FINANCIAL ISSUES CHALLENGING SUSTAINABILITY OF RURAL PHARMACIES
FINANCIAL ISSUES CHALLENGING SUSTAINABILITY OF RURAL PHARMACIES

Summary/Abstract: Medicare Part D has improved access to prescription drugs for Medicare beneficiaries. However, the program has raised certain issues that threaten the viability of pharmacies. After a decade of Part D, we assess these issues as they concern rural pharmacies using survey responses. Independent rural pharmacies, the only retail pharmacy outlets in their communities, were surveyed. Email-based surveys were returned by 118 respondents. Rural pharmacies ranked two issues – direct and indirect remuneration (DIR) fees and delayed maximum allowable cost (MAC) adjustment – highest on scales of magnitude and immediacy of the challenge they posed to sustainability. 80% of respondents reported DIR fees as a challenge of very large magnitude and 83% reported it as a very immediate challenge. 78% of respondents reported MACs not being updated quickly enough as a very large magnitude challenge, with 80% indicating it is a very immediate challenge. Exclusion from the preferred networks of Part D plans was reported as a challenge of very large magnitude and immediacy by about 60% of pharmacies. Pharmacy staffing, competition from pharmacy chains, and contracts for services rendered to Medicaid patients were less likely to be reported as significant or immediate challenges. Policies that address the issues of delayed MAC adjustment and DIR fees could go a long way in ensuring the viability of these critical sources of pharmaceutical services.

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