According to a NPR report, rural areas are having problems obtaining necessary drugs.
Hospital pharmacist Mandy Langston, who works in rural Arkansas, recalls using the drug Activase to help a woman suffering from a stroke. Activase must be administered as soon as possible after symptoms present.
“If we don’t keep this drug [in stock], people will die,” Langston said.
However, an overlooked provision in the Affordable Care Art makes it difficult for hospitals in rural areas to keep these drugs on hand. Hospitals like Langston’s must pay full price for drugs, while larger medical centers can buy them at a discount.
The hospital Langston works at has 25 beds and must pay $8,010 for one dose of Activase. At a hospital 36 miles away, the same dose costs about $1,600. That hospital, White River Medical Center, has over 200 beds.
White River is able to take advantage of something called the 340B program, which was created in the 1990s. The program gives discounts to hospitals that work with low-income patients. On average, these hospitals receive discounts from 20 to 50 percent.
The Affordable Care Act added rural hospitals to the 340B program, with one exception: rural hospitals are not eligible for discounts on drugs used to treat rare diseases. Colloquially, this is known as the orphan drug exclusion. These drugs treat diseases that affect fewer than 200,000 people.
Pharmacists and pharmacy directors across the rural U.S. have to make tough choices. Langston once had to do with only a single dose of Activase because she couldn’t afford an order.
This rare-disease exclusion was written into the Affordable Care Act at the very end of the legislative process. Former PhRMA executive Billy Tauzin said he did not recall asking for the exclusion.
However, PhRMA has subsequently used the courts to ensure that rural hospitals remain ineligible for the discount program. Some pharmaceutical companies voluntarily give discounts to rural hospitals.
In recent hearings, Congressional Republicans questioned the program’s growth. About 40 percent of U.S. hospitals are eligible for the program.
Dana Smith, director of pharmacy at Dallas County Medical Center in Fordyce, Ark., says the program’s growth and its problems are not necessarily related.
“Basically, Genentech [maker of Activase] is saying to me that rural health care and the patients in rural America are not as important as patients in urban areas,” she said.