“We are harming millions of people because of allegiance to a model of innovation that constrains delivering that innovation,” said Peter Bach, a drug pricing expert who directs the Center for Health Policy and Outcomes at the Memorial Sloan Kettering Cancer Center. “That model — the central dogma of pharmaceutical development — is broken.”

As people with private insurance gained access to hepatitis C treatment, it became less defensible to withhold it from prisoners. Florida had treated just 13 inmates when the federal court intervened. More than 5,000 inmates there have been diagnosed with chronic hepatitis C, but the corrections department does not conduct proactive screening, so officials concede there are likely closer to 20,000.

The Florida Legislature has allocated $36 million to fund treatment through June 30, 2019, in a budget bill that awaits the governor’s signature. State Senator Jeff Brandes, chairman of the Appropriations Subcommittee on Criminal and Civil Justice, believes that amount will be sufficient to satisfy the court’s order to treat the sickest inmates, but it will leave thousands of others infected.

“You kind of feel like Sisyphus pushing the rock up the hill,” he said.

Left untreated, prisoners will suffer irreparable liver damage and may transmit the infection to others. While state prisons that withhold drugs may protect their own budgets, the cost will likely still fall on taxpayers once the prisoners are released and seek care through Medicaid or other avenues, said Dr. Harish Moorjani, an infectious disease specialist who oversees care for prisoners in New York State.

“You may take a short-term view, whether you are a governor or a state legislature or whatever budget authority you are, but there is a price to be paid for that,” Dr. Moorjani said.

New York has taken a longer view, approving 2,009 inmates for treatment between 2014 and 2017 at a cost of about $140 million.

Some states have tried to obtain drugs at lower prices by banding together for greater bargaining power and by enrolling prisoners as patients in hospitals that already get discounted drugs. These tactics have moderately reduced prices, but corrections officials say they would need to be vastly cheaper to even consider treating all eligible prisoners.