Rural Health Research Gateway

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
    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)
    Date: 01 / 2007
    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
    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)
    Date: 05 / 2007
    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
    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.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    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
    Date: 01 / 2003
    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
    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
    Date: 01 / 2006
    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
    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
    Date: 09 / 2004
    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
    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.
  • 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.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    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
    Date: 06 / 2000
    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.
  • Medicare Reforms: The Rural Perspective
    Author(s): Curt Mueller, Sheila J. Franco, Gail Wilensky
    Research center: Walsh Center for Rural Health Analysis
    Topics: Medicare, Pharmacy and prescription drugs
    Date: 04 / 2000
    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
    Research center: Southwest Rural Health Research Center
    Topics: Long term care, Pharmacy and prescription drugs
    Date: 02 / 2005
    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)
    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.
  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
    Report Number: Policy Brief No. 1
    Date: 01 / 2006
    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)
    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
    Date: 12 / 2005
    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
    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
    Date: 2006
    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
    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
    Date: 04 / 2008
  • Reliance on Independently Owned Pharmacies in Rural America
    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
    Date: 11 / 2007
    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
    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
    Date: 12 / 2004
    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
    Author(s): Keith Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Aging, Pharmacy and prescription drugs, Poverty
    Date: 10 / 2002
    Elderly who live below the poverty level, seniors without prescription drug coverage, Medicare plans
  • Rural Hospitals' Experience with the 340B Drug Pricing Program
    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
    Date: 09 / 2007
    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.
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    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
    Date: 2005
    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 in Rural Areas: A Focus on Policy Equity
    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
    Date: 01 / 2005
    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.

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