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About half in NM’s prisons have hep C

Copyright © 2015 Albuquerque Journal

SANTA FE – About half of New Mexico’s prison inmates have hepatitis C, and corrections officials are seeking millions of dollars to treat some of them with new, more effective – and expensive – drugs.

The Department of Corrections is asking the Legislature for $10 million to supplement the current year’s budget and another $2.4 million for the budget year that begins July 1, 2016.

There are over 3,000 inmates with hep C infection in Corrections Department custody, officials told the Legislative Finance Committee recently.

The requested extra funding would only be enough to treat a fraction of them.

A bloodborne viral disease that causes inflammation of the liver and can lead to cirrhosis, liver failure or liver cancer, hep C is commonly transmitted through unsafe injections. That includes intravenous drug users.

Most prisoners with hep C arrived in the system with the disease – instead of acquiring it once they were imprisoned – and its prevalence is linked to the state’s epidemic of heroin use, according to Corrections Secretary Gregg Marcantel.

“Inmates have a constitutional right to the indigent minimum standards of care that we establish as a community,” Marcantel told the Journal .

Inmates in at least a couple of other states have sued prison officials for failing to provide access to the newest drugs.

The New Mexico department says it has treated inmates for hepatitis C in the past, but the available drug regimens were more complicated and less effective – with a 50 percent cure rate – and had more adverse side effects.

Drugs that have emerged recently have cure rates of 90 to 98 percent and minimal side effects.

Harvoni, for example, approved in late 2014 by the U.S. Food and Drug Administration, combines two drugs in a single pill taken once a day that can cure hep C within weeks or months – at a cost of tens of thousands of dollars per patient.

The Corrections Department partnered with the University of New Mexico’s Project ECHO – which uses videoconferencing to link clinicians in underserved areas with UNM disease-management specialists to treat hep C – to set guidelines and treatment criteria.

“We triage who’s going to get these expensive drugs,” based not just on medical need but on lifestyle, Marcantel said. For example, inmates who engage in tattooing or other high-risk activities would not be eligible, he said.

People who are successfully treated for hep C can be re-infected if they’re exposed to the virus again.

The department started using the new drugs in the budget year that began July 1 on inmates determined to need immediate treatment.

It plans to treat as many as 150 inmates in this budget year, which ends June 30, 2016, if lawmakers agree in the coming legislative session to add $10 million to the roughly $1 million the department is currently spending on hep C.

About 90 prisoners with the most common strain of hep C would be eligible for Harvoni – at an estimated cost of $5.7 million, or an average of $63,000 per patient. The remainder would require other, even more expensive treatment, according to the department.

The treatment would continue in the next budget year, which begins July 1, under the department’s request. It’s asking lawmakers to approve a $12 million increase over this year’s operating budget – for a total request of nearly $303 million – with $2.4 million of the new spending earmarked for hep C treatment.

Medical care for New Mexico prisoners is paid for from the general fund, the state’s main pot of money. The federally backed Medicaid program picks up medical costs only when prisoners get inpatient services for more than 24 hours in a hospital.

The Legislature will decide in the session that begins Jan. 19 how much money to appropriate to state agencies next year and whether to provide them supplemental funding for this year.

With oil prices falling, state officials have been trimming their estimate of how much revenue will be available for additional spending this year and next year, and it’s uncertain whether, or to what extent, the Corrections Department’s request for hep C funding would be approved.

“It may be an overreach right now, given what’s happening with revenues,” Senate Finance Committee Chairman John Arthur Smith, D-Deming, said of the agency’s request.