KEYSTONE PHARMACIES AND PUBLIC HEALTH ACCESS IN INDIANA

Background: Community pharmacies are essential healthcare access points, particularly in medically vulnerable communities where their closure would create a pharmacy desert. Keystone Pharmacies (KPs), defined as the sole pharmacy serving a census tract using the Pharmacy Vulnerability Index, play a critical yet poorly described public health role.Objective: To characterize public health service delivery at Indiana KPs during routine workflow and to compare KPs with non-KP pharmacies across the five dimensions of the Levesque Conceptual Framework of Access to Healthcare.Methods: Two complementary studies were conducted. A descriptive electronic card study prospectively documented public health encounters at four Indiana KPs over two-week observation periods. A statewide cross-sectional telephone survey compared 38 KPs and 19 non-KP pharmacies across the Levesque dimensions. Both studies were conducted within Rx-SafeNet, Indiana's community pharmacy practice-based research network.Results: Forty-eight public health encounters were documented by pharmacists across 4 KPs during the card study, spanning 12 of 14 predefined service categories. Walk-in encounters were most frequent (58.3%), more than half were provided free of charge (56.3%), and most involved pharmacist counseling (79.2%) and referral or follow-up (41.7%). The telephone survey identified significant KP to non-KP differences in availability and accommodation, appropriateness, and affordability, including KP having more operating hours, greater delivery service capacity, and higher rates of after-hours emergency services and durable medical equipment availability. Non-KP pharmacies were more likely to offer public health services free of charge and reported higher biometrics screening rates.Conclusion: KPs function as multi-service public health access points in medically vulnerable communities. Findings reveal a structural reimbursement mismatch that could be addressed through new policies to better position KPs for sustainability as essential public health infrastructure.