By Rose Hoban

Even though members of the General Assembly have said they’ve come to Raleigh for a short, special session to pass bills related to Hurricane Florence relief funding and create rules around voter identification, lawmakers are also pushing the state’s prison system to change the way it purchases some expensive drugs given to inmates.

A bill that has moved quickly through both the Senate and the House of Representatives would also compel health care providers in the state’s prisons to watch as inmates take pricey medications, a practice known as directly observed therapy, or DOT.

Some of the most expensive drugs given by prison officials are those to treat Hepatitis C, a virus which many people acquire while injecting drugs. For years, treatments for the disease were inadequate, even as they gave patients many side effects during the course of treatment. But in 2013, drugmakers introduced the first new anti-viral medications that effectively cure Hepatitis C.

When first on the market, a Hepatitis C treatment could cost as much as $60,000 for a course of treatment, staff from the Department of Public Safety told lawmakers at a meeting of the Senate Health Care Committee on Tuesday. In recent years, the cost has come down to as little as $24,000 to cure the disease.

And soon, DPS could end up treating many more inmates for the disease.

sign lists many medical specialties, such as oncology, dialysis and dental
A directory to specialty departments in the hospital facility at Central Regional Prison in Raleigh. Photo credit: Rose Hoban

In a recent court opinion written for a federal case brought by several North Carolina inmates, a magistrate recommended North Carolina revise its current policy, which often denies Hepatitis C treatment to inmates, despite it being a medically necessary, and frequently lifesaving, treatment.

If the state is compelled to offer Hepatitis C treatment to more inmates, efforts to reign in the costs could become more important.

Buyers club

One mechanism for saving money on medications could come in the form of DPS participation in a federal program that allows hospitals, clinics and others providing medical care to low-income patients to buy medications at a discount.

The hospital facility run at Central Prison in Raleigh is not eligible for participation in the program, known as 340B. But a study performed by the legislative Program Evaluation Division found that correctional systems in at least 16 states are able to purchase some medications for inmates through the 340B program. 

“Several of these states partner with a university hospital system to qualify and gain access to the program,” Brent Lucas, an evaluator with PED told lawmakers during a presentation in September.

“Last year, Hepatitis C and HIV medications accounted for 51 percent of total medication spending,” Lucas told lawmakers. In 2016-17, treating inmates with Hepatitis C cost DPS $18.1 million, and HIV drugs cost $13.5 million, out of the total prison pharmacy expenditure of $72.6 million.

“Based on consumption and prices paid last year, we estimate the state could have saved $13.3 million if these medications were purchased through a 340B program,” he said.

Lucas pointed out that UNC Health Care manages the hospital facility at Central Prison and could facilitate the purchase of the medications as UNC participates in 340B. His report recommended that the General Assembly order UNC Health Care to “modify and expand it’s 340B program to provide for the purchasing of certain inmate medications.”

This order became the first section of House Bill 1108, which completed passage through the Senate on Tuesday. The legislation would also require DPS to take money out of its budget to pay a one-time cost of $25,000 for legal costs of complying with 340B rules, plus annual costs of about $7,000 per year.

“It’s all about saving that million dollars that’s there, and that’s what this bill would do,” said Sen. Brent Jackson (R-Autryville) when asked whether the timing of the bill was related to the hepatitis-treatment lawsuit.

Directly observed therapy

A change to the bill would require that prison staff watch inmates take any medications valued at more than $1,000 per month, something that DPS officials said could require more staffing and perhaps reduce the effectiveness of some of the medications.

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“There are different parts of this that we would need to work on to work out the specifics before we could truly implement,” said Janna Thomas, the pharmacy services director for DPS.

The total cost of these high-value medications was about $282,747, but PED evaluators argued that the state “has no guarantee of the effectiveness of these expenditures.”

But DPS staff members pointed out that sometimes these medications need to be taken with food, or first thing in the morning, and compelling inmates to come to the medical station to take their medications could be disruptive to the prison schedule.

The requirement for “directly observed therapy” drew pushback from state director of prisons Kenneth Lassiter, who said he can’t afford the extra staff.

shows several people wearing scrubs sitting at desks, one leans into a file drawer another with her back to the camera stands at a computer console.
Staff work on patient files at the main nurses’ station in the hospital facility located at Central Regional Prison in Raleigh. Prison officials say they’ve had persistent problems finding and retaining medical staff and have up to a 16 percent vacancy rate for doctors and nurses. Photo credit: Rose Hoban

“Because health care is not truly funded, lapsed salaries already pays for the majority of the health care for offenders,” Lassiter said. He told lawmakers that his department has a 16.8 percent vacancy rate for custodial staff and 16 percent medical staff vacancy rate.

“If we can ever get that vacancy rate down and this would go away, we would be at a deficit,” he said. “Last year, prisons and DPS reverted four dollars from its budget. So we spent every single dime, with the exception of four dollars, including lapsed salaries.”

Despite the pushback from DPS, the bill passed committee and moved quickly to the Senate floor, where some Democrats objected, saying legislators should work with staff rather than ignore their input.

“I don’t understand why there’s not an interest in working through these issues with the department,” said Sen. Don Davis (D-Greenville). “We should take the time to make sure we engage meaningfully with those we’ve charged with the task of running… state agencies.”

Because members of the Senate made changes to the House version of the bill, it now goes to a conference committee where any differences will be hammered out.

UPDATE Dec. 6: Both chambers agreed to the Senate version of the bill, which was approved and subsequently sent to Gov. Roy Cooper for his signature.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...