less advanced states of disease don't need immediate treatment. The office also estimated it would cost about $200 million in taxpayer money to treat all inmates known to be infected, which the state called "an outrageous proposal."

As of Jan. 31, in response to the judge's order, the state corrections department was treating about 230 Florida inmates, the department said in a court filing. The judge has set deadlines for treating or evaluating the rest.

A Florida corrections department spokeswoman said it is committed to ensuring all inmates receive medically necessary treatment and has asked the state legislature for additional funding to expand hepatitis-C treatment.

Attorneys for inmates say cost isn't a defense. "You can't deny them treatment despite the fact that it cost a lot of money, if it's lifesaving," said Randall Berg, an attorney for Florida prisoners who sued the state prison system.

Prices for the new drugs have been coming down. AbbVie introduced a new hepatitis-C drug last year, Mavyret, with a list price of $26,400 per patient for the most common treatment duration. Drugmakers say discounts they provide on list prices have made the drugs more affordable.

(END) Dow Jones Newswires

March 10, 2018 02:47 ET (07:47 GMT)

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