Identifying populations with no access to a community pharmacy or whose community pharmacy is vulnerable to changes in Medicare Part D policy

Background. Access to community pharmacies is vital to the health of rural residents. Rural pharmacies that are the only pharmacy in their community and are located 20+ miles from the next closest retail pharmacy are particularly important because if they close, the community loses its only access to local pharmacy services. This research identifies critical access retail community pharmacies and the populations they serve as well as communities with no access to a pharmacy. Knowing the demographics of these communities is vital to understanding revenue issues these pharmacies face, particularly as a result of their dependence upon Medicare Part D reimbursements.

Methods. We used a March 2009 national pharmacy database and GIS to geocode all retail pharmacies. Counties without access to a community pharmacy were identified. A 20-mile buffer was applied to all national retail pharmacies, and critical access retail community pharmacies were identified.

Findings: Critical access retail community pharmacies are located in approximately 261 U.S. communities. These pharmacies depend upon Medicare Part D reimbursements for nearly half their revenue and are generally in communities with significant elderly populations. In addition, 181 U.S. counties have no access to a community pharmacy, leaving approximately 730,093 persons without access—95,633 aged 65 and older and 120,213 aged 50 to 64.

Implications. Critical access retail community pharmacies may be particularly vulnerable to policy changes in how pharmacies are paid by commercial insurance, Medicaid, and Medicare. Knowing which pharmacies are critical for local access is a first step toward dealing with unintended policy consequences.