Pharmacy benefit companies (also called PBMs) recognize that pharmacies are an important part of patient care across the U.S. Especially in rural areas, patients may depend on their pharmacist for more than just filling prescriptions; for example, providing clinical services such as vaccinations and help managing chronic conditions. Identifying these unique circumstances, PBMs across the industry are partnering with independent pharmacies, ensuring they are fully represented in networks, and developing programs that support rural pharmacy practice so that they can serve their patient populations.
Here are just a few examples of real-world activities pharmacy benefit companies engage in to help rural patients live healthier lives by supporting rural pharmacies through higher reimbursements, tailored rural pharmacy networks, and programs to advance clinical services:
CarelonRx
In 2021, CarelonRx, the PBM for Elevance Health, partnered with Community Pharmacy Enhanced Services Networks (CPESN), a clinically integrated performance-based network of independent community pharmacies, to create a value-based care arrangement to support enhanced services for individuals at higher risk of poor health outcomes. Early results show improved outcomes for Medicaid members in managing complex or chronic conditions such as asthma and COPD, and certain mental health conditions.
CerpassRx
CerpassRx ensures pharmacy access in all areas for patients. They perform pharmacy network access studies to identify potential limitations in pharmacy access, correcting any identified concerns through outreach to non-contracted pharmacies in the radius of the
underserved members.
CVS Caremark
CVS Caremark, a CVS Health company, supports a rural pharmacy network, specifically to ensure members in underserved areas have access to care. They work directly with independent pharmacies located in rural areas, evaluate local circumstances to support community access, and pharmacies in the rural network are reimbursed at higher rates owing to the important role they play. Eligibility for the rural network is based on the distance to other pharmacies, geography, and local conditions.
Evernorth Health Services
In 2023, Express Scripts by Evernorth, launched the IndependentRx Initiative to further support pharmacists in rural communities across the U.S. by offering increased reimbursement to true independent pharmacists, as well as partnering opportunities to expand their clinical practices through expanded services. To help advance these initiatives, Express Scripts hired a Senior Director of Independent Pharmacy Affairs to lead an independent pharmacy advisory committee focused on driving competitive reimbursement practices and creating new solutions that leverage independent pharmacists to alleviate provider shortages across the health care delivery system.
Optum Rx
Optum launched a Pharmacy & Provider Desert Program to support patients who live in rural areas. The program will also support pharmacists in connecting patients with resources and services to address basic needs, such as food, transportation, and housing. Optum Rx has a focus on reimbursing independent pharmacies commensurate with services provided, quality achieved, and access for patients.
PerformRx
PerformRx is building opportunities for pharmacies in their network to provide enhanced clinical services to patients, including health-related social needs screening and resources, specifically in rural areas. In addition to this, their URAC-accredited Drug Therapy Management (DTM) program, designed to comprehensively manage a member’s medication regimen, focuses on those that are the most at risk including those in rural communities.
Prime Magellan Rx
Prime MRx’s data-driven quality network supports independent and rural pharmacies by partnering with clients to create additional reimbursement opportunities for these pharmacies to close gaps in care, improve adherence, and ensure they are addressing basic needs with patients at risk of pharmacy access issues.
ProAct, Inc.
ProAct recognizes the unique challenges faced by pharmacies operating in remote regions and relies on a comprehensive strategy to support their inclusion and sustainability within the network. This strategy includes offering tailored reimbursement methodologies that reflect the specific needs of rural pharmacies, along with partnering closely with Pharmacy Services Administrative Organizations (PSAOs) to extend personalized support. Through these initiatives, ProAct empowers rural pharmacies to thrive as essential health care providers in underserved areas.
Waltz Health
Waltz introduces AI-driven marketplaces and new tools that help pharmacies and their patients. Both insured and uninsured patients can find savings for their prescriptions, lowering their out-of-pocket costs.
These tools can help rural pharmacies act as critical point of care delivery to support patients in their communities.
WellDyne
HealthDyne, the digital pharmacy services division of WellDyne, delivers prescriptions to all communities, including rural areas for a broad list of direct response, provider, payor, manufacturer, and renal care programs.
