By Mary Younts

Special to the Salisbury Post

You might guess that the big state of Texas has the largest rural population in America, but did you know that our state ranks a very close second? North Carolina has the second-largest rural population in the nation, with 80 rural counties having an average population of fewer than 250 people per square mile. Such generous spacing means that many face serious challenges when attempting to secure medical attention.

North Carolina has 125 hospitals to serve its estimated 10 million residents — that’s almost 80,000 people per hospital! So it’s not surprising that North Carolina ranks 15th for the most Primary Care Health Professional Shortage Areas (HPSAs) — or, 147 areas experiencing acute shortages of health professionals.

As one of those health-care professionals, I believe that living in a rural area shouldn’t limit a person’s access to health care or lifesaving drugs. One way that North Carolina hospitals have been able to serve so many is the relatively unknown 340B drug pricing program. This program allows pharmaceutical companies to sell their products in the Medicaid program in return for providing cheaper medications to hospitals that serve low-income patients. For 25 years it has served as a safety net for rural hospitals and small clinics across the country.

But now that might all change. In July 2017, the Centers for Medicare & Medicaid Services (CMS) released shocking news. Changes were proposed for the 340B program that would massively hamstring such health care by ending these crucial discounts.

The impetus for these changes comes from the pharmaceutical industry, or “Big Pharma,” which has spent almost $145 million in lobbying Washington this year alone. They want to dramatically limit the 340B program; for example, by narrowing the number of drugs it covers while at the same time growing the Orphan Drug Program. This important program provides government incentives to maker’s drugs that treat aliments that affect less than 200,000 American citizens. But Big Pharma has repeatedly designated common-use drugs with “orphan” status to receive associated tax breaks and competition-free marketing that the program provides. One reason that the pharmaceutical industry wants to get rid of the 340B program is because it excludes these orphan drugs.

Rural hospitals are a lifesaver in states like North Carolina. They rely on 340B program savings to keep their doors open and treat predominantly low-income patients with extremely limited access to care. As studies have shown, those living in rural areas are likely to be older, with higher rates of premature death and diseases like diabetes. The facilities who treat them must work with limited resources, have low staff retention, and are plagued by recruitment problems. To boot, the Medicare and Medicaid reimbursement rates are usually negligible, and as a result, many rural hospitals operate in the red, or have closed altogether. According to the North Carolina Rural Research Program, 80 rural hospitals have shut their doors since 2010. These closures place a massive burden on an already stretched infrastructure and endanger the lives of many Americans who must try to seek care elsewhere.

Against the many struggles that rural hospitals face every day, the 340B program provides essential savings and access to the necessary medicines for the patients they treat. Cutting 340B would deny many in North Carolina, as well as across America, the care and cures they so desperately need.

Mary Younts works as a home health nurse in Rowan and Cabarrus counties.