Kansas pharmacists warn of 'pharmacy deserts,' urge reimbursement transparency and greater PBM oversight

Representatives of the Kansas Pharmacists Association told the Senate Committee on Financial Institutions and Insurance that closures of independent pharmacies have created "pharmacy deserts" in many rural communities and that state action is needed on reimbursement and transparency in payer and PBM contracts.

Sloan Freeman, a pharmacist and independent pharmacy owner, described local pharmacies as community lifelines and said many independently owned stores provide in‑depth medication reviews, deliveries and compounding services. "We do a lot more than just fill the prescription and send it out the door," Freeman said, adding that several pharmacists closed their pharmacies temporarily to attend the committee hearing so they could advocate on behalf of patients.

Tessa Schnelly, a pharmacist and public‑health practitioner who led a study of rural pharmacy access, told senators that Kansas has seen 52 pharmacy closures in the last decade and that 210 towns meet a commonly used definition of a rural pharmacy desert (communities located 10 miles or more from a pharmacy). She said the single largest distance cited in the study was Mattville, Kansas, where the nearest pharmacy was 25 miles away; if the next closest pharmacy closed, the distance would exceed 50 miles. "Once again, this is a person that they can come. They don't have to make an appointment to see their pharmacist," Schnelly said, describing the pharmacist's role as an accessible point of care.

Schnelly said pharmacy deserts overlap with other workforce shortages: at the time of her study 63 federally designated medically underserved areas existed and roughly 73% of those contained a pharmacy desert; 58% of pharmacy deserts were located within a medically underserved area and 83% were in a health provider shortage area.

Pharmacists outlined three primary policy asks to address closures and access: fair, level reimbursement rates for pharmacies; transparency on where employer and payer dollars are going in contracts with PBMs; and stronger state oversight or "teeth" for PBM registration and conduct. Sloan Freeman summarized those requests as, in her words, a need for "fair payment" and pricing transparency so independent pharmacies can remain viable.

Committee members asked about potential state remedies and about mail‑order alternatives. Pharmacists said mail‑order fills can be an option but that lead times have grown and can be unreliable in emergencies; one presenter described a patient whose mail‑order delay during a snowstorm resulted in hospitalization for seizures. The pharmacists also said state recruitment and rural provider incentive programs typically do not include pharmacists and asked that recruitment policy be broadened.

Senator Rose and others asked what specific statutory or regulatory changes the Legislature could make. Pharmacists said state regulators — principally the insurance commissioner's office where PBMs register — could be given additional authority to require transparency from PBMs and enforce registration standards. They urged legislators to consider reforms to how payer and PBM contracts treat reimbursement and pricing for independent pharmacies.

The presentation closed with committee members thanking the pharmacists and encouraging further engagement; no committee votes or formal actions resulted from the presentation during the recorded meeting.

Why it matters: Pharmacists said local access to medication through independent pharmacies affects routine care, urgent needs and hospital utilization, especially in rural counties where alternatives involve long drives or unreliable mail‑order service.