Rural Health Transformation Efforts Offer an Opportunity for Pharmacy to Shine

With Big Cuts Come Big Grant Opportunities for Rural Health Care Providers

As part of the One Big Beautiful Bill Act of 2025, Congress passed and President Donald Trump tasked the Centers for Medicare and Medicaid Services (CMS) with doling out $10 billion per year for the next 5 years to advance rural health transformation and sustainability.¹ Proportionately large apportionments of $200 million will go to states like Wyoming, with roughly 500,000 individuals within its borders.

The Rural Health Transformation Program (RHTP) was a sort of offset to the cuts to Medicaid included in the same legislation that will hit rural areas more significantly, as those geographies tend to have health systems and providers more dependent on government-provided health care coverage such as Medicaid, Medicare, and children’s insurance programs.

Many Sharp Elbows, but Community Pharmacy Is Making Inroads

Much like Medicaid, RHTP is effectively a federal-state partnership, with CMS providing rules and guardrails and the states deciding how they want to use the funds, who to give them to, and which state-level objectives overlap with federal objectives. Currently, the RHTP has the following 5 categories of focus, according to the CMS website that explains the program^1,2:

• Bring More Care Within Reach: CMS is promoting the RHTP as a Make Rural America Healthy Again effort by “expanding preventive, primary, maternal, and behavioral health services and creating new access points that bring care closer to home and help preserve strong local health systems.” Programs approved for funds that may relate to pharmacies include food-as-medicine initiatives and chronic disease prevention models. Community pharmacy should be flexing its obvious opportunity to be local access points for health care services such as immunizations, test-to-treat services, and medication optimization, but also social determinants screening and referrals, as well as access points for coordinated telemedicine as the local face-to-face touchpoint.
• Strengthen and Sustain the Rural Clinical Workforce: CMS is pushing states to “support clinical workforce training, residencies, recruitment and retention incentives, and new pathways that help students begin health care careers in their own communities, including investing [in] programs to train and support the existing clinical workforce and build futures close to home.” Community pharmacy should be reaching out to state leaders to discuss the critical issue of pharmacist shortages and succession in rural areas, as well as more advanced pharmacy technician training in community health work, phlebotomy, community pharmacy care management, and patient navigation.
• Modernize Rural Health Infrastructure and Technology: The last shall (or at least should) be first when it comes to bringing care to the community via technology, since it can transcend geography. RHTP includes “investments [to] modernize rural facilities and equipment; strengthen cybersecurity and interoperability; and expand telehealth, remote patient monitoring, and digital tools that enable timely access to care.” Community pharmacy should rally together to promote broadband access to frontier pharmacies and simple telemedicine options, such as mobile devices in the pharmacy to connect patients with other care team members, including delivery drivers interfacing with patients at their doorsteps, 30 miles down a gravel road.
• Driving Structural Efficiency and Empowering the Community Providers: Connecting the disconnected, RHTP is “establishing specialized hub-and-spoke models, rural regional centers of excellence, comprehensive data-sharing platforms, and rural clinically integrated networks.” Community pharmacy should be the tip of the spear alongside emergency services and primary care outposts where feasible. As the most frontline of frontline care providers, pharmacies are often the most proximal brick-and-mortar walk-in providers to residents in rural communities.
• Advance Innovative Care Models and Payment Reform: Finally, the all-important sustainability solution: rural-centered care that has payment options. The CMS website says, “states will test new primary care and value-based care models, strengthen partnerships among rural and other providers, and promote regional collaboration that improves health sustainability and patient outcomes.” Community pharmacies have been asking to be paid differently for decades. Now is the time to test payment models explicitly for the provision of health care services by the pharmacy in coordination with other local teammates, with the objective of keeping patients and their caregivers in their communities rather than driving to specialists and subspecialists behind blocks of parking garages and layers of administrative check-ins. Send those dollars to rural communities, including the pharmacies that often have been there for generations, building trust, paying local taxes, and buttressing the local economy.

Put Us in, Coach! We’ve Said It Before, but More Nonpharmacy Actors Need to Hear It

Yes, I’ve written this before and elaborated on the RHTP a few times in prior articles, but this program is meant to be transformational. Community pharmacy needs to play a prominent role in that transformation. The only eventuality worse than being left out of funding and innovation is others stepping in and filling the vacuum of need, establishing themselves as (likely inferior) rural health care provider solutions. Everyone in community pharmacy and the profession at large, regardless of location or care setting, should be shouting, “Community pharmacy is accessible and effective at a range of services beyond dispensing!”

We Are Making Inroads. Keep up the Momentum.

When I first wrote about the RHTP, only a handful of states had written community pharmacy practice into the first-year applications to CMS, with a smattering of engagement in a few other states. Now, more than 30 states have engaged community pharmacy owners, leaders, and state associations, and have started to build momentum, engagement, and dialogue with state officials in charge of applications to CMS and applications to local rural providers. Keep up the momentum!

About the Author

Troy Trygstad, PharmD, PhD, MBA, is the executive director of CPESN USA, a clinically integrated network of more than 3500 participating pharmacies. He received his doctor of pharmacy and master of business administration degrees from Drake University and a doctorate in pharmaceutical outcomes and policy from the University of North Carolina. He has recently served on the board of directors for the Pharmacy Quality Alliance and the American Pharmacists Association Foundation. He also proudly practiced in community pharmacies across North Carolina for 17 years.

REFERENCES

1. Rural Health Transformation (RHT) Program. Centers for Medicare & Medicaid Services. Updated June 29, 2026. Accessed June 29, 2026. https://www.cms.gov/initiatives/rural-health-transformation-rht-program/overview

2. CMS announces $50 billion in awards to strengthen rural health in all 50 states. News release. Centers for Medicare & Medicaid Services. December 29, 2025. Accessed June 29, 2026. https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states