ALEXANDRIA, Va. (May 23, 2017)  A recent government-funded study by the RUPRI Center for Rural Policy Analysis, "Issues Confronting Rural Pharmacies after a Decade of Medicare Part D," found that direct and indirect remuneration (DIR) fees and low or delayed reimbursements continue to pose significant challenges to rural pharmacies and their ability to provide essential health services to their communities. National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA, issued the following statement in support of the findings:

"The RUPRI Center's study offers a much-needed exploration of the challenges facing small pharmacies that participate in Medicare Part D. The paper's conclusions further validate our concerns about DIR fees, maximum allowable cost (MAC) pricing transparency, and exclusion from 'preferred pharmacy' networks.

"Health care should not be dictated by where you live. However, in many rural areas independent community pharmacies are the sole health care providers for many patients. Unfortunately, the business practices of pharmacy benefit manager (PBMs) corporations make it harder for small pharmacy business owners to be profitable. 

"Nearly 80 percent of the surveyed pharmacies in the RUPRI study found both DIR fees and MAC reimbursements to be a significant challenge for their business, while almost 60 percent struggled with being out-of-network. Thankfully, there are legislative solutions pending before Congress that could bring relief on those issues. Health care professionals should urge Congress to pass the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act (S. 413 / H.R. 1038), the Prescription Drug Price Transparency Act (H.R. 1316), and the Ensuring Seniors Access to Local Pharmacies Act of 2017 (S. 1044 / H.R. 1939) to help improve patient access to care."

Some of the study's findings include the following:

  • "A pharmacy in a rural community is more than a place to fill prescriptions. Local pharmacists are part of the health care system, providing essential services such as counseling residents as prescriptions are filled (including medication therapy management), attending to residents with mild illnesses that can be treated with over-the-counter medications, providing immunizations, and supporting other local providers."

  • "With looming closure without replacement of many of these pharmacies, an estimated 3 million rural residents are at risk of losing the only pharmacy in their community. For many of these individuals, the nearest pharmacy is over 10 miles away."

  • "Public policies could ameliorate fiscal stress for rural independent pharmacies by focusing on MAC and DIR, adjusting costs and payments for at least this group of vulnerable pharmacies."