Issues Confronting Rural Pharmacies after a Decade of Medicare Part D.

Purpose. The RUPRI Center for Rural Health Policy Analysis has been monitoring the status of rural independent pharmacies since the implementation of Medicare Part D in 2005. After a decade of Part D, we reassess in this brief the issues that concern rural pharmacies and may ultimately challenge their provision of services. This reassessment is based on survey responses from rural pharmacists. Key Findings: (1) Rural pharmacists indicated that two challenges--direct and indirect remuneration (DIR) fees, and delayed maximum allowable cost (MAC) adjustment--ranked highest on scales of both magnitude and immediacy. Nearly eighty (79.8) percent of respondents reported DIR fees as a very large magnitude challenge, with 83.3 percent reporting this as a very immediate challenge. Seventy-eight percent of respondents reported MACs not being updated quickly enough to reflect changes in wholesale drug costs as a very large magnitude challenge, with 79.7 percent indicating it as a very immediate challenge. (2) Medicare Part D continues to be a concern for rural pharmacies--58.8 percent of pharmacists said being an out-of-network pharmacy for Part D plans was a very large magnitude challenge (an additional 29.0 percent said large magnitude) and 60.5 percent said it was a very immediate challenge (an additional 28.1 percent said moderately immediate). (3) Pharmacy staffing, competition from pharmacy chains, and contracts for services for Medicaid patients were less likely to be reported as significant or immediate challenges.