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Related Articles Impact of Medicare Part D on independent and chain community pharmacies in rural Illinois–A qualitative study. Res Social Adm Pharm. 2010 Jun;6(2):110-20 Authors: Bono JD, Crawford SY BACKGROUND: Although the sustainability of rural pharmacy services is a concern of long standing, the rural marketplace is not monolithic. Enhanced understanding of different experiences, strengths, and potential weaknesses of rural chain and independent pharmacies could help inform health policy debates, legislation, and consideration of disparities and access. This study compared and contrasted experiences by pharmacists in chain and independent community pharmacies during Medicare Part D implementation. OBJECTIVE: The objective was to obtain and describe experiential narratives from rural Illinois pharmacists regarding the implementation of Medicare Part D. Similarities and differences experienced in chain and independent community pharmacies were examined, as well as pharmacists’ perceptions about potential implications of the newly implemented Act on the accessibility of rural pharmacy care and services. METHODS: A semistructured qualitative research approach was used, involving focus groups and telephone interviews, to elicit the subjective experiences of rural Illinois pharmacists. Participants were selected through purposive sampling to include representative perspectives of independent and chain community pharmacists in rural areas across the state. Using a systematic, iterative coding process, recurrent themes were identified in 8 substantive categories. RESULTS: Areas of similarity between the 2 groups included universal criticism of the initial implementation processes, but consensus belief that Medicare patients ultimately benefited if they did not have previous prescription drug coverage. Pharmacists in independent drugstores expressed more concern about their future viability. Corporate communications and infrastructure support were available in chain pharmacies and believed to present them with competitive advantages and a stronger long-term financial position. CONCLUSIONS: The findings showed a disparate impact of Medicare Part D on the initial experiences and perceived viability of independent community pharmacies, in comparison with their chain pharmacy counterparts. The long-term implications of changing regulatory environments and customers’ pharmacy needs in underserved communities should be carefully considered and monitored. PMID: 20511110 [PubMed - indexed for MEDLINE]

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Impact of Medicare Part D on independent and chain community pharmacies in…

Related Articles PDP or MA-PD? Medicare part D enrollment decisions in CMS Region 25. Res Social Adm Pharm. 2010 Jun;6(2):130-42 Authors: Cline RR, Worley MM, Schondelmeyer SW, Schommer JC, Larson TA, Uden DL, Hadsall RS BACKGROUND: The Medicare Prescription Drug Improvement and Modernization Act of 2003 provides outpatient prescription drug coverage for Medicare beneficiaries through private insurers. This coverage is available through 2 primary venues: stand-alone prescription drug plans (PDPs) and integrated managed care (or Medicare Advantage) plans that also provide prescription drug coverage (MA-PDs). OBJECTIVES: The first objective was to describe factors associated with Medicare beneficiaries choosing to enroll in any Medicare part D PDP. The second objective was to describe factors associated with the choice of an MA-PD, given enrollment in the part D program. METHODS: The study used a cross-sectional, survey design. Data were collected from a stratified random sample of 5000 community-dwelling adults, aged 65 years and older in the Center for Medicaid and Medicare Services Region 25. Data were collected by means of a mailed questionnaire. Data analyses included univariate and bivariate descriptive statistics and multivariate probit modeling. RESULTS: The overall adjusted response rate was 50.2% (2309 of 4603). Data from 1490 respondents (32.4% of those attempted) were analyzed in this study. Nearly 75% of sample members elected to enroll in one of the Medicare part D coverage options in 2007, with more than 3 times as many choosing a PDP compared with a MA-PD option (57.2% vs 17.8%). A variety of variables including rurality, plan price, perceived future need for medications, and preferences emerged as important predictors of choosing to enroll in any Medicare part D drug plan, whereas rurality, state of residence, and number of diagnosed medical conditions were associated with the decision to enroll in a MA-PD. CONCLUSIONS: Models of health insurance demand and plan choice applied in this context appear to be modestly effective. Rurality and state of residence were particularly important contributors to both of these decisions, as were a variety of individual characteristics. PMID: 20511112 [PubMed - indexed for MEDLINE]

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PDP or MA-PD? Medicare part D enrollment decisions in CMS Region 25.