As Rural Pharmacies Close, Western States Seek A Prescription

Oct 29, 2019
Originally published on November 18, 2019 3:25 pm

Updated Monday, November 18, 2019 to include a visualization of pharmacy closure in the Mountain West.

A national study published in the journal JAMA Internal Medicine found that 1 in 8 pharmacies closed between the years 2009 and 2015. 

Counterintuitively, the total number of pharmacies is growing. 

“So you see kind of a net growth at a national level,” said Dima Qato, an associate professor at the University of Illinois College of Pharmacy and an author of the study. “But at the local, at the county, level there is variation. Some areas are not experiencing growth. Some counties are not only experiencing closures but they’re experiencing net loss.”

Independent pharmacies -- like those in many rural areas -- and pharmacies in low-income urban neighborhoods were particularly hard-hit. The researchers say reimbursement may have something to do with those trends. 

“If a pharmacy is in a community that is serving more publicly insured populations that have Medicaid or Medicare coverage, they’re making less money per prescription than pharmacies serving patients that have more private insurance or commercial insurance,” Qato said.

Other researchers have homed in on patterns among rural pharmacies specifically. 

“Over the last 16 years or so, about 16 percent of the independently owned pharmacies in rural America have closed,” said Keith Mueller, who directs the Center for Rural Health Policy Analysis at the University of Iowa. “There were 630 rural communities that at one point had at least one retail pharmacy back in March of 2003 that now have none.”

In the Mountain West, Mueller and his colleagues found that since 2003, dozens of rural zip codes lost all of their retail pharmacies. 

“And I don’t want people to think this is just a matter of filling prescriptions,” Mueller said. “Pharmacists are an important part of any health team in terms of reviewing medications, answering questions that we may have as consumers or patients.” 

And, in doing so, helping people and communities stay on top of their health.

On the brighter side, there are certain state policies that seem to protect pharmacies from closure. Pharmacies located in rural areas that are federally designated as medically underserved were less likely to close than other pharmacies. Qato said that could in part be due to policies like tiered Medicaid reimbursement. 

“Pharmacies in certain neighborhoods that fill fewer prescriptions are compensated or reimbursed more than pharmacies that serve areas that have a higher population,” Qato explained. “We know those policies exist in some states that are predominantly rural.”

Others are hopeful that telepharmacy -- where one pharmacist can remotely consult with staff at multiple locations, making each individual site cheaper to run -- could go a long way in filling the gaps. 

“The first telepharmacy that opened in Nevada opened about a month ago,” said Adam Chesler, director of regulatory affairs at Cardinal Health, a company that is, among other things, one of the biggest drug distributors in the U.S. “Nevada had a telepharmacy law that said you had to be 50 miles from the closest pharmacy to open a telepharmacy. The fact that patients had to travel 50 miles to get their prescriptions was quite alarming to me.”

Chesler said across the region states are recognizing this is an issue. 

“Wyoming noticed there was an issue with their increase in pharmacy deserts a couple years ago and they allowed telepharmacy to help tackle that,” he said. “Utah is looking at legislation right now because they see it as an issue as well. I know Idaho is taking a lot of efforts to improve pharmacy access to their residents. But I’d say the one that really stands out is Colorado.”

That state, he said, has 40 pharmacy deserts, defined as areas where residents have to travel more than 10 miles to the nearest pharmacy, which translates to about 43,000 Colorado residents.

Keith Mueller agrees that telepharmacy has potential.

“It could play a major role, particularly in the more remote rural sites where there’s just not a business model to sustain the local service with a local physical presence, but there’s a need,” said Mueller. But at the same time, as he and his colleagues have noted, “diffusion of this service has been slow.” And there are plenty of obstacles preventing telepharmacy from offering the silver bullet, including the high variability in state policies that could allow for such a setup.

This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUER in Salt Lake City, KUNR in Nevada and KRCC and KUNC in Colorado. 

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