Continuing declines in the number of retail pharmacies in rural areas has raised important questions about beneficiary access to pharmaceutical services, including how rural beneficiaries acquire medications when their local pharmacy closes. Although access to medications can be maintained through alternative means such as mail-order, delivery, and telepharmacy, these services may not replace the additional benefits of in-person pharmacy services.

Data from the National Council for Prescription Drug Programs from 2016-2017 was used to identify four cohorts of rural counties based on pharmacy availability: counties with no retail pharmacy, counties with an independent pharmacy only, counties with one chain or franchise pharmacy only, and other rural counties with more than one pharmacy. Medicare Part D claims data from 2017 for beneficiaries residing in each of the county cohorts was analyzed to determine the source of their prescription medications.

The analysis showed that more Part D beneficiaries residing in rural counties with no retail pharmacy (19.5 percent) used a mail-order pharmacy compared to beneficiaries in rural counties with a pharmacy presence (15.8 – 17.1 percent across the three other cohorts). Part D beneficiaries in rural counties with no retail pharmacy used a higher number of pharmacies overall (1.84 pharmacies) compared to Part D beneficiaries in rural counties with a pharmacy presence (1.68-1.74 pharmacies). And beneficiaries residing in rural counties with no retail pharmacy traveled an average of 28.5 miles to use a community pharmacy compared to an average range of 6.5 - 13.1 miles for beneficiaries residing in rural counties with some type of pharmacy presence.

Mail-order pharmacies have been cited as an alternate solution for beneficiaries with limited or no retail pharmacy access; however, only 19 percent of rural beneficiaries in these communities used a mail-order pharmacy. Telepharmacy has also been cited as a means to increase medication access in communities with limited pharmacy availability, but fewer than half of all U.S. states have rules or legislation authorizing telepharmacy practice. The findings in this brief suggest that there are persistent access barriers for beneficiaries in rural counties, which may limit their ability to fill their prescriptions and adhere to prescribed medications.