For many Jefferson County residents, picking up a prescription isn't as simple as driving to the nearest Walgreens. Rural Oregon ranks among the worst states in the country for pharmacy access — and for communities like Madras, Culver, Metolius, and the Warm Springs Reservation, that gap has real health consequences.
A recent review of Oregon pharmacy access data found that some rural communities are forced to travel significant distances for medications, or to rely on workarounds like medication pickup boxes and mail-order services that don't always work for controlled substances, refrigerated medications, or urgent needs.
The PBM Problem
At the root of the access crisis, many health advocates and rural pharmacists point to pharmacy benefit managers, or PBMs — the largely invisible middlemen who negotiate drug prices between insurers and pharmacies. Critics say PBM reimbursement rates have made it financially unsustainable for independent and rural pharmacies to stay open.
Oregon's legislature has been considering reforms targeting PBMs for several sessions, but meaningful action has stalled repeatedly. Meanwhile, rural communities continue to lose pharmacy access — and once a rural pharmacy closes, it rarely reopens.
What This Means Locally
Jefferson County is not immune. The county's population is spread across a large geographic area, with many residents living well outside Madras proper. For elderly residents, people without reliable transportation, or those managing chronic conditions requiring regular medication, the distance to a working pharmacy is not an inconvenience — it's a health risk.
The Warm Springs Reservation, which is entirely within Jefferson County, has historically faced its own pharmacy access challenges as a tribal community that relies on a combination of Indian Health Service resources and off-reservation pharmacies.
What Advocates Want
Healthcare advocates are calling on state legislators to prioritize PBM reform in the next legislative session, including measures that would require fairer reimbursement rates for rural and independent pharmacies and greater transparency in how PBMs set their rates.
Until then, Jefferson County residents will continue navigating a pharmacy landscape that rewards proximity to urban centers — something most of this county's 24,000 residents simply don't have.