The Arkansas Democrat-Gazette on Monday examined some of the challenges facing independent pharmacies nationwide, such as growing competition from large chain and mail-order pharmacies, decreased reimbursement rates, and increased state and federal regulations. Such challenges are "especially tough in rural states such as Arkansas, where pharmacists may be the only health care professionals in small towns that don't have a large enough population to attract chain stores," the Democrat-Gazette reports.

Scott Pace, associate executive vice president of the Arkansas Pharmacists Association, said, "It's a very highly regulated and very intensive profession to be in, in terms of all the administrative stuff that you have to do outside of just taking care of your patients." According to the Arkansas State Board of Pharmacy, 56% of the 747 pharmacies statewide are independently owned.

Mark Riley, executive vice president of APA, said independent pharmacies are at a disadvantage because large chains are able to negotiate better reimbursements for a large number of stores. Federal legislation would exempt independent pharmacists from federal antitrust laws and would allow the pharmacists to band together to collectively bargain with pharmacy benefit managers, Riley said. However, PBMs, the Congressional Budget Office and the Federal Trade Commission all have said the measure would drive up costs.

In addition, CMS in September 2009 will require the pharmacies to seek accreditation to become authorized sellers of durable medical equipment. John Norton, a spokesperson for the National Community Pharmacists Association, said that pharmacists nationwide who cannot afford the accreditation, which costs at least $3,000, would be required to stop selling certain products, which would mostly affect consumers in rural areas. Norton said, "Beneficiaries in underserved areas will be forced to travel dozens of additional miles to other locations for supplies and expert advice previously obtained closer to home."

Norton said that one of the priorities for NCPA will be to find ways to increase the Medicare reimbursements that pharmacies receive for prescription medications, adding that the federal government in fall 2009 will issue new payment formulas for pharmacists that sell generic prescription drugs (Park, Arkansas Democrat-Gazette, 11/17).

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