Why Rural Pharmacies Are Essential Infrastructure in US Health Care

For millions of rural residents across the US, community pharmacists serve as the primary gateway to essential medication management and health care connection, acting as the primary care providers in many regions starved for medical resources.¹

Beyond simply filling prescriptions, rural pharmacists manage chronic conditions, deliver immunizations, counsel on over-the-counter medications, and prevent drug overdoses. Data from national health care surveys show that rural Medicare beneficiaries visit their community pharmacists a median of 14 times per year, compared with only 5 annual visits with primary care physicians.

This frequent contact positions pharmacists to spot critical, non-clinical barriers that never appear in electronic health records, such as unaffordable copays, lack of transportation, or medical devices that patients cannot operate.

To learn more about the constant pressures and challenges facing rural and Appalachian pharmacies, Drug Topics welcomed Jennifer Hammons, PharmD, DrPH, director of rural health advancement at the Appalachian College of Pharmacy, for this week’s episode of the Over the Counter podcast.

READ MORE: Why Pharmacy is a Cornerstone of Public Health in the US

Financial Pressures and Systemic Barriers Threaten Rural Access

The survival of rural pharmacies is increasingly threatened by systemic economic structures and unfavorable insurance practices. Between 2018 and 2023, the number of retail pharmacies in rural communities dropped by 5.9%, leaving dozens of non-core counties without any retail pharmacy presence at all.

Independent rural pharmacies operate under narrow profit margins, burdened by low-volume purchasing, outdated maximum allowable cost pricing, and direct and indirect remuneration fees imposed by pharmacy benefit managers (PBMs).¹

Although PBM reform is essential to halt financial losses, Hammons notes that reform alone is insufficient unless policies establish sustainable payment models for the clinical services pharmacists routinely deliver.

Cultural Competency and Local Trust in Rural Care Delivery

Beyond financial viability, patient satisfaction and trust are critical determinants of health care utilization in rural areas. Research examining health care perceptions in Appalachian Ohio reveals that rural residents report significantly lower satisfaction with health care convenience, quality, information, and provider courtesy than non-rural populations.²

With primary care physician density 60% lower in Appalachian counties than those that are not, local residents frequently report feeling stereotyped or dismissed by visiting health care providers. In contrast, rural pharmacists build long-term relationships rooted in community context and mutual trust, which cannot be replicated by remote technologies or automated platforms.

Elevating Pharmacies to Recognized Essential Infrastructure

To secure the future of rural health care, federal and state health policies must move past treating pharmacies as product retail outlets and formally acknowledge them as essential infrastructure. Rural populations are on average older and experience higher rates of chronic conditions such as diabetes and cardiovascular disease, making sustained local pharmacy access a health outcome imperative.^1,2

Policymakers must invest in workforce development, fair reimbursement for drug acquisition costs, and dedicated compensation for clinical patient management. Recognizing pharmacists as vital clinical partners ensures that rural patients receive not only written prescriptions, but the continuous local support necessary to achieve lasting health improvements.¹

“I think the biggest assumption is that rural communities just have fewer resources, and we need urban solutions to rural problems,” concluded Hammons. “Rural is not a smaller version of urban. Our geography, workforce, transportation, [and] infrastructure [are] different. Culture, trust, and relationships truly matter to most people in this community.”

Stay tuned for weekly podcast episodes of Over the Counter powered by Drug Topics. Check out our most recent episode with Chad Worz, PharmD, BCGP, FASCP, who discussed the Main Street Pharmacy Access Act and its current status in US Congress.

REFERENCES

1. Rural pharmacy and prescription drugs. Rural Health Information Hub. February 19, 2026. Accessed October 1, 2026. https://www.ruralhealthinfo.org/topics/pharmacy-and-prescription-drugs

2. Morrone M, Cronin CE, Schuller K, et al. Access to health care in Appalachia: perception and reality. J Appalach Health. 2021 Oct 25;3(4):123-136. doi: 10.13023/jah.0304.10