Unjust pharmacy deserts

Poor Communities Most Affected

Some deserts encompass whole counties. Others are in poor, inner cities, where many residents do not own cars and public transportation is poor. The National Library of Medicine and the U.S. Census Bureau said 20% or more of these deserts’ populations live below the poverty level. Many people are poorly educated, speak little English and/or lack health insurance.

A study by the University of Southern California found that retail pharmacy closure rates were higher in Black and Latino neighborhoods—37.5% and 35.6% respectively—than in predominantly White ones (27.7%). It also revealed that independent pharmacies were twice as likely to close as chain stores, are more likely to be in low income and ethnic/immigrant neighborhoods and where many people use Medicare or Medicaid.

Sometimes, geography adds barriers. Parts of Appalachia, for example, are bisected by hilly mountain roads and lack interstates, slowing travel. “Unlike Ohio farmland, which is traversed by highways, Whitesville, W.V., has a single two-lane road through the hills,” said Drew Massey, director of pharmacy operations at Fruth Pharmacy, which operates in the region.

“While a pharmacy may be 10 miles away, that’s a 30-minute drive one way in the hills. An independent tried opening but couldn’t weather the storm.”

Possible Solutions

Pharmacy deserts can seriously impact patient outcomes. Elderly and disabled people often face more challenges. Where residents lack cars, drug stores often double as general stores for everything from groceries to UPS services and printer cartridges.

There is no blanket solution. Mail order pharmacy is problematic in crime ridden areas where packages are stolen. Plus, patients require insurance. Telepharmacy serves only 28 states. Mobile pharmacies are helping in some areas, as are hospitals that have created publicly accessible pharmacies.

McKesson launched a micro-access program to expand pharmacy services in federally quali ed health centers (FQHCs) in underserved areas. But Massey fears funding could be shaky, given the many federal programs President Trump wants to cut.

“If [FQHC] disappeared, the map would look like potholes on a West Virginia road where there’s no coverage,” he said. Amazon Pharmacy is bene tting from closures, with plans to open pharmacies in 20 new cities in 2025. Walmart launched same day delivery in 2024. By the end of 2025, services should be available in 49 states.

[Related: Time and money impact pharmacy]

There is also pending legislation to better regulate PBMs. But that fight is ongoing. Nobody knows when the battle will end. “It will continue getting worse,” said Marsh. “I don’t see pharmacies reopening that much. I think we’ll see this for years.”

While we cannot cover every pharmacy desert, we have assembled a sampling of counties, inner city areas and other locales where lack of pharmacy access is seriously impacting the populace. 

San Juan County, N.M.

Encompassing 5,517 square miles with 52 people per square mile, highly rural San Juan County is a worldwide destination for fishing and big game hunting. But it lacks healthcare providers. GoodRx noted just 14 pharmacies for 150,525 denizens, including Walgreens, Walmart, Sam’s, Safeway and independents. More than 40% of respondents to a Professional Research Consultants Community Health report cited lack of healthcare as a “major problem.”

Whites (47%) and Native Americans/Alaska Natives (39.1%) dominate the population, indicated the U.S. Census Bureau. More than 21% of residents are Hispanic. The New Mexico Legislature website said the state has the country’s sixth highest drug overdose rate. In San Juan, 45.4% of people have been impacted by substance abuse, said the afore-mentioned report.

But drugs are not the only problem:

• 23.5% live in poverty.
• 14.2% lack a high school diploma.
• 39.1% have low food access.
• 18.4% have “fair/poor” overall health.
• 27.2% have three-plus chronic conditions.
• 33.4% have high blood pressure.
• 25% have high cholesterol.
• 16.5% experienced intimate partner violence over the past year.
• 25.9% have “fair/poor” mental health.
• 81.5% are overweight.
• 45.9% are obese.
• 15% have asthma.
• Source: 2023 Community Health Needs Assessment report

Douglas County, Ore.

Douglas County, Ore., has far more trees than pharmacies. Spanning more than 5,000 square miles, its 1.8 million acres of forest contain one of the world’s oldest stands of old growth timber. Not surprisingly, the forestry industry plays a major role.

Forty one percent of the population is rural, with 21.4 individuals per square mile. According to GoodRx, there are 18 pharmacies for Douglas’ 147,710 people, including Walgreens, Fred Meyer, Sav-On, Safeway, Rite Aid, Costco and numerous independents.

Douglas’ per capita income is around $33,510, said the U.S. Census Bureau. Among residents, 16% live in poverty, 27% are ages 65+ and 92% are White. Out of a top score of 100, a U.S. News & World Reports study found access to health care ranked 66 among concerns. Other priorities were equity (69), food and nutrition (65) and population health (58).

[Related: Brain Drain: Retail pharmacy struggles to retain pharmacists, pharmacy technicians]

Overall, Oregon has the second fewest number of retail pharmacies per 100,000 residents, said the National Council for Prescription Drug Programs. More than 70% are owned by big box chains. Many have disappeared, including Bi-Mart, which closed most Oregon pharmacies in 2021. According to The Oregonian/OregonLive’s analysis, 23 of Oregon’s 36 counties have fewer than two pharmacies per 10,000 residents. Two counties, Wheeler and Sherman, have no pharmacies. Gilliam and Grant each have one.

Key Concerns in Douglas County:

• Access to Health Care: 66
• Population Health: 58
• Equity: 69
• Education: 24
• Economy: 43
• Housing: 50
• Food & Nutrition: 65
• Source: U.S. News & World Report

Chicago

Black and Latino residents on Chicago’s South and West sides are far more prone to poverty and pharmacy shortages than people elsewhere in the windy city. Since 2022, Walgreens, CVS and Walmart have all closed stores. According to a study by pharmacy professor Dima Qato at the University of Southern California, just 1.2% of Chicago’s largely White census tracts are pharmacy deserts versus 32.6% of predominantly Black tracts.

While CVS’ website lists 57 Chicago stores, less than 15% are below the South Loop. Walgreens also has a low concentration of stores there, according to an article on BlockBusterClubChicago.com. Four zip codes have just two pharmacies and are in neighborhoods that are more than 85% Black and Latino.

Another ethnic neighborhood has just one pharmacy, while an additional one has no pharmacy.

[Related: Going above and beyond]

Across Illinois, 73% of counties are classified as pharmacy deserts, said Congressman Raja Krishnamoorthi’s website (D-IL). House Bill 4548/Senate Bill 2790 would let Illinois residents patronize their pharmacy of choice without insurance penalizing them with higher copays. It would also level the field against PBMs for independent pharmacies. Without this legislation, the congressman’s website says one in three Illinois pharmacies faces potential closure.

Boston

Over the past seven years, about 26 pharmacies have closed in Boston, 200 statewide, said the Massachusetts Department of Public Health. A Boston Globe study found that 15,000 Bostonians live in pharmacy deserts, often lacking cars. Many communities are poorer, sicker and less well resourced than elsewhere in the state.

In the largely Black and Hispanic Boston community of Roxbury, four Walgreens have been darkened over the past 2.5 years, said the Globe. A summer Walgreens closing on Warren Street drew residents, religious leaders and public of cials who picketed, demanding Walgreens change its decision. Average life expectancy in Roxbury is 68, far below the national average.

Half of East Boston and Dorchester are also underserved. Beyond Boston, parts of Brockton, Everett, Revere and Lawrence are deserts and are also often home to Black, Latino, immigrant and low income residents.

Not all deserts have big ethnic mixes. Massachusetts’ Franklin County is 90% White and home to 100,625 individuals. But it has just 12 pharmacies, said GoodRx. Located in the Northwestern part of the state, it is one of the least populated counties. Annual per capita income is $37,688. Unemployment is 3.1%.