Pharmacy and Prescription Drugs Frequently Asked Questions
Question: Why is it important for rural people to have access to pharmacy services?
Answer:
Pharmacists are part of the health care team and provide advice to patients,
case management, and benefits management. Pharmacists have an important
role in helping prevent medication errors and in identifying drug interactions.
Pharmacy services include more than just supplying prescription drugs,
a role that mail-order and Internet prescription drug suppliers can
and increasingly do fill. Pharmaceutical care is an important aspect
of the spectrum of health care.
The rural population tends to be older and have more chronic health conditions than the urban population, which makes access to pharmacy services particularly important to the health of rural residents. The rural elderly, who may have multiple prescriptions, can particularly benefit from a relationship with a pharmacist who, along with their physician, can help them manage their medications.
Pharmacists in rural communities may be one of only a few health care
providers in a community, and because of this, play a larger role in
educating and assisting patients.
Question: What financial challenges exist to maintaining rural pharmacy services?
Answer:
Rural pharmacies typically pay more to drug manufacturers per prescription
and sell a relatively low volume of medications, so the profit that
results can be very low.
There is increasing competition from mail-order and Internet suppliers,
who are able to sell at large volume and negotiate lower prices from
drug manufacturers, and may pass part of these savings on to customers.
Some third-party payers (organizations that
pay for health care for a beneficiary) have low payment rates for prescription
drugs, so that pharmacies may actually lose money supplying the medications
paid for by these programs. Independent pharmacies tend to be more
dependent on revenue from prescription medication sales, making them
more vulnerable to increased competition and to decreases in reimbursement.
The financial pressures on rural pharmacies can lead to closure, which
may leave a community many miles from the next pharmacy. For more information
about the challenges facing rural pharmacies, please see Access
to Pharmaceuticals and Pharmacy Services in Rural Areas, a chapter
from the National Advisory Committee on Rural Health and Human Services' 2006
Report to the Secretary: Rural Health and Human Service Issues and
the journal article, "The Economic Realities of
Rural Pharmacy Practice" ().
Question: Are there enough pharmacists available in rural America?
Answer:
According to a 1999 study in the Journal of the
American Pharmacy Association, the ratio of pharmacists to population
is lower in rural areas, with only 66 pharmacists per 100,000 people,
compared to 78 pharmacists per 100,000 nationwide. The Bureau
of Health Professions report The
Pharmacist Workforce: A Study of the Supply and Demand For Pharmacists states
that
the supply of pharmacists has not been adequate to keep up with increasing
demand, leading to a nationwide shortage in pharmacists. According to
a 2001 Journal
of Rural Health article, "The Economic Realities of Rural Pharmacy
Practice," rural pharmacists tend to work longer hours than
their urban counterparts. Relief coverage for vacation and illness is
often difficult for rural pharmacists to find, which can result in overwork
or temporary pharmacy closings. This combination of lower wages and longer
hours can make it more difficult for rural areas to recruit and retain
pharmacists.
Question: What can communities do to ensure pharmacy access?
Answer:
Communities may want to pursue the development of a locum tenens program
through their state pharmacy board, college of pharmacy
or state pharmacy association. A locum tenens program helps provide
relief staffing by locum tenens (place holder) pharmacists, who are
willing to substitute for other pharmacists on a temporary basis.
The use of telepharmacy, which employs technology to provide pharmacy services at a distance, can make pharmacy services available to a wider range of communities that could not support their own pharmacy. For more information on how to set up a telepharmacy program, please refer to chapter ten, Pharmacy, in A Guide to Getting Started in Telemedicine.
Health information technology (HIT) can also play a role in improving
pharmacy services. Remote access pharmaceutical distribution
networks have the potential to improve the quality of healthcare for
rural populations without a local pharmacy. Computer tracking and automated
dispensing of prescriptions could make medications less expensive and
more readily available for rural patients. For more information on HIT,
please see RAC's Health Information Technology guide.
Question: How
do financial barriers limit access to prescription drugs?
Answer:
The cost of prescription medications can be a barrier, particularly for
the rural elderly and those without health insurance. Because older
people tend to have higher numbers of prescriptions and live on a fixed
income, paying for needed medications can be a problem. Medicare now
includes an optional prescription drug benefit. For more information,
please see the guide, Medicare
Part D Prescription Drug Benefit.
Rural residents under age
65 are more likely to be uninsured than those living in urban areas,
and those that do have health insurance are less likely to have prescription
drug coverage. Rural areas also suffer from higher poverty rates. These
factors combine to make it more difficult for rural residents to pay
for prescription medications.
Question: What resources are available to help individuals pay for prescription drugs?
Answer: Several resources are available to
identify programs that can help individuals pay for prescription drugs.
Partnership for Prescription
Assistance offers a database of over 150 prescription drug assistance
programs available from pharmaceutical companies. The web site allows
patients, caregivers or health care providers to search for specific
medications and find matching assistance programs. The
ASHP/PSSC (American Society of Health-System
Pharmacists/Pharmacy Services Support Center) Patient Assistance Program
(PAP) Resource Center lists state
patient assistance programs and also links to more information about manufacturer-sponsored
programs. Children may be eligible for health insurance, including
prescription coverage, through the State
Children's Health Insurance Program (SCHIP).
Question: What other barriers do rural residents face in obtaining prescription medications?
Answer:
Limited access to transportation can make it difficult for rural residents
to obtain needed medications. People may need
to drive many miles to the nearest pharmacy, and pharmacy hours may
be more limited in rural areas, requiring even those people in a town
with a pharmacy to drive elsewhere in the evening or on weekends. Rural
residents may face geographic barriers to reaching a pharmacy, such
as mountains or rivers, and roads may sometimes be impassable due to
weather or seasonal closure. Public transportation options are also
more limited. Please see the Transportation information
guide for more information on rural transportation issues.
Question: What is the 340B Drug Pricing Program and who benefits from this program?
Answer: The 340B
Drug Pricing Program allows certain facilities, such as Federally
Qualified Health Centers (FQHCs), FQHC Look-Alikes, and disproportionate
share hospitals (DSH) that meets certain requirements, to purchase
prescription and non-prescription medications at reduced cost. Participating
facilities can use these savings to reduce the price of medications
for patients, increase the number of indigent patients served, expand
the number of drugs offered, and expand other services offered to patients.
The 340B program is based on Section 340B of Public Law 102-585, the
Veterans Health Care Act of 1992.
The 340B Prime Vendor Program negotiates
pharmaceutical pricing below the 340B price and establishes distribution
solutions and networks that improve access to affordable medications
for participants of the 340B Drug Pricing Program. The program is free
and voluntary to facilities that are already 340B eligible.
For more information about the 340B Drug Pricing program,
please see the Health Resources and Services Administration's Introduction
to 340B Drug Pricing Program. Additional assistance is available
from the Pharmacy Services Support
Center at 800-628-6297.
Credits
Maintained by: Alex McEllistrem-Evenson,
alex@raconline.org
Last revised 11/18/2009
