Rural Health Research Gateway

Medicare Part D

Publications

Alphabetical list. You can also view by publication date.

  • Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
    Author(s): Michelle M. Casey, Jill Klingner, Ira Moscovice
    Research center: Minnesota Rural Health Research Center
    Topics: Health services, Legislation and regulation, Medicare Part D, Pharmacy and prescription drugs, Workforce
    Report Number: Working Paper No. 36
    Date: 07 / 2001
    Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
  • Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
    Research center: Walsh Center for Rural Health Analysis
    Topics: Legislation and regulation, Medicare, Medicare Part D
    Date: 01 / 2003
    Examines the relationship between a variety of design characteristics of a Medicare prescription drug benefit and their likely impact on rural areas. The research is based on an analysis of three competing legislative proposals, the House passed proposal (HR 4954), the "Tripartisan" proposal (S 2729), and the Graham proposal (S 2625). In addition, there is an analysis of data from the Medicare Current Beneficiary Survey, pharmacy benefit managers, discussions with various state and federal policy makers, and reviews of published literature. The study finds that the different prescription drug proposals will have positive implications for rural areas and address the lack of access to Medicare+Choice drug coverage in rural areas. Rural pharmacies may see a change in revenue, but the actual result of the changes has not been studied.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Author(s): Andrew F. Coburn, Erika C. Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
    Date: 08 / 2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
    Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topic: Medicare Part D
    Report Number: Rural Policy Brief Vol. 12, No. 1 (PB2007-1)
    Date: 01 / 2007
    Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States. Updates findings presented in RUPRI Center policy brief PB2006-8. Maps showing the percent of rural persons enrolled in Part D plans are available: black and white map, color map.
  • Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
    Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare Part D, Pharmacy and prescription drugs
    Citation: Journal of Rural Health, 23(4), 286–293
    Date: 2007
    Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation.
  • 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
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare Part D, Pharmacy and prescription drugs
    Report Number: Working Paper No. 87 (NC), Policy Paper P2006-3 (RUPRI)
    Date: 11 / 2006
    Case study describing first-hand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans (PDPs) in the first seven months of 2006. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. Previously, these patients were mostly non-covered cash or Medicaid-covered clients. Two consequences are apparent in the data collected: 1) Payment per prescription is lower from Medicare PDPs than from either non-covered cash or Medicaid, and in some instances payment from PDPs is less than the combined cost of stocking the medications and dispensing them, representing a reduction in revenue; and 2)The number of plans that provide Part D benefits greatly exceeds the two payment sources pharmacists previously dealt with, representing an increase in administrative burden for independent pharmacies.
  • How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Pre-Implementation Prescription Volume and Payment Sources in Rural and Urban Areas
    Author(s): Erin P. Fraher, Rebecca T. Slifkin, Laura Smith, Randy Randolph, Matthew Rudolf, George M. Holmes
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health care financing, Health policy, Medicare Part D, Pharmacy and prescription drugs
    Citation: Journal of Rural Health, 21(2), 114-121
    Date: 2005
    Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies. The authors found that the volume of mail-order prescriptions is small. Rural providers prescribed fewer retail and mail-order prescriptions per person, but more units per person. Rural areas have a higher percentage of prescriptions paid for by cash (18% vs. 13%) and Medicaid (16% vs. 10%) and a lower percentage of third-party payers than urban areas. Significant variation in volume and payer type exists between states. The authors conclude that rural, independent pharmacies may be negatively affected by MMA implementation as business shifts from cash to third-party reimbursement. The high degree of variation between states also has potentially important implications for the implementation of Prescription Drug Plan regions under MMA.
  • Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
    Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topic: Medicare Part D
    Report Number: Rural Policy Brief Vol. 10, No. 8 (PB2006-8 )
    Date: 04 / 2006
    Provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program. These early findings show mixed results for the Medicare prescription drug plan (PDP) in rural areas, with enrollment in the Medicare stand-alone PDP higher in rural areas (21%) than in urban areas (13%). However, this is balanced by low enrollment in MA-PD plans in rural areas, which offer relatively less generous plan choices to rural persons. Additionally, enrollment in employer and federal plans is lower in rural areas (20%) than in urban areas (24%). Finally, the relatively high enrollment in Part D in rural areas reflects the high enrollment of Medicaid dual eligibles also covered by Medicare, who were not enrolled in Part D voluntarily.
  • Medicare Prescription Drug, Improvement, And Modernization Act Of 2003, (P.L. 108-173): A Summary Of Provisions Important To Rural Health Care Delivery
    Author(s): Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Medicare, Medicare Part D
    Report Number: Policy Paper P2004-1
    Date: 01 / 2004
    Provides a wide audience of rural health policymakers, advocates, and researchers a consolidated summary of legislative provisions contained in Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) that have particular meaning to the delivery of services in rural areas. Includes information on how this Act will impact beneficiaries, health care access, and payments to rural health care providers.
  • One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
    Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare Part D, Pharmacy and prescription drugs
    Report Number: Final Report No. 92 (NC), Final Report No. P2007-1 (RUPRI)
    Date: 09 / 2007
    Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available.
  • One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
    Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare Part D, Pharmacy and prescription drugs
    Report Number: Findings Brief No. 83
    Date: 10 / 2007
    Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available.
  • Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations
    Author(s): Keith J. Mueller, Lisa Bottsford
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topic: Medicare Part D
    Report Number: Rural Policy Brief Vol. 10, No. 2 (PB2005-2 )
    Date: 08 / 2005
    Keeping with their organizational missions to improve and promote the health of rural Americans, state offices of rural health and state rural health associations have an inherent interest in helping beneficiaries access necessary health care services, including prescription medications. Implementation of Part D creates an opportunity to help beneficiaries through leadership, by connecting beneficiaries and those who serve them to resources that will help them react appropriately to changes in the program.
  • Rural Beneficiaries' Projected Drug Coverage Under Three Medicare Prescription Drug Proposals
    Research center: Walsh Center for Rural Health Analysis
    Topics: Medicare, Medicare Part D
    Report Number: P 2003-1
    Date: 06 / 2003
    Estimates the expected increase in urban and rural Medicare beneficiaries eligible for drug coverage under three current Medicare prescription drug proposals. Also gives an estimate of the urban and rural per capita federal payments for drug coverage under the three proposals. Finds that total dollar impact of the three proposals is driven by their generosity. The costliest offers the greatest taxpayer-funded benefits. Per dollar of spending, the urban/rural division of federal drug outlays differs across the proposals. The Administration proposal would result in much higher per-capita federal drug spending in rural areas than urban ones. Congressional Republican and Democratic proposals show smaller rural-urban differences. Concludes that higher poverty and lower current drug coverage in rural areas affect projected spending under Medicare drug proposals. Per dollar of spending, the Administration's proposal to focus spending on near-poor without current coverage strongly favors rural areas. Congressional Democratic and Republican proposals subsidize coverage for all, including those currently with and without coverage. The urban-rural split of federal spending under those proposals depends on the extent to which the currently uninsured are willing to take up the newly offered benefit.
  • Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
    Author(s): Curt Mueller, Keith Mueller, Janet Sutton
    Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
    Topics: Legislation and regulation, Medicare, Medicare Part D
    Report Number: Walsh W Series No. 6, RUPRI P2004-6
    Date: 08 / 2004
    Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.

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This web site includes content provided by and adapted from the Maine Rural Health Research Center, University of Southern Maine under a Cooperative Agreement with the University of North Dakota.