Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Sarah Wackerbarth, PhD; Kathi Harp, PhD

Committee Member

Holly Divine, PharmD, BCACP, BCGP, CDE, FAPhA


The shift in healthcare towards cost-savings mechanisms is hindering business operations of pharmacies in Kentucky, especially independent pharmacies. Independent pharmacists have reported that the operations of pharmacy benefit managers within Kentucky Medicaid networks have created financial hardships for their pharmacies and there is a threat of closure that could be associated with a potential access barrier to pharmacy services for Medicaid beneficiaries. During legislative meetings, much focus was on this issue and several bills are currently being drafted to correct this issue. It is important to define independent pharmacy and describe, geographically and in terms of utilization, chain and independent pharmacies in the Kentucky Medicaid network. Describing independent and chain pharmacies in the Kentucky Medicaid network provides insight for upcoming legislative issues and provides additional value to public health efforts.

Medicaid pharmacy claims data for the 2017 fiscal year (July 2016- June 2017) were examined subsequent to defining “independent pharmacy” to determine if the closing of independent pharmacies would impact the delivery of medications to the Kentucky Medicaid population. ArcGIS software was utilized to map the radius between pharmacy types throughout Kentucky. Regional claims data was used to define the percent of chain and independent pharmacies within regions. Claim counts and total expenditures were evaluated to identify potential differences in the types of medications supplied to the Medicaid population by chains and independent pharmacies and/or potential differences in the utilization of pharmacy types.

According to distance requirements set by the Department for Medicaid Services contracts with Managed Care Organizations, there would not be an access issue if independent pharmacies were to close. However, when the proportions and utilization of independents and chains are described regionally, results suggest a chain pharmacy access to be a barrier for rural regions of the state. Descriptions of the most common medications within regions by total spend and claim count implies essential services are also provided by independent pharmacies compared to chains.

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