Rural pharmacies are medical 'cornerstones' in their communities; despite financial stresses, some are growing

Photo by Tbel Abuseridze, Unspash

Rural pharmacies have long served their communities as multi-service medical clinics, and many have faced financial stresses lately, but the future may be brighter. "Pharmacies are often cornerstones of rural communities providing access to medication and medical equipment as well as providing medication counseling, monitoring of blood pressure and glucose, and other services," reports Dr. Whitney Zahnd for The Rural Monitor. "Over the past several years, studies from the Rural Research Alliance of Community Pharmacies have demonstrated notable decreases in pharmacies in rural communities. The now 20-year financial impact of Medicare Part D, coupled with the increasing influence of pharmacy benefit managers, has negatively impacted the financial viability of rural pharmacies. This has led to a 9.8% decline in pharmacies in non-core rural areas and a 4.4% decline in micropolitan rural areas between 2003 and 2021."

Not all the news is bad. Zahnd writes, "Recent findings from Rural Policy Research Institute have identified that, since 2020, the tide may be turning. The rate of closures has slowed since 2020, and new rural pharmacies have opened throughout the country." NuCara Pharmacy, which began as a rural pharmacy in Conrad, Iowa, pop. 1,000 is an example of a smaller pharmacy chain that has managed to innovate and stay open. "CEO Brian Wegmann noted additional changes that have broadened both the modalities of pharmacy services, such as the inclusion of telepharmacy, and the expansion of services provided by NuCara, such as infusion, home health, and respiratory services. Additionally, NuCara has moved into areas where chain pharmacies like ShopKo moved out of rural communities, such as Greenfield, a rural town of just over 2,000 people in southwestern Iowa."

Beyond additional "modalities" of support, some area researchers made rural pharmacies their object study to "understand the unique challenges and strengths they possess, especially as many interventions and initiatives are developed in urban or suburban settings that may not be translatable to rural settings," Zahnd reports. In the Southeast, researchers from several universities formed Rural-CP, which "reviewed how other pharmacy practice-based research networks were structured and started making in-person and virtual site visits to rural pharmacies. . . . They are now engaged with 125 rural community pharmacies across seven states in the Southeast, most of which are independent or small chain pharmacies. . . . Any projects that engage these pharmacies also must provide a financial incentive, which has ensured that pharmacies are supported for their time."

Rural pharmacies are also finding ways to face their recruitment challenges. The University of Illinois-Chicago rural pharmacy education program "is one of a handful of programs at schools of pharmacy that provide a concentration or certificate in rural pharmacy," Zahnd explains. "The Rpharm program, established in 2010, is an interprofessional program that educates students about unique elements of rural pharmacy practice and prepares them for working in an interprofessional environment alongside medical and nursing students who are participating in the University's rural medicine and rural nursing programs. . . . . Wegmann of NuCara Pharmacy noted the mutual benefit of having pharmacy students do rotations in rural NuCara Pharmacy locations. He told Zahnd: "We're an attractive spot for student rotations because of the dynamic and diverse practice settings that we can offer because of our compounding and home infusion services as well as our community sites."