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.
Related Guides
Frequently Asked Questions
Tools
340B Prime Vendor Program
Web site
Service that 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.
ASHP/PSSC Patient Assistance Program (PAP) Resource Center
Web site
Information and resources to establish a patient assistance program (PAP) to increase medication access. Also includes links to state and manufacturer PAPs.
BenefitsCheckUp
Web site
Helps Medicare beneficiaries learn about and enroll in government benefits, including Medicare Part D, the Supplemental Nutrition Assistance Program, and Eldercare Assistance.
CMS Pharmaceutical, Pharmacy, & Device Manufacturers Open Door Forums
Technical assistance
Provides information on a series of CMS forums addressing pharmacy issues. Includes call-in instructions for the next call, how to register for the mailing list, and links to pharmacy-related fact sheets.
Drug Information Portal
Web site
Gateway to selected drug information from the U.S. National Library of Medicine and other key U.S. Government agencies. Provides links to individual resources with potential drug information, including summaries tailored to various audiences.
Extra Help With Medicare Prescription Drug Plan Costs
Web site
Provides resources for Medicare beneficiaries who may qualify for the Medicare Prescription Drug Plan Extra Help program.
HRSA Pharmacy Support Services Center (PSSC)
Web site
Information and resources related to the 340B prescription drug program, which requires drug manufacturers to provide outpatient drugs to eligible health care facilities at a reduced price. Includes information on program eligibility requirements, FAQs, and other information.
InsureKidsNow.gov
Web site
Supplies information on free and low-cost health insurance programs for children including Medicaid and CHIP (Children's Health Insurance Program).
Medicare Health and Prescription Drug Plan Tracker
Web site
Consists of an interactive tool which provides information about private plans participating in the Medicare Advantage program and the Medicare prescription drug program. Includes national statistics specific to rural areas.
Office of Pharmacy Affairs Pharmacy Technical Assistance
Technical assistance
Pharmacy technical assistance for 340B-eligible entities via a team of consultants. Toll-free: 1-866-PHARMTA.
Partnership for Prescription Assistance
Web site
Provides patients and providers with resources to help qualifying patients who lack prescription drug coverage, gain access to low-cost medications. Provides access to public and private patient assistance programs, including programs offered by pharmaceutical companies.
Pharmaceutical Manufacturers Patient Assistance Programs (PAPs)
Web site
Links to websites that help patients enroll in drug manufacturer-sponsored PAPs. Also includes information on manufacturer-sponsored drug discount cards.
Postmarketing Drug Safety Evaluations
Web site
Provides summary information on the safety of recently approved drugs and biologics.
Rural Health Research: Pharmacy and prescription drugs
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of pharmacy and prescription drugs, produced by the Office of Rural Health Policy's funded rural health research centers.
RxAssist - Patient Assistance Programs
Database
Provides a searchable database of patient assistance programs that provide free or low-cost prescription medications to people who cannot afford to buy their medicine. Includes information for patients and for health care providers.
State Patient Assistance Program (PAP) Resource Sites
Web site
Links to state programs that provide Patient Assistance Programs (PAP) or support access to PAPs.
Together Rx Access
Web site
Helps eligible individuals and families save money on prescription medications. Also available in Spanish
Funding
340B Drug Pricing Program
Allows certain facilities such as Critical Access Hospitals and Federally-qualified health center look-alikes to purchase prescription and non-prescription medications at reduced cost.
Award for Excellence in Medication-Use Safety
An award program to honor a pharmacist-led multidisciplinary team for its significant institution-wide system improvements relating to medication use.
Walgreen Community Grant Program
Funding for access to health and wellness, pharmacy education programs and mentoring initiatives, civic and community outreach, and emergency and disaster relief.
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Regulations, Forms & Other Useful Documents
340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
Author(s): Andrea Radford, Rebecca Slifkin, Marianne Baernholdt, Claudia Schur, Karen Cheung
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Summarizes the results of a survey of pharmacy directors at rural hospitals eligible to participate in the 340B program but identified as not participating at the time of the survey. Studies why rural hospitals that are eligible for the program are not participating and if there are barriers to participation.
Date: 01 / 2007
340B Drug Pricing Program: Results of a Survey of Participating Hospitals
Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin, Marianne Baernholdt
Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation. A joint paper from the NORC Walsh Center for Rural Health Analysis and North Carolina Rural Health Research & Policy Analysis Center.
Date: 05 / 2007
Access to Pharmaceuticals and Pharmacy Services in Rural Areas
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Chapter from the 2006 Report to the Secretary: Rural Health and Human Service Issues. Discusses rural access to prescription drugs and pharmacy services, including affordability, utilization, and pharmacy workforce.
Date: 01 / 2006
Adequacy of Pharmacist Supply: 2004 to 2030
Sponsoring organization: Health Resources and Services Administration
Examines the current and projected future adequacy of pharmacist supply in the United States, and the future balance between supply and demand, by using HRSA's Bureau of Health Professions Pharmacist Supply and Requirements Model (PhSRM). Reflects findings from a literature review, original empirical analysis, and discussions with representatives from pharmaceutical associations and subject matter experts to develop supply and demand scenarios.
Date: 12 / 2008
Critical Access Hospitals: 340B Eligibility, Enrollment, and Participation
Sponsoring organization: Health Resources and Services Administration
Provides eligible Critical Access Hospitals and other interested parties basic background information about the 340B Drug Pricing Program and instructions on how to enroll in 340B.
Date: 08 / 2010
Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
Sponsoring organization: Safety Net Hospitals for Pharmaceutical Access
Suggests short-term actions that can be taken to address the challenges faced by rural independent pharmacies who are the sole providers in their communities. A joint publication of the North Carolina Rural Health Research & Policy Analysis Center and the RUPRI Center for Rural Health Policy Analysis.
Date: 11 / 2006
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
Author(s): Michelle Casey, Walter Elias, Alana Knudson, Walter Gregg
Sponsoring organization: Upper Midwest Rural Health Research Center
Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
Date: 12 / 2008
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Policy Brief)
Sponsoring organization: Upper Midwest Rural Health Research Center
Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
Date: 03 / 2009
Independently Owned Pharmacy Closures in Rural America, 2003-2010
Author(s): Kaitlin Boyle, Fred Ullrich, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2010.
Date: 06 / 2011
Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems
Author(s): Andrea Radford, Indira Richardson, Michelle Mason, Stephen Rutledge
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Presents findings from a 2008 survey of 401 community pharmacists that are the only retail provider in their community to document their extended relationships with other health care providers.
Date: 03 / 2009
Loss of Community Pharmacies Since 2006: State Experiences
Author(s): Liyan Xu, Fred Ullrich, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Presents data on rural pharmacies. Local rural pharmacies continue to serve many of the nation's communities as the sole provider of pharmacy services. However, between May 2006 and December 2008, the number of retail pharmacies in 213 rural places dropped from one to zero, and the number of retail pharmacies in 118 rural places dropped from more than one to only one.
Date: 04 / 2009
Medicare Drug Coverage under Medicare Part A, Part B, and Part D
Sponsoring organization: Centers for Medicare and Medicaid Services
Overview of drug coverage under Medicare Part A, Part B and Part D, with information on what drugs are covered under each part of the Medicare program.
Date: 08 / 2007
National ADAP Monitoring Project: Annual Report
Author(s): Alicia L. Carbaugh, Jennifer Kates, Beth Crutsinger-Perry, Britten Ginsburg, Murral C. Penner
Sponsoring organization: National Alliance of State and Territorial AIDS Directors
Detailed data on the state AIDS Drug Assistance Programs (ADAPs), a part of the Ryan White Program, that provides HIV medications to low-income people with HIV/AIDS who have limited or no prescription drug coverage.
Date: 05 / 2010
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety
Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson
Sponsoring organization: Upper Midwest Rural Health Research Center
Assesses the capacity of rural hospitals to implement medication safety practices. Found that many small rural hospitals have limited hours of on site pharmacist coverage.
Date: 12 / 2005
Practical Guide to Electronic Prescribing: Guide 3
Sponsoring organization: Minnesota Department of Health
A guide to help providers meet Minnesota’s 2011 e-prescribing mandate and to tap into incentives under Medicare and Medicaid stimulus funds.
Date: 06 / 2009
Prescription Drug Safety Net: Access to Pharmaceuticals for the Uninsured
Author(s): Jack Hoadley
Sponsoring organization: National Health Policy Forum
Overview of organized programs that provide access to prescription drugs for the uninsured. Focuses on manufacturer-sponsored pharmacy assistance
programs (PAPs) and the federal 340B drug pricing program.
Date: 05 / 2007
Prescription Drug Trends
Sponsoring organization: Kaiser Family Foundation
Trend data for prescription drug coverage, expenditures, and the key factors that contribute to rising prescription spending: increases in utilization and prices, and changes in drug use from older drugs to newer higher-priced drugs.
Date: 05 / 2010
Profile of Sole Community Pharmacists’ Prescription Sales and Overall Financial Position
Author(s): Andrea Radford, Michelle Lampman, Indira Richardson, Stephen Rutledge
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Examines the role sole community pharmacies play in their local health care system.
Date: 08 / 2009
Recruitment and Retention of a Quality Health Workforce in Rural Areas, Number 3: Pharmacists and Pharmacy Technicians
Sponsoring organization: National Rural Health Association
Discusses the challenges of recruiting pharmacists and pharmacy technicians to work in rural areas. Describes successful recruitment programs in Minnesota and West Virginia. Part of a series of issue papers addressing rural health care workforce development through career pipeline programs.
Date: 05 / 2005
Reliance on Independently Owned Pharmacies in Rural America
Author(s): Michael D. Shambaugh-Miller, Nicole Vanosdel, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Policy brief providing locations of independently owned pharmacies in rural America that are the sole sources of access to local pharmaceutical services. The information in this brief lays a foundation for analyzing vulnerability of pharmacy services in rural America and identifies the questions that research and policy activities should address. State maps show the locations of communities with only one pharmacy, independently owned.
Date: 11 / 2007
Review of the Relationship between Medicare Part D Payments to Local, Community Pharmacies and the Pharmacies' Drug Acquisition Costs
Author(s): Office of Inspector General
Sponsoring organization: U.S. Department of Health and Human Services
Analyzes the relationship between Medicare Part D payments, excluding dispensing fees, to local, community pharmacies and the pharmacies’ drug acquisition costs. Estimate Part D dispensing fees and compares them with Medicaid dispensing fees. Includes some data specific to rural pharmacies.
Date: 01 / 2008
Rural Hospitals' Experience with the 340B Drug Pricing Program
Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin
Policy brief describing the results of surveys of rural hospitals participating in the 340B drug pricing program and of rural eligible but non-participating hospitals. Includes information on factors affecting participation in the program and the benefits and challenges of participation.
Date: 09 / 2007
Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
Author(s): Victoria Freeman, Indira Richardson, Rebecca Slifkin
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used Prescription Drug Plans (PDPs)available in their state.
Date: 02 / 2009
Trends in Outpatient Prescription Drug Utilization and Expenditures, 1997 and 2004
Author(s): Marie N. Stagnitti
Sponsoring organization: Agency for Healthcare Research and Quality
Compares 1997 and 2004 estimates for the U.S. population on total expenditures, total number of purchases, average total expenditure, average out-of-pocket payment and average number of purchases for outpatient-prescribed medicines for those with a prescribed drug purchase. Also provides the percentage of total health care expenditures represented by prescribed drug expenditures for 1997 and 2004.
Date: 04 / 2007
Workforce Issues Among Sole Community Pharmacies
Author(s): Donald Klepser, Michelle Lampman, Andrea Radford, Indira Richardson, Stephen Rutledge
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacy's future.
Date: 07 / 2009
Organizations
Office of Pharmacy Affairs
Federal government
Administers the 340 Drug Pricing Program, through which certain federally funded grantees and other safety net health care providers may purchase prescription medication at significantly reduced prices. A federal resource on pharmacy services. Part of the Health Resources and Services Administration.
Safety Net Hospitals for Pharmaceutical Access (SNHPA)
National organization
Works to increase the affordability and accessibility of pharmaceutical care for the underserved. An organization of approximately 700 public and private non-profit hospitals and health systems throughout the U.S. that participate in the Public Health Service 340B drug discount program.
Terms & Acronyms
340B Drug Pricing Program Program that allows qualified entities, such as FQHCs, to purchase prescription and non-prescription medications for their outpatients at reduced cost. Based on Section 340B of Public Law 102-585, the Veterans Health Care Act of 1992.
Computerized Provider Order Entry (CPOE) A system that includes both inpatient orders and the electronic ordering of outpatient prescriptions often referred to as e-prescribing. The CPOE allows physicians and other caregivers to input orders directly into a computer, thereby eliminating problems with handwriting legibility and order transcription.
Enrollment Period For Medicare Part D, those already on Medicare can enroll in the drug benefit between November 15 and December 31, and coverage would be effective on January 1 of the new year. If you were first eligible to enroll before May 15, 2006 but did not sign up, you may need to pay a late enrollment penalty.
Formulary A list of prescription drugs covered by a prescription plan.
Locum Tenens Someone who is available on a temporary basis to substitute for another member of the same profession.
Medicare Part D (Prescription Drug Plans) (PDPs) Provides outpatient prescription drug coverage that is delivered through private plans that contract with Medicare. The benefit includes additional assistance with plan premiums and cost-sharing amounts for low-income beneficiaries. People enrolled in Medicare drug plans pay a monthly premium. Prescription drug benefit added to Medicare in 2006. Created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Medigap A Medicare supplement insurance policy sold by private insurance companies to fill gaps in Original Medicare Plan coverage.
Patient Assistance Program (PAP) Program to provide reduced-cost prescription medications to people with financial need. PAPs are typically sponsored by drug manufacturers and have specific eligibility requirements related to income.
PBM (Pharmacy Benefit Manager) Organization that administers and addresses cost containment issues for pharmacy benefits programs.
SCHIP (State Children's Health Insurance Program) A State and Federal partnership to help children without health insurance, many of whom come from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance.
State Pharmaceutical Assistance Program (SPAP) State-sponsored program to provide reduced-cost prescription medications to people with financial need.
True Out-of-Pocket Costs (TrOOP) Drug costs paid by a Medicare enrollee, or on behalf of an enrollee by a family member, charitable organization, or State Pharmacy Assistance Program.
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