Sovaldi (sofosbuvir) may be a breakthrough for curing hepatitis C virus (HCV). However, a recent report from The New York Times shows that the new medicine—which currently sells for $1,000 a pill, or $86,000 for a full course of treatment—is forcing prisons to choose between their inmates’ rights or an impending budgetary disaster.

That’s because prisoners are the only group in the United States with a constitutional right to the latest standards in medical care. Unfortunately for prison penny-pinchers, the inmate population also makes up a disproportionate number of people living with hep C, with an estimated 17 percent of all inmates currently infected. What’s more, state prison systems usually have to pay retail prices for prescription meds, unlike federal programs like Medicaid, which can get the drugs at a discount.

That means curing even a small proportion of U.S. prisoners with hep C at Sovaldi’s current price could cost the system billions of dollars. Already, many states are choosing to ration out Sovaldi to only the sickest inmates, or refusing to provide the drug at all. But mounting litigation against these potentially illegal exclusions is already forcing prisons to pay up.

However, some hep C experts argue that treating the prison population for HCV could benefit the general public. Several studies show that prison settings are very good at making sure hep C patients adhere to their meds. Advocates also argue that curing inmates before they are released back into the community could also help curb the spread of the disease.

To read the full New York Times report, click here.