As prescription drug cost and usage increase in America, problems with their affordability and access are also exacerbated. This is particularly prevalent in rural areas. Though the role of the community pharmacist is expanding at a rapid rate throughout the country, no one’s role is more critical than the role of the community pharmacist in the rural United States. As the trend of younger generations moving to urban areas intensifies, rural communities tend to have a higher senior population as time goes on. Additionally, these communities have patients with more chronic illnesses. Quite often, they require multiple medications, and limited access to transportation can make it difficult for rural residents to obtain them. People may need to make long drives to the nearest pharmacy, and pharmacy hours can be more limited in rural areas, making it doubly difficult to reach a community pharmacy. Rural residents may face geographic barriers to reaching a pharmacy, such as mountains or rivers, and roads often can be impassable due to weather or seasonal closure. Public transportation options are also more limited in rural America, which poses a significant hindrance to low-income seniors.

Pharmaceutical care is an important aspect of the spectrum of healthcare, especially when there is a scarcity of primary care physicians. Rural pharmacists have an important role in helping prevent medication errors and in identifying drug interactions. Pharmacy services include more than just supplying prescription drugs, a role that mail-order and Internet prescription drug suppliers can and increasingly do fill. Pharmacists in rural communities may be one of only a few healthcare providers in a community, and because of this, play a larger role in educating and assisting patients. Additionally, pharmacists often collaborate with one or more healthcare organizations within the community, serving as a prescription drug dispensary and a consultative contact point for rural residents. Independents represent 39% of all retail pharmacies, but represent 52% of all rural retail pharmacies. Over 1,800 independent community pharmacies operate as the only retail pharmacy within their rural community.

Despite this demand for services, rural pharmacies face many challenges to stay open, including financial pressures and a lack of pharmacists to provide services. According to RUPRI Center for Rural Health Policy, from March 1, 2003, to December 1, 2013, there was a loss of 924 independently owned rural pharmacies in the United States. Between March 2003 and December 2013, 490 rural communities lost their only retail pharmacy.

While the growth of Internet and mail order pharmacies might suggest that geographical limits to access are no longer a concern, many rural residents do not have the technology, technical skills, and/or accessibility that these services require to ensure their medications are delivered in a manner that fits their needs. Rural beneficiaries typically have less access to a variety of plan types compared to their urban counterparts. This further complicates patient adherence and medication management. As such, rural pharmacies and pharmacists will continue to fill an increasingly important role in the health of their patients. Still, these pharmacies typically pay more to drug manufacturers per prescription and sell a relatively low volume of medications, so the resulting profit can be very low. There is increasing competition from mail-order and Internet suppliers, who are able to sell at large volume and negotiate lower prices from drug manufacturers, and occasionally pass part of these savings on to customers.

However, all is not lost. Rural pharmacies have a chance at not just survival, but success. Rural pharmacists have the capacity to maintain their relationships with patients with increased communications. iMedicare pharmacies are able to identify which Medicare Part D plans attempt to steer their patients to inconvenient mail-order or chain pharmacies. The rural pharmacists of America have ability to perform plan comparisons also has the potential to save pharmacists and patients both from further financial hardship.