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Creating a Critical Access Pharmacy Program - Congressional Summit

Updated: Feb 5



CPI Congressional Summit

This Article was written by CPI Admin.


Introduction:

In response to the underexplored challenges faced by rural independent pharmacies, CpI published a briefing from our Congressional Summit which highlights the urgent need for a Critical Access Pharmacy Program. These pharmacies, often the lifeblood of healthcare in rural communities, encounter financial vulnerabilities leading to closures. Between 2003 and 2021, 16.1% of independently-owned rural pharmacies shut down, with the most significant closures aligning with the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). This bill, while beneficial for seniors, unintentionally impacted pharmacy reimbursements adversely.


Critical Access Pharmacy Program Description:

To ensure the viability of critical access pharmacies throughout the United States, Congress should designate the Centers for Medicare & Medicaid Services to establish a Critical Access Pharmacy Care Program. Eligible pharmacies must be U.S.-based, situated in counties with fewer than fifty thousand residents, designated as a Medically Underserved Area by the Health Resources & Services Administration (HRSA), and owned by entities with fewer than ten U.S.-based brick-and-mortar pharmacies. The program, funded as available, would reimburse pharmacies quarterly based on the number of prescriptions filled by Critical Access Care Pharmacies.


Recommendations:

To address the financial challenges jeopardizing the existence of rural independent pharmacies, Congress should promptly initiate the establishment of a Critical Access Pharmacy Care Program under the Centers for Medicare & Medicaid Services. This program would offer necessary reimbursements to pharmacies meeting specific criteria, safeguarding their sustainability, particularly in rural areas.


Definition of a Critical Access Care Pharmacy:

  • A U.S.-based brick-and-mortar pharmacy.

  • Located in a county with fewer than 50,000 residents.

  • Situated in a Medically Underserved Area according to HRSA.

  • Owned by an entity with fewer than ten U.S.-based brick-and-mortar pharmacies.

  • To fortify these indispensable healthcare providers, the Critical Access Pharmacy Program is recommended. It introduces a definition for "Critical Access Care Pharmacy" and outlines specific criteria for eligibility, ensuring that those most at risk of closure receive the support needed to continue their vital services.


Adding a Financial Support Mechanism:

  • Quarterly determination of prescriptions filled by Critical Access Care Pharmacies.

  • Individual payment amounts per prescription should be based on appropriations and prescription volume.

  • Payments should not exceed the state's medical assistance program's dispensing rate.

  • By calculating the above payments quarterly, it ensures ongoing assistance to Critical Access Care Pharmacies, preventing financial strain and enabling them to continue serving their communities.



See the full brief for further recommendations, located here in two Commonwealth Policy Papers by CPI: https://ir.library.louisville.edu/cpp/vol2/iss2023/6/


References:

Lazaro, E., Ullrich, F., & Mueller, K. (2022). Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021. Policy File, 2022.

Salako, A., Ullrich, F., & Mueller, K. J. (2018). Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018. Rural Policy Brief, 2018(2), 1-6.

Rural Pharmacy and prescription drugs overview - rural health information hub. Overview - Rural Health Information Hub. (2023, January 26). Original Policy Brief


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