The relationship between the financial status of sole community independent pharmacies and their broader involvement with other rural providers.

PURPOSE: To document sole community pharmacists' involvement with other local health care organizations, these pharmacies' current financial status, and to determine whether financial position was associated with the provision of pharmacy services to other local health care providers. METHODS: We conducted semistructured interviews with pharmacist-owners of 401 sole community pharmacies randomly selected using data from the National Council for Prescription Drug Programs, Inc. Bivariate and multivariate analyses of responses were conducted to examine associations between pharmacy characteristics, financial position, and involvement with other local health care providers. FINDINGS: About 4 in 5 pharmacies provided services to at least 1 local health care organization. Most respondents (70%) described their store's overall financial position as good or very good, but about one-third reported that their financial conditions had deteriorated since the previous year. Providing services to other organizations was associated with higher prescription sales volume. After controlling for prescription volume, there was no association between providing services to other organizations and pharmacist-owners' self-assessed financial position. CONCLUSION: Sole community pharmacists provide important pharmaceutical support services to other health care organizations. Other than increased volume of business, this support often does not translate directly to an improved financial position for the pharmacy. The survival of sole community pharmacies not only ensures retail access to pharmaceuticals and patient counseling, but it also, in many cases, plays a key role in supporting other local health care providers, helping to preserve access to important services that are particularly needed in communities with limited health care options.

A rural-urban comparison of allied health professionals' average hourly wage.

Nationwide, demand for allied health services is projected to grow significantly in the next several decades, and there is evidence that allied health shortages already exist in many states. Given the longstanding history of health professional shortages in rural areas, the existing and impending shortages in allied health professions may be particularly acute in these areas. To assess whether rural areas are potentially at a recruiting disadvantage because of relative wages, this report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for eight allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates. Overall the data show that the national average wage of each of the eight allied health professions is higher in metropolitan than nonmetropolitan areas. On average, the unadjusted rural hourly wage is 10.3% less than the urban wage, although the extent of the difference varies by profession and by geographic area. Adjustment for the cost of living narrows the discrepancy, but does not eliminate it. It is likely that rural providers in areas with the greatest wage discrepancies find it more difficult to recruit allied health professionals, but the extent to which this is the case needs to be assessed through further research with data on workforce vacancy rates.

Continuing effects of Medicare Part D on rural independent pharmacies who are the sole retail provider in their community.

BACKGROUND: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient prescription drug coverage beginning in January 2006. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies. OBJECTIVES: To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2006 resolved over time. METHODS: A semistructured interview protocol was used in telephone interviews with 51 pharmacist owners of rural sole community pharmacies in 27 states who were identified through a random sampling process. RESULTS: The sole community pharmacists interviewed continue to face challenges directly related to Medicare Part D. Dealing with Part D plans and working with patients during enrollment periods remains administratively burdensome. Reimbursement amounts, complexity of dealing with multiple plans, and timeliness of payments continue to be cited as problems which could threaten the viability of independently owned pharmacies who are the sole retail providers in their communities. CONCLUSIONS: Actions should be considered to help sole community pharmacies deal with the ongoing administrative and financial challenges of Part D. To ensure full choice for rural Medicare beneficiaries and full access to pharmaceuticals through the ongoing presence of a local pharmacy, the development of a mechanism to structure prescription reimbursement so that drug acquisition costs and related overhead are covered and a reasonable profit margin provided should be considered. Further study is needed to determine how existing policies and regulations can be modified to ensure reasonable access to pharmacy services for rural Medicare and Medicaid beneficiaries.