This article was adapted from an edition of Policy Perspectives, published in the February 2020 issue of Innovations.

For decades, members of Congress and health policy thought leaders have prioritized policies to improve rural health through increased federal appropriations, special reimbursement structures, and distinct models of care delivery for rural health providers. For the nearly 60 million (one in five) Americans who live in census-designated “rural” areas outside of cities and suburban communities, this federal support has been a lifeline. However, in recent years, hospital closures, physician shortages, and health disparities have made it clear that new, innovative solutions must be brought forward to address continuing health challenges in rural America. Washington has taken notice, and in 2020, rural health debates are likely to continue as Congress and the Trump Administration identify and implement policies to improve the health of rural Americans.

Rural America Is Facing a Health Crisis

The Centers for Disease Control and Prevention’s (CDC’s) data demonstrates the need for improved care in rural America. Rural populations are at greater risk than their urban counterparts of dying from heart disease, cancer, chronic respiratory disease, stroke, and unintentional injuries. Meanwhile, rates of death by drug overdose have continued to rise in rural America, surpassing rates in urban communities. All of these issues are underscored by a growing rural hospital crisis: Half of all hospitals are rural, and nearly a quarter of them are at risk of closing their doors due to financial problems. Mortality rates rise in patient populations that do not have access to a local hospital.

These statistics may sound dire, but they represent an opportunity for real reform of how health care is delivered in rural communities.

While there will not be a simple solution to fixing access to quality health care in rural areas, ensuring access to health care providers is arguably the first step. Because hospitals are often the main employer in a rural town, serving as a health and economic center for most of the population, there is a lot of focus on maintaining the viability of rural hospitals. Many policy proposals, therefore, aim to shore up funding for rural hospitals, but funding extensions that fuel an out-of-date care delivery model are not a long-term solution.

Other proposals consider addressing the well established physician shortage in rural communities. However, enticing providers to move to rural – and often impoverished – areas is easier said than done. Proposals must be multifaceted, and an essential part should be to consider the providers who are already living and working in these communities – enter pharmacists.

Pharmacists Could Be Part of the Solution for Rural Communities

Deservedly so, hospitals and physician shortages receive a lot of attention in the rural health policy debate that is raging across the country. There are also shortages of rural pharmacies and pharmacists due to reimbursement challenges in recent years, forcing many to close their doors.

However, in most rural communities, pharmacists are still practicing and seeing patients day in and day out. Rural pharmacists play an essential role in care delivery and disease management. In fact, for many rural areas, the pharmacist may be the only or one of only a few health care providers for miles, meaning that they are the first line of defense and the provider with whom patients routinely have direct access. This presents an excellent opportunity for rural pharmacists to serve as a key solution, as policymakers and candidates consider the future of health care delivery and improved health outcomes in these underserved communities. To do this, policies must acknowledge that pharmacists can do more than “just count pills.”

Too often, policymakers forget that pharmacists – providers who are already invested and located in the communities – have advanced doctorate training and a license that allows them to do much more than hand out prescriptions. Allowing pharmacists – and reimbursing them – to practice to the full scope of their license, in accordance with state laws and regulations, could be a big piece of the solution to provider shortages in rural areas.

Congress Is Looking for Solutions

The health care delivery challenges of rural America have captured the attention of the powerful US House Committee on Ways and Means in Washington. Near the end of 2019, the newly formed Rural and Underserved Communities Health Task Force collected information from stakeholders and communities on, among other topics, health care and community factors that impact health, successful models currently improving outcomes in rural America, provider access, and use of data and technology. The ultimate goal of the task force is to identify sensible, bipartisan policy options that can improve health outcomes in rural and underserved communities. Through this process, pharmacists and boards of pharmacy can engage and provide ideas for reform in their communities.

Another idea members of Congress have considered in recent years is reimbursing pharmacists in rural or underserved areas through the Medicare program for cognitive, patient care services, rather than tying reimbursement to the dispensing of a product. The idea is simple: If state law authorizes and the respective board of pharmacy issues a license allowing a pharmacist to provide a patient care service, Medicare should reimburse for that service. This is a policy goal for which pharmacists have advocated for years. Achieving Medicare “provider status” for all pharmacists may be a heavy – and costly – policy lift at the federal level. However, recent proposals that provide for a limited expansion of reimbursed services in rural or underserved communities could be a popular and simple fix to some of the health care problems plaguing America’s rural communities.

There may also be an opportunity for the Trump Administration to move on this topic without congressional action. In October 2019, President Donald J. Trump signed an executive order on Protecting and Improving Medicare for Our Nation’s Seniors. The executive order directs CMS to eliminate Medicare requirements that “limit professionals from practicing at the top of their profession.” Within weeks of the executive order, CMS Administrator Seema Verma confirmed that granting pharmacists provider status could be something considered in the rulemaking required within one year of the signing of the order.

Improved Medicare reimbursement for pharmacists could be one part of the solution to the ongoing rural health crisis across the country, but even without change at the federal level, pharmacists should be at the center of any reforms in rural communities. Pharmacists know their communities and see their patients regularly. They are the providers who detect and avoid negative drug interactions, provide preventive services like vaccines, and help patients manage chronic diseases.

In rural America, where disease rates and comorbidities remain high and provider access continues to decline, pharmacists should be an accessible and appropriate health care option. These providers should be considered as the rural health debate continues, and boards of pharmacy should keep an eye on the 2020 election and the growing conversation around rural health care to see how the rural population could help determine the type of solutions considered in Washington for rural Americans and their pharmacists.