of all rural retail pharmacies. There are just slightly over 1,800 independent pharmacies operating as the only retail pharmacy within their rural community. A study conducted by the RUPRI Center for Health Policy Analysis and the North Carolina Rural Health Research & Policy Analysis Center found that 91% of all sole community pharmacies are located in rural communities and that 22% are located more than 20 miles from the next closest retail pharmacy. Furthermore, the study found that 83% of sole community pharmacists provide important services to other health care organizations, with blood pressure checks, diabetes counseling, and immunizations as the most common services provided. Challenges Faced by Independent Community Pharmacies Independent pharmacies face several key challenges. First, independent pharmacies are unable to negotiation on a level playing field with pharmacy benefit managers (PBMs). Second, independent pharmacies are disadvantaged when health plan sponsors (employers, et al.) decide to require, or financially incentivize, patients to use mail order pharmacies – often against the patients’ wishes. Third, many independent pharmacies are challenged by the growth of “preferred pharmacy” health plan designs that greatly restrict the patients’ choice of pharmacy. Other key issues for community pharmacists are creating a fair reimbursement system for generic drugs covered under Medicaid, preserving patient access to durable medical equipment provided by local pharmacies, and implementing greater regulations and transparency over pharmacy benefit managers. References External links National Community Pharmacists Association, organization representing independent pharmacists in the United States Pharmacies of the United States