Assessing the Stability of Rural Pharmacy Services

Research center:
Lead researcher:
Project funded:
September 2015
Project completed:
April 2017

Problem statement: As of December 2012, over 2.7 million people lived in 633 rural communities served by a sole, independently owned pharmacy. Maintaining access to pharmacy services in those places may be challenging if circumstances beyond their control drive those pharmacies out of business.

This research will hypotheses that decisions and practices associated with an unregulated market are jeopardizing local access to pharmacy services due to disproportionate impacts on financial sustainability. A second stream of analysis will focus on the viability of local services in the absence of a retail outlet staffed by Pharm D trained professional, through the use of tele-pharmacy, which would require favorable state policies. The RUPRI Center has a long-standing interest and investment in research related to the future of rural pharmacy services which this project would continue.

Project goals include deepening our understanding of economic forces beyond the immediate control of local pharmacies that are affecting their ability to remain in business, assessing the future of sole community retail pharmacies in rural places, and exploring alternative modalities for delivering pharmacy services in the absence of retail pharmacy businesses.


  • Financial Issues Challenging Sustainability of Rural Pharmacies
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Findings from a survey of rural lone community retail pharmacies about issues perceived as a threat to their sustainability. Reimbursement issues were cited as being most immediate and of highest magnitude.
  • Issues Confronting Rural Pharmacies after a Decade of Medicare Part D
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2017
    This brief reports on a survey of very rural independent pharmacies designed to assess threats to their sustainability. Major, immediate issues included delays in updates to maximum allowable costs (MACS), charges for remuneration fees, competition from mail order pharmacies; and, status as a "non-preferred pharmacy" for Medicare Part D plans.
  • Telepharmacy Rules and Statutes: A 50-State Survey
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2017
    This is summary analysis reviews administrative rules and legislative statutes governing the practice of telepharmacy in all 50 states. Telepharmacy is specifically authorized in 23 states and 16 states have no rules or legislation authorizing telepharmacy. Other states have pilot programs or waivers that would enable telepharmacy.
  • Telepharmacy Rules and Statutes: A 50-State Survey (Journal Article)
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2018
    Peer-reviewed paper identifying state-enacted regulations and legislation authorizing use of community telepharmacy initiatives and describing implications for patients in underserved rural communities. Also provides a table listing states that permit telepharmacy, and pilot programs and waivers that enable telepharmacy initiatives.