A Bleak Future for Independent Community Pharmacy Under Medicare Part D

Trends in Community Pharmacy Counts and Closures Before and After the Implementation of Medicare Part D

“…Medicare Part D has increased prescription drug utilization among Medicare beneficiaries by between 3.9% and 12.8% per year, 1,2 at least partly due to increased patient compliance as a result of decreased patient cost for prescriptions. While Medicare Part D increased overall medication use by 158 million prescriptions in 2006 and provided a payment mechanism for medication therapy management services, 2 it also created low reimbursement rates for pharmacies, for whom cash‐paying patients are often a primary source of profits 3 …”

Medication Therapy Management Favors Large Pharmacy Chains and Creates Potential Conflicts of Interest

“…22 Third, some pharmacists do not feel prepared for consulting; many pharmacists need more training in MTM itself and may not have the space to conduct private consults. [23][24][25][26] Many pharmacists are unfamiliar with billing as service providers, and most have not often been exposed to this concept in formal education or training. 24,25 We suggest that these 3 obstacles make Part D MTM more attractive to large businesses, particularly if they have instore clinical space and an existing billing infrastructure.…”

“…While independent community pharmacists may not be particularly encouraged by the development of recent Medicare programs, 26,27,28 larger community chain pharmacies appear to have an advantage in addition to larger scale. Informal discussions with local certified geriatric pharmacists suggested that a potential vehicle for Part D MTM delivery that would not face the same barriers encountered by independent pharmacies is the chain pharmacy in combination with the new in-store medical clinics.…”

The Challenge of Medicare Part D for Community Pharmacies

“…A commentary by Spooner, published in the November/December 2008 issue of JMCP, highlighted many of the issues faced by independent community pharmacies under Medicare Part D. 1 The relatively lower reimbursement and delay in payment under Medicare Part D creates a dilemma that is keenly described by the author-that the "closure of an independent pharmacy not only affects the business owner and his or her staff, but can also mean the end of convenient access to pharmacy services for patients, including the very Medicare beneficiaries for whom Part D was created. "…”