In the United States, one in seven state inmates (the majority of U.S. inamtes are in states prisons) are believed to have the hepatitis C virus (HCV) compared with 1 percent of the rest of the population. Meanwhile, prisons across the country continue to drag their heels in providing the lifesaving cures that can help the inmates while also preventing future transmissions. A recent article in The New York Times outlines the reasons why U.S. prisoners are still not getting access to treatment—and the solutions many advocates are fighting for today.

The biggest problem, according to the paper, continues to be the high price of hepatitis C treatment, which many prisons are unable to afford. When next-generation treatments first came out in 2013, they cost upwards of $80,000 per patient for a standard 12-week course of treatment. That price has gone down significantly over the past few years, but cures still cost in the tens of thousands of dollars, meaning state prisons would likely have to shell out millions to tackle the problem.

Prison inmates have filed lawsuits in at least nine states—including Massachusetts, Florida, Rhode Island, Pennsylvania and Missouri—alleging that refusing to provide treatment constitutes cruel and unusual punishment under the law by deliberately ignoring their medical needs. The cases have helped thousands of people access treatment, often times ending in settlements that require state correctional systems to give all prisoners with advanced cases of hepatitis C the option of medication.

Advocates also argue that treating hepatitis C in prisons would make great strides in decreasing transmission across the country. Some studies suggest that one in three Americans living with hepatitis C passes through the U.S. prison system in any given year. What’s more, if left untreated, hepatitis C can cause irreparable liver damage and significantly increase the risk for cancer.

Several solutions are currently being proposed to fix the problem. At a recent meeting of the National Governors Association, which convenes representatives from states and pharmaceutical companies across the country, participants broached the idea of a Netflix-type treatment model, where states license the use of treatment in bulk rather than pay per patient. Some states are also starting to band together for greater bargaining power with drugmakers; others are enrolling prisoners as patients in hospital systems that have already negotiated discounted treatments.

For more information about hepatitis C in the U.S. prison system, click here.