Although the exact costs that correctional institutions incur for medications remain unclear, many state and local jails purchase the same drugs as Medicaid agencies due to their limited negotiating power as individual entities. In contrast, larger prison systems can secure better prices through the federal 340B Drug Discount Program.12 This program, funded by the federal government, mandates that drug manufacturers participating in the Medicaid drug rebate program also provide covered outpatient drugs to enrolled covered entities at or below a statutorily defined ceiling price.13
Even with such assistance, the cost of these medications remains exceptionally high, and many correctional facilities maintain strict formularies that restrict access to such costly treatments, often requiring patients to fail multiple less expensive options before qualifying for biologics or targeted synthetic DMARDs.
In addition to the direct costs of medications, additional costs are tied to medication use, such as lab monitoring, specialized storage requirements, and the administrative burden of obtaining prior authorizations and managing appeals. For infusion medications, further costs arise from the need to transfer patients to specialized facilities, which adds travel expenses and requires additional personnel.
Access to medications is not an issue exclusive to incarcerated populations—the high cost of medications can be a significant barrier for both insured and uninsured Americans—but it remains crucial to explore solutions for alleviating this burden on incarcerated patients. By implementing policies that enable correctional facilities to purchase DMARDs at reduced costs, whether through ways similar to other systems providing care to low-income individuals or by improving the purchasing power of 340B programs, we can improve access to essential medications. This, in turn, could lead to better health outcomes and reduced disabilities for this population.
Environmental Challenges
It is well-documented that as the general population ages, so does the incarcerated population. Current estimates in the U.S. indicate that 12% of incarcerated individuals are older than 55, reflecting a 300% increase in this demographic over the past two decades.14 Studies also reveal that 15% of inmates in both state and federal prisons have arthritis or other rheumatic diseases.14 This presents a unique challenge because exercise is a key component in managing and alleviating symptoms of arthritis and rheumatic diseases.
Within the prison system, inmates often lead sedentary lifestyles due to limited mobility within their cells, restricted access to exercise facilities and insufficient opportunities for physical therapy, which is crucial for teaching proper techniques to reduce symptoms. Even when facilities offer exercise training programs, their effectiveness is maximized when tailored to the individual and their specific rheumatic disease. Unfortunately, the majority of studies examining prison-based exercise programs focus on healthy individuals without chronic conditions, leaving a gap in knowledge regarding the needs of those with such diseases.15
