Recent discussions at the April MedPAC meeting highlighted pharmacy topics such as preferred networks and pharmacy access. The meeting shed light on the accelerating rate of retail pharmacy closures and the resulting threat to Medicare Part D beneficiary access. Data shared during the meeting showed that between 2021 and 2025, the number of pharmacy closures more than doubled, jumping from 1,764 to 3,929. While chain pharmacies drove most these recent closures, the downstream effects are raising serious concerns for rural and underserved communities.
The MedPAC data emphasized the critical role of independent pharmacies, which make up 62 percent of pharmacies in rural ZIP code areas. Despite this, Part D preferred networks continue to heavily favor large chains. In 2025, approximately 66 percent of chain pharmacies were granted "preferred" status, compared to a stark three percent of independent pharmacies.
During the session's discussion, some commissioners reacted strongly to the striking number of beneficiaries lacking access to preferred pharmacies, particularly the fact that 65 percent of rural Part D beneficiaries live in a ZIP code without a single preferred option. This sparked a critical dialogue on several fronts crucial to the future of community practice.
Commissioners questioned whether beneficiaries actually save money at preferred pharmacies, pointing out instances where "preferred" does not mean "cheaper.” They requested data about the true out-of-pocket impact on patients forced to fill at non-preferred locations.
With chains dominating preferred networks, commissioners highlighted the model’s vulnerability; should a major chain leave an area, massive populations could be left entirely uncovered. The potential CVS exits in Tennessee amidst state-level PBM reform efforts were highlighted as a current example.
Mail-order prescriptions were often suggested as a solution to not living near a preferred pharmacy. While mail-order was initially floated as a potential patch for access gaps, additional analysis suggested that mail-order can be costly. This challenges its viability as a blanket solution for communities losing their local brick-and-mortar pharmacies.
Other comments made throughout the discussion echoed long-standing professional advocacy efforts. One commissioner emphasized that pharmacists are currently underutilized in the broader health care system. Just as other health care providers are compensated for preventive care, there was a vocal call to properly pay pharmacists for their advanced clinical skills and leverage their access to the community.
Moving forward, the commission proposed analyzing the feasibility of establishing objective criteria for preferred status. Creating a level playing field where all pharmacies can compete fairly could be a vital step toward incentivizing preferred network access in underserved areas.
