Drug Store Deserts Become the New Norm

Some rural communities are experiencing a decline in brick and mortal pharmacies.

Last week I discussed the disappearing OB/GYN services across rural hospitals, and disappearing healthcare across those regions in general. Over 200 rural hospitals have closed in the last 15 years, and health professional shortage areas are leaving populations without sufficient primary care, dental, and mental health. Yet one aspect of rural care receiving insufficient attention is the expansion of “drugstore deserts.”

Our readers like the facts, so here you go:

• More than 41 million Americans are struggling to access their prescriptions or other over-the-counter medications.
• More than 1,230 independently owned rural pharmacies have closed since 2005, representing 16 percent of all pharmacies across the U.S.
• More than 630 communities nationwide have no retail store with a pharmacy.
• Twelve percent of Americans are forced to drive more than 15 minutes to reach the closest pharmacy, or lack enough pharmacies to meet medication demands, representing 40 percent of U.S. counties.

The era of the corner or independent drugstore is ending. Causal factors are related to competition, with price savings of vertical mergers of drugstore chains, insurance companies, and pharmaceutical benefit managers. Insurers want low pricing, which hits smaller pharmacies hard; 50 percent of drug plan reimbursements fail to cover the costs of drugs and their overhead.

Pharmacy benefit managers also notoriously steer customers away from independent pharmacies to larger and more established mail-order or specialty pharmacies; these have lower out-of-pocket costs. The market has gotten so competitive that pharmacy benefit managers may prevent local pharmacies from offering more expensive drugs, which leaves little opportunity for them to make a profit. It’s a game of juggling odds; occasionally, larger prescriptions come in to make up for the losses, but they are getting fewer and fewer in between. The most vulnerable patients still suffer the most, with increasing barriers to accessing needed medications:

• Hampered medication access due to ongoing postal delays; yes, these other pharmacies rely on the U.S. mail.
• Ongoing digital chasms: limited rural broadband and WIFI access, plus lack of digital device availability or proficiency with usage.
• Let’s not forget that with healthcare access more limited in rural areas, a local pharmacist might serve as a default medical provider, offering basic guidance.

There are two major takeaways from this story: first, there is a ripple effect to other pharmacies. CVS plans to close 900 pharmacies in the next three years, this to expand more lucrative offerings, such as healthcare services and digital health. One wonders, how many brick-and-mortar pharmacies will be left? Second, guess what is another contributor to readmissions? Yup, lack of pharmacies, and hiccups with prescription access. Studies consistently show that upwards of 20 percent of readmissions are medication-related, often due to lack of patient ability to access them.

We asked our Monitor Mondays listeners, how often do the patients served by their organizations face challenges in accessing or receiving their medications? The concerning responses are viewable here.

Programming Note: Listen to Ellen Fink-Samnick’s live reports on the social determinants of health, (SDoH) Mondays on Monitor Mondays, 10 Eastern.