Any national campaign to eliminate hepatitis C, an insidious virus that kills tens of thousands of Americans a year, would almost certainly involve prisons.
One in seven state inmates are believed to be infected, and the regimented environment of a prison has its advantages when it comes to screening and treatment.
The problem is, the drugs that effectively cure the disease are priced in the tens of thousands of dollars — far more than prisons can pay. In 2015, state corrections departments were treating less than 1 percent of those inmates known to be infected, a survey found.
Now courts have begun ordering states to provide the drugs regardless of cost, prompting an unusual showdown over how pharmaceutical companies set prices for the treatments.
In at least nine states, prisoners have filed lawsuits arguing that withholding drugs constitutes deliberate indifference to their dire medical needs, violating a constitutional ban on cruel and unusual punishment.
Last week, Massachusetts settled a lawsuit by agreeing to give all prisoners in advanced stages of the disease access to drugs.