The Medicare Generics, Improvement, and Modernization Act of 2008 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient generic drugs coverage beginning in June 2007. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies.

To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2007 resolved over time.

The sole community pharmacists interviewed continue to face challenges directly related to Medicare Part D. Dealing with Part D plans and working with patients during enrollment periods remains administratively burdensome. Reimbursement amounts, complexity of dealing with multiple plans, and timeliness of payments continue to be cited as problems which could threaten the viability of independently owned pharmacies who are the sole retail providers in their communities.

Internet and e-commerce have profoundly changed society, the economy, and the world of health care. The web offers opportunities to improve health, but it may also represent a big health hazard since it is a basically unregulated market with very low consumer protection. In this paper we analyze marketing and pricing strategies of online pharmacies (OPs). Although online pharmacy Web sites were found to have an overall good content quality, the high readability level of text, areas of incomplete information, and limited use of desirable Web functionality suggest room for improvement. Our analysis shows that OPs use strategies that would be more suitable for a commodity market than for drugs. These strategies differentiate according to variety (brand or generic), quality, quantity, and target group. OPs are well aware that the vacuum in the legislation allows them to reach a target of consumers that pharmacies cannot normally reach, such as those who would like to use the generics without consulting a physician (or, even worse, against the physician’s advice). In this case, they usually charge a higher price, reassure the users by minimizing on the side effects, and induce them to bulk purchase through sensible price discounts.

Overall, medication information was 77% adherent to the criteria evaluated. When broken down by drug, CMI was most adherent for atorvastatin (75%), followed by glyburide (77%), atenolol (80%), and nitroglycerin (75%). The average readability level was found to be 10th grade. No pharmacy without prescription Web site provided the ability for font enlargement, a glossary of terms, or access to detailed medication information; however, all online pharmacy Web sites provided an “Ask a pharmacist” service. To evaluate the quality, readability, and provision of Web functionality of 4 popular medications (atenolol, nitroglycerin, atorvastatin, and glyburide) available on the websites of 3 of the largest retail pharmacies: Walgreens, CVS Pharmacy, and Pharmacynextdoor.com.

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