Sole Community Pharmacies and Part D Participation: Implications for Rural Residents
Sole Community Pharmacies and Part D Participation: Implications for rural residents
BACKGROUND
The Medicare Part D Drug Plan (Part D), which was implemented on January 1, 2006, allows Medicare’s 44 million elderly and disabled beneficiaries to join a private Prescription Drug Plan (PDP) or join a Medicare Advantage Plan that provides supplemental health insurance with a prescription drug benefit. Under the Part D program, beneficiaries can choose between multiple competing PDPs. This choice affects not only the insurance costs and benefits, but also the pharmacies that beneficiaries can use in order to have their prescription purchase covered by the PDP, as each pharmacy decides with which of the many available PDPs they will contract. Therefore, in small rural towns that are served by only a single retail pharmacy, beneficiary access to local pharmacy services including counseling depends on whether or not the local pharmacy contracts with the enrollee’s PDP. This brief describes the contracting patterns of sole rural community pharmacies in 16 states, to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state. When the sole pharmacy does not contract with all major plans, road miles to the next closest retail outlet were calculated to assess the minimum distance a beneficiary who was enrolled in a plan with which their local pharmacy did not participate would have to travel in order to have a prescription paid for by their PDP.