Missouri will spend about $147 million this year on health care for its 32,500 prison inmates. That could go up by $236 million if a judge orders the state to treat just 2,500 of its prisoners with Harvoni, a new drug that can cure hepatitis C. An already bleak state budget picture could get considerably bleaker. But 2,500 people, whose serious medical needs the state has a legal obligation to meet, would get potentially life-saving treatment.

The state Department of Corrections faces a class-action suit in federal court filed by the MacArthur Justice Center in St. Louis and the American Civil Liberties Union of Missouri. The lawsuit seeks to have the state provide about 5,000 inmates with the latest — and very expensive — drugs for hepatitis C, a liver disease that kills more than 20,000 Americans a year.

About half of those inmates are candidates for Harvoni, a direct-action antiviral drug manufactured by Gilead Sciences Inc. The list price is $94,500 for a 12-week course. Studies show that in at least 94 percent of cases, Harvoni doesn't just treat hepatitis C; it cures it.

Missouri is not alone. Lawsuits have been filed against prison systems in at least seven other states, according to a report by Alex Smith of KCUR Radio in Kansas City. KCUR, National Public Radio and Kaiser Health News funded the reporting. The disease is particularly prevalent among inmates because hepatitis C is transmitted by infected blood and prison populations have a disproportionately large number of people who use injectable drugs.

This potentially leaves state governments with an ethical problem within another ethical problem: whether to withhold life-saving treatment because legislatures won't pay for expensive drugs — drugs whose manufacturers can charge whatever they want.

Pharmaceutical companies argue that high prices reward them for the costs and risks involved in developing new drugs. In fact, Gilead inherited Sovaldi, Harvoni's parent drug, when it bought a company called Pharmasset in 2011 for $11 billion. In three years, Gilead sold $44 billion worth of Sovaldi and Harvoni. Its profit margins hit 50 percent in mid-2016 before tapering off.

As other drugs have come onto the market, Gilead has discounted Harvoni to state Medicaid programs by as much as 46 percent. If Missouri loses its lawsuit and gets a similar discount, the cost could still be $127 million for those 2,500 inmates, plus whatever it costs to treat the other 2,500 with direct-action antivirals.

The Supreme Court has ruled that "deliberate indifference" to a prisoner's medical needs violates the Eighth Amendment prohibition against cruel and unusual punishment. Lawmakers may want to hold off on further tax cuts. In the meantime, they may want to speak to their congressional delegations about reining in drug profiteers.

REPRINTED FROM THE ST. LOUIS POST-DISPATCH