The purpose of this research was to understand impacts of Medicare Part D on rural Medicare beneficiaries at the level of receiving and filling medication prescriptions. Work of the RUPRI Center has provided a great deal of information about impacts at the level of rural independent pharmacies, which raised questions about beneficiary access to pharmaceutical services, including acquiring medications when the local pharmacy closes. Recent Center studies have shown a continued challenge to sustain local pharmacies, originating in the drug pricing policies currently under policy scrutiny such as the role of prescription benefit management firms. Access to pharmacy services is now likely to be through some combination of remaining local pharmacies, a neighboring pharmacy (that may include delivery service), telepharmacy (perhaps staffed by a pharmacy technician), and mail order. Previous RUPRI Center case study work found that in places where rural pharmacies closed access to prescription medications had not surfaced as a major problem, because of alternatives to direct access to a local pharmacist. Findings based on case studies of communities wherein pharmacies closed, though, are insufficient to answer the question of "how do Part D enrollees access prescription medications?" The analytic approach to answering that question has to employ beneficiary-level data.

We know that an increasing number and percent of Medicare beneficiaries, including those in rural places, rely on Part D (either through Medicare Advantage Prescription Drug plans or standalone Part D plans) for prescription drug coverage. This makes understanding how the benefit translates into prescription-filling behavior a significant policy question (assuming the policy objective is affordable and timely care, not merely the presence of a benefit). For places where there are no local services available, the policy concern is that beneficiaries are able to secure medications, and this analysis provided some indication. We at least know how it is possible to acquire medications even if not all beneficiaries do so. Another policy implication from this research is understanding a dynamic that may affect continued access to local services where they currently exist. If local beneficiaries enrolled in Part D are not using the local pharmacy to acquire medications, the total revenue stream of that pharmacy may be impacted, including sales of products other than prescriptions. A final implication is the cost of medications to rural beneficiaries. Patterns of filling prescriptions may influence total out-of-pocket costs. These are important phenomena for Federal Office of Rural Health Policy to understand as debates become more heated about cost of medications, and modifications to Part D may be suggested as a result.

Publications

• Access to Medicare Part D Plans: A Comparison of Metropolitan and Nonmetropolitan Areas
  Policy Brief
  RUPRI Center for Rural Health Policy Analysis
  Date: 05/2020
  This policy brief updates previous reports on rural activity in the Medicare Part D program. Comparisons are made across county type, within type of Part D plan (standalone and part of Medicare Advantage plans), and between the types of plans within county classifications.
• Medicare Beneficiary Access to Prescription Drugs in Rural Areas
  Policy Brief
  RUPRI Center for Rural Health Policy Analysis
  Date: 08/2022
  Declines in the number of retail pharmacies in rural areas have raised concerns about beneficiary access to prescription medications when their local pharmacy closes. The purpose of this policy brief is to identify the types of pharmacies used by beneficiaries in rural areas with limited or no access to local pharmacies.