Radford Andrea, Mason Michelle, Richardson Indira, Rutledge Stephen, Poley Stephanie, Mueller Keith, Slifkin Rebecca
North Carolina Rural Health Research & Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC 27599-7590, USA.
Res Social Adm Pharm. 2009 Mar;5(1):17-30. doi: 10.1016/j.sapharm.2008.04.004. Epub 2009 Jan 21.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient prescription drug coverage beginning in January 2006. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies.
To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2006 resolved over time.
A semistructured interview protocol was used in telephone interviews with 51 pharmacist owners of rural sole community pharmacies in 27 states who were identified through a random sampling process.
The sole community pharmacists interviewed continue to face challenges directly related to Medicare Part D. Dealing with Part D plans and working with patients during enrollment periods remains administratively burdensome. Reimbursement amounts, complexity of dealing with multiple plans, and timeliness of payments continue to be cited as problems which could threaten the viability of independently owned pharmacies who are the sole retail providers in their communities.
Actions should be considered to help sole community pharmacies deal with the ongoing administrative and financial challenges of Part D. To ensure full choice for rural Medicare beneficiaries and full access to pharmaceuticals through the ongoing presence of a local pharmacy, the development of a mechanism to structure prescription reimbursement so that drug acquisition costs and related overhead are covered and a reasonable profit margin provided should be considered. Further study is needed to determine how existing policies and regulations can be modified to ensure reasonable access to pharmacy services for rural Medicare and Medicaid beneficiaries.
2003年的《医疗保险处方药、改进与现代化法案》设立了专项资金，使医疗保险受益人能够从2006年1月起参加提供门诊处方药保险的计划。医疗保险D部分计划改变了受益人购买处方药的方式，对药房的业务运营产生了影响。
描述在医疗保险D部分实施1年后，作为所在社区唯一零售药房的农村独立药房的经历，以了解2006年该计划实施初期相关的财务和管理问题是否随着时间推移得到解决。
采用半结构化访谈方案，通过随机抽样程序确定了27个州的51家农村社区唯一药房的药剂师所有者，并对其进行电话访谈。
接受访谈的社区唯一药剂师继续面临与医疗保险D部分直接相关的挑战。在参保期间处理D部分计划并与患者合作在管理上仍然负担沉重。报销金额、应对多个计划的复杂性以及付款及时性仍然被视为问题，这些问题可能威胁到作为所在社区唯一零售提供者的独立药房的生存能力。
应考虑采取行动，帮助社区唯一药房应对D部分持续存在的管理和财务挑战。为确保农村医疗保险受益人的充分选择以及通过当地药房的持续存在充分获得药品，应考虑建立一种机制来构建处方报销，以便涵盖药品采购成本和相关间接费用，并提供合理的利润率。需要进一步研究以确定如何修改现有政策和法规，以确保农村医疗保险和医疗补助受益人能够合理获得药房服务。
