title: Continuing effects of Medicare Part D on rural independent pharmacies who are the sole retail provider in their community.
abstract: BACKGROUND
  The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient prescription drug coverage beginning in January 2006. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies.
  
  
  OBJECTIVE
  To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2006 resolved over time.
  
  
  METHODS
  A semistructured interview protocol was used in telephone interviews with 51 pharmacist owners of rural sole community pharmacies in 27 states who were identified through a random sampling process.
  
  
  RESULTS
  The sole community pharmacists interviewed continue to face challenges directly related to Medicare Part D. Dealing with Part D plans and working with patients during enrollment periods remains administratively burdensome. Reimbursement amounts, complexity of dealing with multiple plans, and timeliness of payments continue to be cited as problems which could threaten the viability of independently owned pharmacies who are the sole retail providers in their communities.
  
  
  CONCLUSIONS
  Actions should be considered to help sole community pharmacies deal with the ongoing administrative and financial challenges of Part D. To ensure full choice for rural Medicare beneficiaries and full access to pharmaceuticals through the ongoing presence of a local pharmacy, the development of a mechanism to structure prescription reimbursement so that drug acquisition costs and related overhead are covered and a reasonable profit margin provided should be considered. Further study is needed to determine how existing policies and regulations can be modified to ensure reasonable access to pharmacy services for rural Medicare and Medicaid beneficiaries.
authors.affiliation: North Carolina Rural Health Research & Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC 27599-7590, USA. aradford@schsr.unc.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: Radford
authors.forename: Michelle
authors.initials: M
authors.lastname: Mason
authors.forename: Indira
authors.initials: I
authors.lastname: Richardson
authors.forename: Stephen
authors.initials: S
authors.lastname: Rutledge
authors.forename: Stephanie
authors.initials: S
authors.lastname: Poley
authors.forename: Keith
authors.initials: K
authors.lastname: Mueller
authors.forename: Rebecca
authors.initials: R
authors.lastname: Slifkin
mesh_terms: D003625:Data Collection; D019468:Disease Management; D006801:Humans; D007349:Insurance, Health, Reimbursement; D054524:Medicare Part D / Q000191:economics* / Q000639:trends*; D010067:Ownership; D010594:Pharmacies / Q000191:economics* / Q000639:trends*; D010595:Pharmacists; D012424:Rural Population; D014481:United States; D000078329:Workforce