Financial threats and opportunities experienced by rural community pharmacies.

Background: The cost of prescription medications is a significant health expenditure in the United States. Recent efforts to curtail these costs may have unintended consequences for patients in rural communities and the rural community pharmacies that serve them.

Objective: The objective of this project was to understand the financial threats and opportunities facing practicing rural community pharmacists.

Methods: This was a cross-sectional online survey comprising two key measures, financial threats and practice opportunity. Each of these measures were captured using both quantitative and qualitative data. The sampling frame included current members of a rural community pharmacy practice-based research network. Quantitative data were analyzed using descriptive statistics. Sub-group analyses examined differences by pharmacy rurality (highly rural and less rural) and pharmacy type (independent vs other). Qualitative data were analyzed using qualitative content analysis.

Results: Fifty-four rural community pharmacies responded. The most concerning financial threats included: predatory health insurance, lower point of sale reimbursements for Medicare PartD medications, prescription discount cards, inadequate reimbursement for prescription fills, and Direct and Indirect Remuneration (DIR) fees. More highly rural pharmacies were also less likely to provide asthma and heart failure management, annual wellness visits, and travel medicine services. Independent pharmacies were less likely to provide travel medicine services than other pharmacy types. The top practice opportunities for expansion included point of care testing and diabetes self-management education and support programing. Qualitative data analyses yielded two themes: financial threats and the impact of efforts to reduce effects on patients and patient outcomes.

Conclusion: Prescription drugs are a costly but necessary feature of healthcare. While efforts to minimize these costs are needed, it is important that these efforts do not negatively impact patient outcomes. Rural community pharmacists identified several key financial threats and connected those threats to negative impacts on patients' ability to access quality care.