Rural Pharmacies Needed - No Walls Required (Part One of a Two Part Series)

Posted by Allison S. Bybee

Pharmacies and the pharmacists that staff them play a critically important role in caring for millions of Americans each year. Yet with profit margins falling and diminishing incentives for rural pharmacists, pharmacies are being forced to shut their doors. As pharmacists leave or choose not to serve in rural and remote communities, patients in need of critical pharmaceutical assistance are being left making potentially life-altering decisions without medical oversight.

Across America it is generally recognized fact that rural communities are more likely to have higher rates of older residents. Overall, this demographic has more chronic illnesses which require one or more prescription drug treatments. As in any population, as the number of drug regimens increase, there is a higher risk that potentially harmful drug interactions could occur. For most urban or suburban Americans under the care of a physician and with prescription health insurance, this element of risk is reduced by the presence of a local pharmacist who is familiar with a patient’s medication profile and can caution patients away from potentially fatal interactions.

While critically important to thousands of communities around the country, rural pharmacies are being forced to shut their doors due to low Medicare/Medicaid reimbursement rates (which tend to produce low profit margins) and more professional and personal opportunities for pharmacists in urban areas. As rural pharmacies shut down or relocate to higher populated areas, rural residents are being left in the lurch because of the intrinsically important role that pharmacists play as one of the only sources of medical advice and care in a community.

Some would argue that the arrival of the internet and mail-order pharmacies are the perfect solution for those who are unable to find transportation to pharmacies which are increasingly further afield. Yet with the uptake of mail-order prescriptions has come the concern that quality care (including detection of medical errors, management of interactions, and provision of preventive education) is being diminished by the lack of pharmaceutical oversight of individual patient regiments.

A Solution to the Dilemma? A New Wall-less Pharmaceutical Model

To counteract the ill effects of the loss of pharmacies, the PharmAssist program was launched in Montana in 2006. Based on a successful, but now budget-defunct program in Wyoming, Montana’s PharmAssist program sends pharmacists out to areas across the state for rural patient consultations. Through PharmAssist, Montana’s patients have access to the advise of a community pharmacist who can assist them with finding ways to manage prescription cost, drug interactions, and prescription side effects. Furthermore in an effort to improve patient-pharmacist-physician communication, after a PharmAssist consultation, pharmacists send a letter detailing recommendations to a patient’s prescribing physician. Regardless of age or income status, these consultations are made free of charge to patients by a revenue funding stream from state garnered tobacco taxes. The currently 27 participating PharmAssist pharmacists are specially trained to handle the unique to the road responsibilities through a certification program at the University of Montana at Missoula. (To learn more about this program, please click here).

Needless to say there are many issues that plague rural pharmacy, yet innovative models are being tested to improve existing systems. In part two of Rural Pharmacies Needed - No Walls Required, issues surrounding pharmaceutical workforce recruitment, training, and retention will be addressed.