Impact of Medicare Part D on independent and chain community pharmacies in rural Illinois--A qualitative study.
BACKGROUND
Although the sustainability of rural pharmacy services is a concern of long standing, the rural marketplace is not monolithic. Enhanced understanding of different experiences, strengths, and potential weaknesses of rural chain and independent pharmacies could help inform health policy debates, legislation, and consideration of disparities and access. This study compared and contrasted experiences by pharmacists in chain and independent community pharmacies during Medicare Part D implementation.


OBJECTIVE
The objective was to obtain and describe experiential narratives from rural Illinois pharmacists regarding the implementation of Medicare Part D. Similarities and differences experienced in chain and independent community pharmacies were examined, as well as pharmacists' perceptions about potential implications of the newly implemented Act on the accessibility of rural pharmacy care and services.


METHODS
A semistructured qualitative research approach was used, involving focus groups and telephone interviews, to elicit the subjective experiences of rural Illinois pharmacists. Participants were selected through purposive sampling to include representative perspectives of independent and chain community pharmacists in rural areas across the state. Using a systematic, iterative coding process, recurrent themes were identified in 8 substantive categories.


RESULTS
Areas of similarity between the 2 groups included universal criticism of the initial implementation processes, but consensus belief that Medicare patients ultimately benefited if they did not have previous prescription drug coverage. Pharmacists in independent drugstores expressed more concern about their future viability. Corporate communications and infrastructure support were available in chain pharmacies and believed to present them with competitive advantages and a stronger long-term financial position.


CONCLUSIONS
The findings showed a disparate impact of Medicare Part D on the initial experiences and perceived viability of independent community pharmacies, in comparison with their chain pharmacy counterparts. The long-term implications of changing regulatory environments and customers' pharmacy needs in underserved communities should be carefully considered and monitored.
Bono
James D
JD
University of Illinois at Chicago, 833 S. wood street, M/C 874 Chicago, IL, USA. jimbono@uic.edu
Crawford
Stephanie Yvonne
SY
D003132:Commerce; D003157:Community Pharmacy Services / Q000191:economics / Q000458:organization & administration*; D003363:Cost Control; D016527:Drug Costs; D016568:Drugs, Generic / Q000627:therapeutic use; D004608:Eligibility Determination; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007087:Illinois; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration*; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008297:Male; D054524:Medicare Part D / Q000191:economics / Q000458:organization & administration*; D033262:Narration; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use*; D036301:Qualitative Research; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D014481:United States
D016568:Drugs, Generic; D055553:Prescription Drugs