Drug prices especially hit hard in rural America

Which is more valuable - the life of someone who lives in Mountain View, Ark., (population 2,860) or someone who lives just one county over?

That's the question from a good NPR piece about how high drug prices hit rural hospitals extra hard, a story beginning with the story of a stroke patient coming in to a small, rural hospital needing an expensive drug:

For example, Langston's 25-bed hospital pays $8,010 for a single dose of Activase — up nearly 200 percent from $2,708 a decade ago. Yet, just 36 miles down the road, a bigger regional hospital gets an 80 percent discount on the same drug. White River Medical Center, a 235-bed facility in Batesville, Ark., buys Activase for about $1,600 per dose.

White River participates in a federal drug discount program Congress approved in the early 1990s. The program offers significant price breaks on thousands of drugs to hospitals that primarily serve low-income patients. One federal report found the average discount ranged from 20 to 50 percent, though as illustrated with Activase, it can be much higher.

Rural hospitals have long wanted to be part of the 340B program, too, but were blocked from participating until the Affordable Care Act of 2010. The law added rural hospitals to the program, but, unlike bigger hospitals, rural hospitals can't get discounts on expensive drugs that treat rare diseases because of a last-minute exclusion written into the ACA.

That has left rural hospital pharmacists and health care workers struggling to keep medicines in stock, and wondering if they will be able to adequately care for patients.

Arkansas, for example, is in the "stroke belt," where medical staff depend on Activase to help them battle one of the highest rates of stroke deaths in the country. When Langston went to restock Activase this year, it was so expensive she left a reorder unfilled for more than week, anxiously keeping only one dose on hand.

The rest of the story, as Paul Harvey used to say: I was administered this drug at the White River Medical Center in Batesville, Ark., almost 20 years ago. I was born and raised in that town (population 10,740, according to the latest Census Bureau numbers), about 36 miles from the other town, Mountain View. I love both of those places.

And the problem of drug prices for rural providers and residents are aggravated by the facts that rural America has generally lower incomes, an older population and, in many cases, poorer health than the rest of the country.

Read the whole NPR piece, or click below to listen.


(Photo of Stone County Courthouse in Mountain View by Brandonrush - Own work, CC BY-SA 4.0, Link)