NACDS to States: Leverage Pharmacies to Deliver on Rural Health Transformation Goals

One of the graphics NACDS is utilizing in a targeted digital communications campaign to promote the inclusion of pharmacy in states' rural health transformation efforts.

The application window for the Rural Health Transformation Program (RHTP) closed earlier this week, with the Centers for Medicare and Medicaid Services (CMS) reporting that all 50 states submitted proposals. The National Association of Chain Drug Stores (NACDS) commends the states for their commitment to advancing rural health and calls on them to put pharmacies at the center of their efforts, so that every rural American can receive the care they need, when and where they need it - close to home.

Specifically, NACDS is encouraging states whose RHTP proposals centered on improving chronic disease management or increasing access to healthcare services to operationalize those commitments by leveraging pharmacies and pharmacists in service delivery, while also clearing policy barriers - including lack of reimbursement and scope-of-practice rules that have not kept pace - to ensure success.

"This is a defining moment for rural America. With strong support from the Administration and all 50 states on board, we have a once-in-a-generation chance to fix what's broken in rural healthcare," said NACDS President and CEO Steven C. Anderson. "The facts are clear: 90% of Americans live within five miles of a pharmacy. In rural America, that pharmacy is often the only healthcare option for miles. States can take action to help bring healthcare closer and within reach for their most vulnerable citizens."

The RHTP, created by the One Big Beautiful Bill Act, allocates $50 billion over five years for rural health. CMS has indicated that half of the funds are designated for states whose applications are approved, and the other half will be awarded to states based on their plans and perceived impact. The goal of the program is to strengthen rural healthcare across the country and "empower states to transform the existing rural health care infrastructure and build sustainable health care systems that expand access, enhance quality of care, and improve outcomes for patients."

Pharmacies are uniquely positioned to deliver on these goals. In addition to being the most accessible healthcare destination, pharmacies offer extended hours, like evenings and weekends, when other providers are unavailable - filling gaps in care. In many rural areas, there are more pharmacies than physician offices. Still, pharmacists aren't always utilized to their full potential - a missed opportunity this program can address.

"We're sitting on a wellspring of untapped healthcare capabilities. Pharmacists train for six years to help Americans prevent and manage tough health problems - yet most states' outdated policies hold them back," Anderson said. "Every day we wait to let pharmacists do all they can is another day rural Americans struggle to access the care they need. States have the power to change this."

NACDS has worked diligently since the RHTP was first announced in July to educate leaders on the critical connection between pharmacies and rural health, and to demonstrate clear pathways for leveraging these healthcare destinations to improve outcomes nationwide. Highlights include:

• Meeting with the Department of Health and Human Services (HHS) to outline the essential role pharmacies can play in improving access, quality, and outcomes in rural America.
• Sending letters to all 50 governors - followed by targeted outreach - emphasizing the value of including pharmacies in state strategies to strengthen rural care.
• Responding to 47 unique state requests for information (RFIs) with detailed feedback on how to leverage pharmacies in RHTP plans.
• Developing a "Pharmacy-Led Wellness Program Proposal" which recommends empowering pharmacists to take a greater role in managing chronic diseases such as diabetes and hypertension.
• Creating advocacy materials, such as one-pagers and member letter templates, to increase awareness of pharmacy capabilities.
• Convening pharmacy associations, pharmacy schools, rural health partners, and other allies to amplify impact.
• Launching a digital communications campaign targeting government decision-makers and their influencers in priority states with messaging that reinforces pharmacies as essential to strengthening healthcare access in rural communities.
• Participating in state public comment opportunities (e.g., listening sessions, workgroups).

Among NACDS' arguments to leaders: Pharmacists can deliver high-impact clinical care - from chronic disease prevention and management to testing and treatment for routine illnesses - with unmatched accessibility, yet remain underutilized. Historically reimbursed solely for dispensing rather than for clinical services, pharmacies have had limited ability to scale and sustain healthcare services for their patients. Implementing sustainable, value-aligned payment models for pharmacist services would expand access, improve outcomes, and reduce downstream costs, especially in rural and underserved communities.

Beyond payment misalignment, NACDS highlighted opportunities to advance scope-of-practice rules in the interest of improving healthcare outcomes and saving money. States that enable pharmacists to practice at the top of their training will unlock more convenient, community-based care options - particularly in rural areas.

Support for pharmacies' role in rural health has achieved high-profile attention. HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz have both called for expanded access to pharmacy-based care. In a USA Today op-ed, Kennedy and Oz argued that RHTP can help solve workforce shortages by allowing pharmacists to take on bigger roles in delivering care: "Without such measures, staffing shortages will continue to compromise access in too many rural communities," they wrote.

Initial RHTP funding awards are set to be announced by December 31.