Pharmacy and prescription drugs

Publications

Alphabetical list. You can also view by publication date.

340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
Date: 01 / 2007
Author(s): Andrea Radford, Rebecca Slifkin, Claudia Schur, Karen Cheung
Research centers: North Carolina Rural Health Research and Policy Analysis Center , Walsh Center for Rural Health Analysis
Topics: Hospitals and clinics, Pharmacy and prescription drugs
Report Number: Working Paper No. 88 (UNC), Working Paper 2007-01 (Walsh)
Summarizes the results of a 2006 survey of pharmacy directors at rural hospitals that are eligible but currently not participating in the 340B Drug Pricing Program, which enables certain types of safety-net organizations to obtain discounted outpatient medications.
340B Drug Pricing Program: Results of a Survey of Participating Hospitals
Date: 05 / 2007
Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin, Marianne Baernholdt
Research centers: North Carolina Rural Health Research and Policy Analysis Center , Walsh Center for Rural Health Analysis
Topics: Hospitals and clinics, Pharmacy and prescription drugs
Report Number: Working Paper No. 2007-03 (Walsh), Working Paper No. 90 (NC)
Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation.
Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
Date: 07 / 2001
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
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.
Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
Date: 01 / 2003
Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs
This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
Barriers to Autonomous Practice
Date: 01 / 2006
Author(s): Louise Kaplan, Marie-Annette Brown, Holly Andrilla, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Mid-level practitioners, Nurses, Pharmacy and prescription drugs, Workforce
Citation: Nurse Practitioner, 31(1), 57-63
Describes a study of the impact of a Washington State law changing nurse practitioners (NPs) prescribing authority. The study examined whether prescribing with indirect physician involvement eliminated barriers to practice, the extent to which the law created barriers to prescribing certain drugs, and compared NPs' experiences prescribing or providing controlled substances before and after implementation of the current law.
Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
Date: 09 / 2004
Author(s): Keith J. Mueller, Rebecca T. Slifkin, Michael D. Shambaugh-Miller, Randy K. Randolph
Research centers: North Carolina Rural Health Research and Policy Analysis Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Defining rural, Legislation and regulation, Pharmacy and prescription drugs
Report Number: RUPRI Policy Paper P2004-7, North Carolina Working Paper No. 79
Access to local pharmacy services is dependent upon the extent to which prescription drug plans offering the Medicare benefit incorporate local rural pharmacies into their provider networks. This will be based on market considerations and on the requirements for local access contained in the MMA and regulation, which in turn will be shaped by how "rural" is defined. This paper assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
Date: 08 / 2000
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
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.
Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers
Date: 10 / 2009
Author(s): Scott J. Adams, Stan Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topics: Children, Mental health, Pharmacy and prescription drugs
Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers.
Effect of Medicare Part D Plan Switching and Formulary Changes on Sole Community Pharmacies and the Patients They Serve
Date: 03 / 2010
Author(s): Michelle Lampman, Andrea Radford, Anh Nguyen
Research centers: North Carolina Rural Health Research and Policy Analysis Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topic: Pharmacy and prescription drugs
Presents findings from a 2008 survey of 401 pharmacist-owners of sole community independent pharmacies.
Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
Date: 2007
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
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
Date: 11 / 2006
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)
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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
February 2010: A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
Date: 03 / 2010
Author(s): Leah Kemper, Timothy D. McBride, M. Katherine Stone, Keith Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA), Pharmacy and prescription drugs
Report Number: 2010-3
In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010.
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
Date: 2005
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
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.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
Date: 12 / 2008
Author(s): Michelle Casey, Walter Elias, Alana Knudson, Walter Gregg
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth
Report Number: Final Report #8
Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Policy Brief)
Date: 03 / 2009
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth
Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
Date: 06 / 2000
Author(s): Andrew F. Coburn, Erika 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: Legislation and regulation, Pharmacy and prescription drugs
This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
Independently Owned Pharmacy Closures in Rural America (Policy Brief)
Date: 07 / 2008
Author(s): Donald Klepser, Liyan Xu, Fred Ullrich, Keith Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Medicare Advantage (MA), Medicare Part D, Pharmacy and prescription drugs
Report Number: 2008-2
The purpose of this policy brief is to provide policy makers, researchers, and stakeholders with information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 to 2008. This period coincides with the implementation of two major policies related to payment for prescription medications: Medicare prescription drug discount cards were introduced on January 1, 2004, and the Medicare prescription drug benefit began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
Independently Owned Pharmacy Closures in Rural America, 2003-2010
Date: 06 / 2011
Author(s): Kaitlin Boyle, Fred Ullrich, Keith Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Medicare Part D, Pharmacy and prescription drugs
Provides information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2010.
Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems
Date: 03 / 2009
Author(s): Andrea Radford, Indira Richardson, Michelle Mason, Stephen Rutledge
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Pharmacy and prescription drugs, Workforce
This findings brief presents findings from a 2008 survey of 401 community pharmacists that are the only retail provider in their community to document their extended relationships with other health care providers and the additional health care services these pharmacists provide to their patients. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine the presence in their community of other types of health care organizations that require pharmaceutical support(such as hospitals, long-term care facilities, hospice providers, home health agencies and community health centers), their level of involvement with those facilities, and the types of clinical services (other than dispensing and counseling) the pharmacists offered to their own patients.
Loss of Community Pharmacies Since 2006: State Experiences
Date: 04 / 2009
Author(s): Liyan Xu, Fred Ullrich, Keith Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topic: Pharmacy and prescription drugs
Report Number: 2009-3
This brief presents the latest data from a continuous monitoring of the status of rural pharmacies by the RUPRI Center. Local rural pharmacies continue to serve many of the nation's communities as the sole provider of pharmacy services. However, between May 2006 and December 2008, the number of retail pharmacies in 213 rural places dropped from one to zero, and the number of retail pharmacies in 118 rural places dropped from more than one to only one. The brief includes a table showing the data by state.
Medicare Beneficiaries' Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
Date: 01 / 2009
Author(s): Victoria A Freeman, Indira Richardson, Rebecca T. Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
Report Number: Final Report No. 95
Describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
Medicare Reforms: The Rural Perspective
Date: 04 / 2000
Author(s): Curt Mueller, Sheila J. Franco, Gail Wilensky
Research center: Walsh Center for Rural Health Analysis
Topics: Medicare, Pharmacy and prescription drugs
Discusses Medicare reforms considered by the National Bipartisan Commission on the Future of Medicare (created by the Balanced Budget Act of 1997 - BBA), including prescription drug coverage, funding graduate medical education, and increasing the eligibility age. To request a copy, contact the Walsh Center at 301-951-5070.
National Study Comparing Resident Medication Use in Rural and Non-Rural Assisted Living Facilities
Date: 02 / 2005
Research center: Southwest Rural Health Research Center
Topics: Long term care, Pharmacy and prescription drugs
In addition to comparing rural and non-rural assisted living residents' medication utilization, this study examined the prevalence of inappropriately prescribed medications (IPMs) and drug-to-drug interactions (DDIs) among residents of rural and non-rural assisted living facilities (ALFs). Residents of rural ALFs tended to be somewhat more impaired in physical functioning and cognitive status, and on average, took slightly more medications than their non-rural counterparts. Residents in rural ALFs appeared somewhat more likely to have an IPM and a DDI, a finding that, although not statistically significant, is consistent with their higher likelihood of taking more medications and their slightly lower likelihood of being in a facility with a RN on staff. Report available on request.
One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
Date: 09 / 2007
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)
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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
Date: 10 / 2007
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
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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
Date: 01 / 2006
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
Report Number: Policy Brief No. 1
To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. A full report is also available.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Date: 12 / 2005
Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
Report Number: Working Paper No. 1
To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
Date: 2006
Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
Citation: Journal of Rural Health, 22(4), 321-330
Reports the results of a study that assessed the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
Date: 04 / 2008
Author(s): Gary Cochran, PharmD, SM, Katherine Jones, PhD, PT, Liyan Xu, MS, Keith Mueller, PhD
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
Citation: This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in the nations smallest hospitals. A key finding is that hospitals with an average daily census of six or more patients were more likely to report having adopted safe medication practices than were hospitals with an average daily census of five or fewer patients. Findings from this research reveal considerable opportunity for improvement in hospitals with 49 or fewer beds to achieve evidence-based standards of medication safety.
Report Number: Issue Brief 2008-1
Profile of Sole Community Pharmacists' Prescription Sales and Overall Financial Position
Date: 08 / 2009
Author(s): Andrea Radford, Michelle Lampman, Indira Richardson, Stephen Rutledge
Research center: Rapid Response to Requests for Rural Data Analysis
Topic: Pharmacy and prescription drugs
Sole community independent pharmacists provide essential services to residents of small towns and isolated communities. In an effort to document the role sole community pharmacies play in their local health care system and to monitor their financial and operational status we conducted a survey in 2008 of 401 community pharmacists that owned the only retail outlet in their community. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine their reliance on prescription sales and to understand their store's current financial position.
Reliance on Independently Owned Pharmacies in Rural America
Date: 11 / 2007
Author(s): Michael D. Shambaugh-Miller, Nicole Vanosdel, Keith J. Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topic: Pharmacy and prescription drugs
Report Number: Rural Policy Brief No. 2007-6
Policy brief providing locations of independently owned pharmacies in rural America that are the sole sources of access to local pharmaceutical services. In over 2,000 rural communities, the only local pharmacy is independently owned, and in 1,044 of those communities, there is no other pharmacy within 10 miles. The information in this brief lays a foundation for analyzing vulnerability of pharmacy services in rural America and identifies the questions that research and policy activities should address. State maps show the locations of communities with only one pharmacy, independently owned.
Retail Pharmacies in Washington State: Results of the 2003 Workforce Survey
Date: 12 / 2004
Author(s): Susan M. Skillman, L. Gary Hart, Elise Bowditch, Beth A. Kirlin
Research center: WWAMI Rural Health Research Center
Topics: Pharmacy and prescription drugs, Workforce
Report Number: Working Paper No. 100
Researchers surveyed retail pharmacies in Washington to estimate the demand for pharmacists, as well as pharmacy technicians and administrative/clerical staff, and to describe the impact of implementation of the Health Insurance Portability and Accountability Act (HIPAA) on retail pharmacies. Combining the results of this survey with the estimates from a survey of pharmacist vacancies in the state's hospitals, 403 pharmacists were needed statewide for retail and hospital pharmacies in 2003-2004. Pharmacy schools in Washington graduated 180 pharmacists in 2003, which was not enough to fill all of the vacancies across the state.
Rural Beneficiary Need for a Medicare Drug Benefit Delivered Through the Rural Delivery System
Date: 10 / 2002
Author(s): Keith Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Aging, Pharmacy and prescription drugs, Poverty
Elderly who live below the poverty level, seniors without prescription drug coverage, Medicare plans
Rural Hospitals' Experience with the 340B Drug Pricing Program
Date: 09 / 2007
Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin
Research centers: North Carolina Rural Health Research and Policy Analysis Center , Walsh Center for Rural Health Analysis
Topics: Hospitals and clinics, Pharmacy and prescription drugs
Policy brief describing the results of surveys of rural hospitals participating in the 340B drug pricing program and of rural eligible but non-participating hospitals. Includes information on factors affecting participation in the program and the benefits and challenges of participation.
Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
Date: 02 / 2009
Author(s): Victoria Freeman, Indira Richardson, Rebecca Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Medicare Part D, Pharmacy and prescription drugs
This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
Date: 2005
Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield
Research centers: Maine Rural Health Research Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis , Upper Midwest Rural Health Research Center
Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
Citation: Journal of Rural Health, 21(3), 194-197
The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.
Workforce Issues Among Sole Community Pharmacies
Date: 07 / 2009
Author(s): Donald Klepser, Michelle Lampman, Andrea Radford, Indira Richardson, Stephen Rutledge
Research centers: North Carolina Rural Health Research and Policy Analysis Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Pharmacy and prescription drugs, Workforce
Pharmacy services are delivered through a sole community pharmacy in over 1000 small rural communities nationwide. This brief presents the findings from 401 telephone interviews of sole community pharmacist-owners nationwide about their current staffing and future plans. Thirty-three percent of those interviewed have one or fewer pharmacist FTEs on staff. Thirty percent of those interviewed would like to retire in five years or fewer, and most would like to sell their pharmacies upon retirement. This brief explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacy's future.
Workforce Issues in Rural Areas: A Focus on Policy Equity
Date: 01 / 2005
Author(s): Thomas C. Ricketts
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Health policy, Nurses, Pharmacy and prescription drugs, Physicians, Workforce
Citation: American Journal of Public Health, 95(1), 42-48
Reviews the geographic distribution of 6 classes of health professionals: physicians, nurses, dentists, pharmacists, mental health professionals, and public health professionals. Describes the government and private policies and programs intended to affect the geographic distribution of these health professionals.

Topics Centers Researchers Other Resources Search		Pharmacy and prescription drugs Publications Alphabetical list. You can also view by publication date. 340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals Date: 01 / 2007 Author(s): Andrea Radford, Rebecca Slifkin, Claudia Schur, Karen Cheung Research centers: North Carolina Rural Health Research and Policy Analysis Center , Walsh Center for Rural Health Analysis Topics: Hospitals and clinics, Pharmacy and prescription drugs Report Number: Working Paper No. 88 (UNC), Working Paper 2007-01 (Walsh) Summarizes the results of a 2006 survey of pharmacy directors at rural hospitals that are eligible but currently not participating in the 340B Drug Pricing Program, which enables certain types of safety-net organizations to obtain discounted outpatient medications. 340B Drug Pricing Program: Results of a Survey of Participating Hospitals Date: 05 / 2007 Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin, Marianne Baernholdt Research centers: North Carolina Rural Health Research and Policy Analysis Center , Walsh Center for Rural Health Analysis Topics: Hospitals and clinics, Pharmacy and prescription drugs Report Number: Working Paper No. 2007-03 (Walsh), Working Paper No. 90 (NC) Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation. Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota Date: 07 / 2001 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 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. Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective Date: 01 / 2003 Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel. Barriers to Autonomous Practice Date: 01 / 2006 Author(s): Louise Kaplan, Marie-Annette Brown, Holly Andrilla, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Mid-level practitioners, Nurses, Pharmacy and prescription drugs, Workforce Citation: Nurse Practitioner, 31(1), 57-63 Describes a study of the impact of a Washington State law changing nurse practitioners (NPs) prescribing authority. The study examined whether prescribing with indirect physician involvement eliminated barriers to practice, the extent to which the law created barriers to prescribing certain drugs, and compared NPs' experiences prescribing or providing controlled substances before and after implementation of the current law. Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans Date: 09 / 2004 Author(s): Keith J. Mueller, Rebecca T. Slifkin, Michael D. Shambaugh-Miller, Randy K. Randolph Research centers: North Carolina Rural Health Research and Policy Analysis Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Defining rural, Legislation and regulation, Pharmacy and prescription drugs Report Number: RUPRI Policy Paper P2004-7, North Carolina Working Paper No. 79 Access to local pharmacy services is dependent upon the extent to which prescription drug plans offering the Medicare benefit incorporate local rural pharmacies into their provider networks. This will be based on market considerations and on the requirements for local access contained in the MMA and regulation, which in turn will be shaped by how "rural" is defined. This paper assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed. Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment Date: 08 / 2000 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 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. Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers Date: 10 / 2009 Author(s): Scott J. Adams, Stan Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topics: Children, Mental health, Pharmacy and prescription drugs Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers. Effect of Medicare Part D Plan Switching and Formulary Changes on Sole Community Pharmacies and the Patients They Serve Date: 03 / 2010 Author(s): Michelle Lampman, Andrea Radford, Anh Nguyen Research centers: North Carolina Rural Health Research and Policy Analysis Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topic: Pharmacy and prescription drugs Presents findings from a 2008 survey of 401 pharmacist-owners of sole community independent pharmacies. Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field Date: 2007 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 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 Date: 11 / 2006 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) 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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research February 2010: A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment Date: 03 / 2010 Author(s): Leah Kemper, Timothy D. McBride, M. Katherine Stone, Keith Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Medicare, Medicare Advantage (MA), Pharmacy and prescription drugs Report Number: 2010-3 In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010. 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 Date: 2005 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 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. Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report) Date: 12 / 2008 Author(s): Michelle Casey, Walter Elias, Alana Knudson, Walter Gregg Research center: Upper Midwest Rural Health Research Center Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth Report Number: Final Report #8 Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Policy Brief) Date: 03 / 2009 Research center: Upper Midwest Rural Health Research Center Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals. Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals Date: 06 / 2000 Author(s): Andrew F. Coburn, Erika 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: Legislation and regulation, Pharmacy and prescription drugs This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel. Independently Owned Pharmacy Closures in Rural America (Policy Brief) Date: 07 / 2008 Author(s): Donald Klepser, Liyan Xu, Fred Ullrich, Keith Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Medicare Advantage (MA), Medicare Part D, Pharmacy and prescription drugs Report Number: 2008-2 The purpose of this policy brief is to provide policy makers, researchers, and stakeholders with information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 to 2008. This period coincides with the implementation of two major policies related to payment for prescription medications: Medicare prescription drug discount cards were introduced on January 1, 2004, and the Medicare prescription drug benefit began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research Independently Owned Pharmacy Closures in Rural America, 2003-2010 Date: 06 / 2011 Author(s): Kaitlin Boyle, Fred Ullrich, Keith Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Medicare Part D, Pharmacy and prescription drugs Provides information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2010. Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems Date: 03 / 2009 Author(s): Andrea Radford, Indira Richardson, Michelle Mason, Stephen Rutledge Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Pharmacy and prescription drugs, Workforce This findings brief presents findings from a 2008 survey of 401 community pharmacists that are the only retail provider in their community to document their extended relationships with other health care providers and the additional health care services these pharmacists provide to their patients. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine the presence in their community of other types of health care organizations that require pharmaceutical support(such as hospitals, long-term care facilities, hospice providers, home health agencies and community health centers), their level of involvement with those facilities, and the types of clinical services (other than dispensing and counseling) the pharmacists offered to their own patients. Loss of Community Pharmacies Since 2006: State Experiences Date: 04 / 2009 Author(s): Liyan Xu, Fred Ullrich, Keith Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topic: Pharmacy and prescription drugs Report Number: 2009-3 This brief presents the latest data from a continuous monitoring of the status of rural pharmacies by the RUPRI Center. Local rural pharmacies continue to serve many of the nation's communities as the sole provider of pharmacy services. However, between May 2006 and December 2008, the number of retail pharmacies in 213 rural places dropped from one to zero, and the number of retail pharmacies in 118 rural places dropped from more than one to only one. The brief includes a table showing the data by state. Medicare Beneficiaries' Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans Date: 01 / 2009 Author(s): Victoria A Freeman, Indira Richardson, Rebecca T. Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs Report Number: Final Report No. 95 Describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state. Medicare Reforms: The Rural Perspective Date: 04 / 2000 Author(s): Curt Mueller, Sheila J. Franco, Gail Wilensky Research center: Walsh Center for Rural Health Analysis Topics: Medicare, Pharmacy and prescription drugs Discusses Medicare reforms considered by the National Bipartisan Commission on the Future of Medicare (created by the Balanced Budget Act of 1997 - BBA), including prescription drug coverage, funding graduate medical education, and increasing the eligibility age. To request a copy, contact the Walsh Center at 301-951-5070. National Study Comparing Resident Medication Use in Rural and Non-Rural Assisted Living Facilities Date: 02 / 2005 Research center: Southwest Rural Health Research Center Topics: Long term care, Pharmacy and prescription drugs In addition to comparing rural and non-rural assisted living residents' medication utilization, this study examined the prevalence of inappropriately prescribed medications (IPMs) and drug-to-drug interactions (DDIs) among residents of rural and non-rural assisted living facilities (ALFs). Residents of rural ALFs tended to be somewhat more impaired in physical functioning and cognitive status, and on average, took slightly more medications than their non-rural counterparts. Residents in rural ALFs appeared somewhat more likely to have an IPM and a DDI, a finding that, although not statistically significant, is consistent with their higher likelihood of taking more medications and their slightly lower likelihood of being in a facility with a RN on staff. Report available on request. One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report) Date: 09 / 2007 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) 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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief) Date: 10 / 2007 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 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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief) Date: 01 / 2006 Research center: Upper Midwest Rural Health Research Center Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology Report Number: Policy Brief No. 1 To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. A full report is also available. Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report) Date: 12 / 2005 Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson Research center: Upper Midwest Rural Health Research Center Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology Report Number: Working Paper No. 1 To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals Date: 2006 Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson Research center: Upper Midwest Rural Health Research Center Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology Citation: Journal of Rural Health, 22(4), 321-330 Reports the results of a study that assessed the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology. Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals Date: 04 / 2008 Author(s): Gary Cochran, PharmD, SM, Katherine Jones, PhD, PT, Liyan Xu, MS, Keith Mueller, PhD Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality Citation: This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in the nations smallest hospitals. A key finding is that hospitals with an average daily census of six or more patients were more likely to report having adopted safe medication practices than were hospitals with an average daily census of five or fewer patients. Findings from this research reveal considerable opportunity for improvement in hospitals with 49 or fewer beds to achieve evidence-based standards of medication safety. Report Number: Issue Brief 2008-1 Profile of Sole Community Pharmacists' Prescription Sales and Overall Financial Position Date: 08 / 2009 Author(s): Andrea Radford, Michelle Lampman, Indira Richardson, Stephen Rutledge Research center: Rapid Response to Requests for Rural Data Analysis Topic: Pharmacy and prescription drugs Sole community independent pharmacists provide essential services to residents of small towns and isolated communities. In an effort to document the role sole community pharmacies play in their local health care system and to monitor their financial and operational status we conducted a survey in 2008 of 401 community pharmacists that owned the only retail outlet in their community. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine their reliance on prescription sales and to understand their store's current financial position. Reliance on Independently Owned Pharmacies in Rural America Date: 11 / 2007 Author(s): Michael D. Shambaugh-Miller, Nicole Vanosdel, Keith J. Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topic: Pharmacy and prescription drugs Report Number: Rural Policy Brief No. 2007-6 Policy brief providing locations of independently owned pharmacies in rural America that are the sole sources of access to local pharmaceutical services. In over 2,000 rural communities, the only local pharmacy is independently owned, and in 1,044 of those communities, there is no other pharmacy within 10 miles. The information in this brief lays a foundation for analyzing vulnerability of pharmacy services in rural America and identifies the questions that research and policy activities should address. State maps show the locations of communities with only one pharmacy, independently owned. Retail Pharmacies in Washington State: Results of the 2003 Workforce Survey Date: 12 / 2004 Author(s): Susan M. Skillman, L. Gary Hart, Elise Bowditch, Beth A. Kirlin Research center: WWAMI Rural Health Research Center Topics: Pharmacy and prescription drugs, Workforce Report Number: Working Paper No. 100 Researchers surveyed retail pharmacies in Washington to estimate the demand for pharmacists, as well as pharmacy technicians and administrative/clerical staff, and to describe the impact of implementation of the Health Insurance Portability and Accountability Act (HIPAA) on retail pharmacies. Combining the results of this survey with the estimates from a survey of pharmacist vacancies in the state's hospitals, 403 pharmacists were needed statewide for retail and hospital pharmacies in 2003-2004. Pharmacy schools in Washington graduated 180 pharmacists in 2003, which was not enough to fill all of the vacancies across the state. Rural Beneficiary Need for a Medicare Drug Benefit Delivered Through the Rural Delivery System Date: 10 / 2002 Author(s): Keith Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Aging, Pharmacy and prescription drugs, Poverty Elderly who live below the poverty level, seniors without prescription drug coverage, Medicare plans Rural Hospitals' Experience with the 340B Drug Pricing Program Date: 09 / 2007 Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin Research centers: North Carolina Rural Health Research and Policy Analysis Center , Walsh Center for Rural Health Analysis Topics: Hospitals and clinics, Pharmacy and prescription drugs Policy brief describing the results of surveys of rural hospitals participating in the 340B drug pricing program and of rural eligible but non-participating hospitals. Includes information on factors affecting participation in the program and the benefits and challenges of participation. Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief) Date: 02 / 2009 Author(s): Victoria Freeman, Indira Richardson, Rebecca Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Medicare Part D, Pharmacy and prescription drugs This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state. Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff Date: 2005 Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield Research centers: Maine Rural Health Research Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis , Upper Midwest Rural Health Research Center Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs Citation: Journal of Rural Health, 21(3), 194-197 The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects. Workforce Issues Among Sole Community Pharmacies Date: 07 / 2009 Author(s): Donald Klepser, Michelle Lampman, Andrea Radford, Indira Richardson, Stephen Rutledge Research centers: North Carolina Rural Health Research and Policy Analysis Center , Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Pharmacy and prescription drugs, Workforce Pharmacy services are delivered through a sole community pharmacy in over 1000 small rural communities nationwide. This brief presents the findings from 401 telephone interviews of sole community pharmacist-owners nationwide about their current staffing and future plans. Thirty-three percent of those interviewed have one or fewer pharmacist FTEs on staff. Thirty percent of those interviewed would like to retire in five years or fewer, and most would like to sell their pharmacies upon retirement. This brief explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacy's future. Workforce Issues in Rural Areas: A Focus on Policy Equity Date: 01 / 2005 Author(s): Thomas C. Ricketts Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Health policy, Nurses, Pharmacy and prescription drugs, Physicians, Workforce Citation: American Journal of Public Health, 95(1), 42-48 Reviews the geographic distribution of 6 classes of health professionals: physicians, nurses, dentists, pharmacists, mental health professionals, and public health professionals. Describes the government and private policies and programs intended to affect the geographic distribution of these health professionals. Related Topics These related topics also list publications: Medicare Part D (21 items)

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