Hepatitis C in Oklahoma prisons is an expensive time bomb

There are now more than 3,000 people in Oklahoma prisons who’ve tested positive for the antibodies for hepatitis C, a potentially debilitating liver disease. For nearly a decade lawmakers have only appropriated enough dollars to treat the symptoms of the disease. Policymakers have yet to fully invest in the costly but life-saving cure. This is short-sighted. Treatment is prevention. Studies show that treatment in prison saves money for the health care system outside of prison. Oklahomans who return to their communities without treatment have a higher risk of spreading the disease to others. This is especially true as Oklahoma struggles to combat the terrible impacts of the opioid crisis. Most people are infected with hepatitis C by sharing needles or other equipment to inject drugs and other forms of blood contact transmission.

Once released from prison untreated, Oklahomans are more likely to access emergency room care to manage the expensive and painful long term symptoms of chronic hepatitis C. Oklahoma must invest in a comprehensive treatment plan for the growing hepatitis C crisis in our prisons before the cost of treatment and the human toll of this crisis become unmanageable.  

Treating hepatitis C now will save taxpayers millions in the future

 As the chart above shows, in FY 2013 the Oklahoma Department of Corrections estimated that 1,587 people in its custody were infected with hepatitis C. For the past seven years the Department of Corrections has requested the budget dollars necessary to treat this disease. To date, none of these budget requests have been adequately funded, and the disease continues to spread. By FY 2020, the number of infected inmates has nearly doubled to 3,107. 

 The Department of Corrections requested nearly 100 million dollars just to treat hepatitis C in its 2020 budget–22 million more than the entire healthcare budget for all prisons in 2019. The cost of treatment will likely exceed 100 million dollars by 2021 if nothing changes. This year the legislature agreed to spend $12 million on treatment, meaning they are only treating the most dire cases. Each year legislators wait, this problem gets more expensive for taxpayers and more dangerous for those in prison unnecessarily suffering from this life-threatening illness. 

 The devastating human toll of hepatitis C can be reversed

Hepatitis C kills far more Americans than any other infectious disease, but the pain and suffering that come with chronic hepatitis C symptoms can finally be prevented because the disease can be cured with fewer complications than in the past.  Someone can carry the disease for years without any symptoms, but once symptoms appear they can be catastrophic.  The illness is associated with cirrhosis (scarring on the liver), liver cancer, and is the most common reason for liver transplants in the United States. These health problems are not only painful, but they are also another expensive and difficult hurdle for those returning home from prison. Oklahomans leaving the justice system have to worry about finding housing, a job, and transportation- in addition to numerous other challenges. Being sick makes all of this more difficult. Treatment in prison would essentially fix this problem. When the illness is fully tested and fully treated in prison the rate of painful and eventually debilitating cirrhosis declines by more than half.   

The courts have mandated that if prisons can treat an illness they have a constitutional duty to do so. The Supreme Court calls a failure to treat people in prison “deliberate indifference.” Returning Oklahoma inmates to their communities with this untreated chronic illness is immoral. It’s also eventually likely to result in a serious legal challenge in our courts.

[pullquote]If lawmakers act now they can save our state millions in new treatment costs, and more importantly, they can save thousands of Oklahomans from the painful and life-threatening impact of this treatable illness. [/pullquote]

Funding strategies like the “Netflix model” are working in states like Louisiana

In 2019, Louisiana officials adopted the “Netflix model” to fund hepatitis C treatment in prisons. Similar to the Netflix subscription model, the state pays an annual subscription fee for treatment. This means that Louisiana will pay a flat fee for unlimited access to hepatitis C medication for five years, and the state will be able to treat as many people as it can, rather than pay a per-patient drug price. This lowers the overall cost of treatment while providing access to lifesaving medication. The goal is to treat 31,000 people with hepatitis C by 2024. Before this new pricing deal in 2018 Louisiana was only able to treat about 1,100 people. Using this model, Louisiana will be able to treat ten times the amount of people than before and spend 62 percent less. This is estimated to save the citizens of Louisiana nearly $500 million longterm.

Louisiana is not alone. States across the US are using cost-saving innovations to manage this public health crisis. This is yet another issue in which Oklahoma would benefit from Medicaid expansion.  If more Oklahomans infected with hepatitis C were eligible for Medicaid the state would have a greater ability to negotiate for cost savings innovations like the “Netflix model.” Oklahomans deserve the best policy solutions in the nation-even those in prison. Especially since the vast majority of those in prison- at least 95 percent will eventually return to their communities.   

The hepatitis C crisis in Oklahoma’s prison is a time bomb

The cost to treat hepatitis C in our prisons has exploded in the past decade, but there are ways to give more people access to treatment and spend less money at the same time. Since 2012 thousands of justice-involved Oklahomans have contracted and spread this illness. Oklahoma’s devastating opioid crisis has helped spread hepatitis C in our communities, but ignoring this problem in our prisons has left too many Oklahomans to suffer needlessly with a terrible disease which we now have the power to cure. It’s only a matter of time before the courts or the sheer scale of the crisis forces policymakers to act. Why wait? If lawmakers act now they can save our state millions in new treatment costs, and more importantly, they can save thousands of Oklahomans from the painful and life-threatening impact of this treatable illness. 


Damion served as the criminal justice policy analyst for the Oklahoma Policy Institute from July 2018 until June 2022. He grew up in Jackson, Mississippi and has lived in Oklahoma since the late 90s. Prior to joining OK Policy, he was an educator at Jenks Public Schools and the Oklahoma School for the Performing Arts. He’s written education and justice features as a contributing writer for the Tulsa Voice since 2016, and he was awarded best Education and General News Reporting features by the Society for Professional Journalists in 2017. Damion earned a Bachelor’s Degree from Oral Roberts University and started several voter registration and political advocacy initiatives during his time on campus. He lives in Tulsa with his wife Rachel.

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