I began my career at Patton Pharmacy, my family’s pharmacy in Northern Cambria County, which my father started from scratch in 1974 — one of the few independents left in that part of the state. For more than 30 years, I have practiced almost entirely in rural Pennsylvania, including years at Mission Pharmacy in Armstrong County and Klingensmith’s Drug Stores across Armstrong and Clarion counties. In each community, I watched the same pattern: hospitals struggle to stay open, physicians retire without replacements, specialists move to urban centers , and the community pharmacy remains, often as the most accessible provider left standing.

Rural Pennsylvanians face shrinking access to physicians, hospitals and specialists, leaving the community pharmacy as the most accessible — and sometimes only — point of care within reasonable driving distance. By 2036, the U.S. could face a deficit of up to 86,000 physicians, with rural communities hit hardest. Pennsylvania’s Rural Health Transformation Plan (RHTP) recognizes pharmacists as key stakeholders. Now state leaders must do the same.

Pennsylvania recently received federal CMS funding for a five-year RHTP — a historic opportunity to reshape rural care. The Pennsylvania Pharmacists Care Network (PPCN), with more than 170 community pharmacies across 46 counties, is one of the most geographically distributed care networks in the commonwealth. In 2025, PPCN pharmacies delivered more than 62,000 patient care interactions to over 11,000 patients, including medication adherence support, asthma and COPD check-ins, diabetes encounters and blood pressure visits. In maternal care deserts, PPCN pharmacists already provide prenatal planning, pregnancy care and postpartum support.

These services are already making a difference. Erich Cushey of Curtis Pharmacy in Carmichaels recently worked with a patient who was improperly using a maintenance inhaler as a rescue inhaler. His team adjusted her therapy, provided a rescue inhaler, taught proper technique and developed a smoking cessation plan. “The patient was in tears because someone finally had time to listen,” Cushey said. That visit kept her out of the hospital.

David Cippel at Klingensmith’s Pharmacy sees similar results with diabetes patients using continuous glucose monitors. The technology can reduce dangerous blood sugar swings and improve quality of life — but only if patients know how to use it. Klingensmith’s pharmacists help patients access devices, set them up and interpret the data. “That hands-on access is what turns a device into actual diabetes control,” Cippel said.

These stories are not exceptions. They are happening every day in rural communities where pharmacists know their patients by name and are often the first to notice when something is wrong.

Pennsylvania needs to take four steps to strengthen rural pharmacy care.

First, pharmacists must have a formal seat at every Rural Care Collaborative table as the RHTP rolls out through PREP organizations. Pharmacists are clinicians, employers and health care innovators who already help drive disease prevention and medication management in underserved communities.

Second, rural transformation funding should support pharmacy infrastructure and help sustain independent pharmacies in vulnerable areas. Since 2020, more than 1,000 Pennsylvania pharmacies have closed, with another 213 operating in areas where closure would create or expand a pharmacy desert. Protecting access to local pharmacies must be part of any serious conversation about health care affordability and access.

Third, Pennsylvania should adopt a Pharmacist Standard of Care model similar to Iowa’s House File 555, which allows pharmacists to practice at the top of their training through statewide protocols and modernized regulations. Pennsylvania pharmacists have the same education and clinical expertise — they simply lack the legal framework to use it fully.

Finally, pharmacist provider status should be extended from Medicaid to commercial insurance plans so pharmacies can sustainably provide the care rural communities already depend on.

The challenge facing Pennsylvania is not whether pharmacists can help transform rural health care. They already are. The question is whether policymakers will modernize laws and payment systems before more communities lose one of their last accessible health care providers. Rural Pennsylvanians cannot afford to wait.

Robert L. Maher Jr., Pharm.D., is president and chief operating officer of the Pennsylvania Pharmacists Care Network. A board-certified geriatric pharmacist with more than 30 years of experience in rural community and long-term care pharmacy, he has practiced in Cambria, Armstrong and Clarion counties and serves as adjunct faculty at Duquesne University School of Pharmacy.