Pharmacy and Prescription Drugs
Pharmacy services are especially important in rural communities. Rural areas tend to have an older population with more chronic illnesses, with a greater need for advice from a pharmacist on managing medications. Despite this demand for services, rural pharmacies face many challenges to stay open, including financial pressures and a lack of pharmacists to provide services. Rural residents may also be unable to get transportation to the nearest pharmacy.
While the growth of Internet and mail-order pharmacies might suggest that geographical limits to access are no longer a concern, many rural residents do not have the equipment, technical skills, and/or telecommunications accessibility that these services require. As such, rural pharmacies and pharmacists will continue to fill an important and much-needed role in the health of rural people.
Frequently Asked Questions
- Why is it important for rural people to have access to pharmacy services?
- What challenges exist to maintain rural pharmacy services?
- Are there enough pharmacists available in rural America?
- What can communities do to ensure pharmacy access?
- What resources are available to help individuals pay for prescription drugs?
- What is the 340B Drug Pricing Program and who benefits from this program?
Why is it important for rural people to have access to pharmacy services?
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.
What challenges exist to maintain rural pharmacy services?
Rural pharmacies typically pay more to drug manufacturers per prescription and sell a relatively low volume of medications, so the resulting profit 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 pharmacies may actually lose money supplying 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.
Financial pressures on rural pharmacies can lead to closure, which may leave a community many miles from the next pharmacy. For more information about challenges facing rural pharmacies, see Access to Pharmaceuticals and Pharmacy Services in Rural Areas, a chapter from the 2006 Report to the Secretary: Rural Health and Human Service Issues, National Advisory Committee on Rural Health and Human Services.
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.
Are there enough pharmacists available in rural America?
Independent, rural pharmacies are fighting to survive. Declining rural populations, along with increased competition from Internet and chain store pharmacies, have contributed to pharmacy closures throughout the United States.
According to RUPRI Center for Rural Health Policy Analysis, Rural Policy Brief 2013-11, August 2013, Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study, the most common cause of pharmacy closure was pharmacist retirement, followed by financial difficulty.
According to RUPRI Center for Rural Health Policy, Rural Policy Brief 2012-5, January 2013, Rural Pharmacy Closures: Implications for Rural Communities, 119 sole community pharmacies closed between May 1, 2006, and October 31, 2010. Of those 119 pharmacies, 31 were located in rural communities with no other health professionals or clinical providers. Of those 31 pharmacy closures, 17% were located in remote rural areas (RUCA score of 10 or higher).
According to RUPRI Center for Rural Health Policy, Rural Policy Brief 2012-4, July 2012, Independently Owned Pharmacy Closures in Rural America, from March 1, 2003, to December 1, 2011, there was a loss of 852 independently owned rural pharmacies in the United States. Between May 2006 and December 2011, 296 rural communities lost their only retail pharmacy.
Yet, the picture isn’t entirely bleak. Rural pharmacies are finding new business models and rural pharmacists are embracing new technologies, like telepharmacy and remote pharmacy, to reach their patients.
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.
What can communities do to ensure pharmacy access?
Communities may want to pursue the development of a locum tenens (place holder) program through their state pharmacy board, college of pharmacy or state pharmacy association. These programs help provide relief staffing by pharmacists willing to substitute for other pharmacists on a temporary basis.
The use of telepharmacy, which employs technology to provide pharmacy services at a distance, is being used to provide additional access to pharmacist services in existing pharmacies such as in rural hospitals with limited hours of on-site pharmacist coverage. Telepharmacy also allows more timely review of medication orders. For more information on how to set up a telepharmacy program, please refer to chapter ten, Pharmacy, 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.
What resources are available to help individuals pay for prescription drugs?
Several resources are available to identify programs that can help individuals pay for prescription drugs. Partnership for Prescription Assistance offers a database of prescription drug assistance programs available from pharmaceutical companies. The website allows patients, caregivers, or health care providers to search for specific medications and find matching assistance programs.
The American Society of Health-System Pharmacists (ASHP) provides resources and materials for various assistance programs.
What is the 340B Drug Pricing Program and who benefits from this program?
The 340B Drug Pricing Program allows certain facilities, such as Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes, Critical Access Hospitals (CAHs), Sole Community Hospitals, Rural Referral Centers, 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, is a free federal program open to all eligible entities. The PVP negotiates pricing below the 340B ceiling price, helping to establish distribution solutions and networks that improve access to affordable medications for participants of the 340B Drug Pricing Program. In addition the PVP offers value added products and services in an effort to decrease the cost of providing medication to patients of the participating facilities. The program is voluntary and open to facilities that are already registered with HRSA for the 340B program. Registration for the program is done via the Internet. A tutorial, located on the 340B Multimedia Center page, provides further information about the program. Additional assistance is available at 888.340.2787.
For more information about the 340B Drug Pricing program, please see the Health Resources and Services Administration's Introduction to 340B Drug Pricing Program. Should you need technical assistance, please contact the Prime Vendor Program by phone at 888.340.2787 or email at ApexusAnswers@340BPVP.com.