When It Comes to Prison Health Care, Should Price Matter?

Steven Tharratt, the California Prison Health Care Services' CMO, was brave to take this topic on at McGeorge SOL's recent conference on Ethical Pricing Decisions in Healthcare. California's prison system is staggering under the burden of next generation pharmaceuticals such as Gilead's Hep C pill Sovaldi.  Of course the problem is writ large in California's state prison system for a few reasons including  the prevalence of Hep C in our prison population and the lengthier time of incarceration in the "three strikes" era.

What frames this issue so nicely is that Sovaldi — sometimes called the $1,000 a pill medication — is a cure  for Hep C, though you may acquire Hep C again after you are cured. It does not confer immunity.

By any estimation, Sovaldi is an amazing development probably priced against the cost of treating an individual with end stage liver failure. Not surprisingly, the U.K.'s NICE has compared its Sovaldi acquisition cost (call it the $700 a pill medication in the U.K.) as compared with its end stage liver failure treatment cost and declared it a good value.

But is it a good value for the California Correctional System, who may not acquire at the U.K. acquisition cost or even our own Medicaid acquisition cost (both estimated at about $700 a  pill)? Given the movement of Sovaldi to mainstream Hep C treatment therapy in California, is this a question that can even be asked?

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