Pharmacy and Prescription Drugs Frequently Asked Questions
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 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 National Advisory Committee on Rural Health and Human journal article, "The Economic Realities of Rural Pharmacy Practice" (Stratton T.P., Journal of Rural Health. 2001 Spring;17(2):77-81).
Question: Are there enough pharmacists available in rural America?
Answer: 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.
Since May 2006, 503 independently owned rural pharmacies have been lost, leaving 213 rural areas with no retail pharmacies, according to Keith Mueller, director of the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis at the University of Nebraska Medical Center.
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.
Question: What can communities do to ensure pharmacy access?
Answer: 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, 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 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 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 ASHP/PSSC (American Society of Health-System
Pharmacists/Pharmacy Services Support Center) Patient Assistance Program (PAP) Resource Center provides resources and materials for various assistance 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. See the Transportation topic 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, is a free federal program open to all eligible entities. The PVP negotiates pricing below the 340B ceiling price, helps 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 Navigating 340B is on the home page of the website to provide 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. Additional assistance is available
from the Pharmacy Services Support
Center at 800-628-6297.
Credits
Maintained by: Mary Reinertson-Sand, mary@raconline.org
Last revised 07/26/2011
