The growing crisis of pharmacy deserts

By Michael Murphy, PharmD, MBA and Jennifer Rodis, PharmD, FAPhA for the PolicyRx newsletter

What are pharmacy deserts and how prevalent are they?

Pharmacy deserts are areas where residents lack reasonable access to a local pharmacy. Typically, these communities are defined as locations where individuals must travel excessive distances—often greater than 10 miles—to reach the nearest pharmacy. While pharmacy deserts may develop in underserved urban neighborhoods due to store closures, rural communities are particularly hard-hit due to a lack of other nearby health care services, which compounds the loss of the pharmacy to the community.

The prominence of pharmacy deserts is increasing at an alarming rate. Between 2010 and 2021, over 29% of pharmacies across the country closed, exacerbating pharmacy deserts, particularly in low-income, rural and underserved communities. This trend highlights a widening gap in access to essential health care services and medications, posing significant challenges for patients who rely on their local pharmacy and pharmacist for care.

Why do pharmacy deserts matter?

Impact on patients and communities

Pharmacy deserts create real, tangible harm to patients and communities. When residents lose access to a local pharmacy, they face significant barriers to obtaining critical medications, vaccinations and pharmacist-led care. Delays in medication adherence can worsen chronic conditions, increase hospitalizations and result in poorer overall health outcomes.

These negative impacts are disproportionately felt in more socially vulnerable areas, such as underserved, rural, and racial and ethnic minority communities, where pharmacy deserts are most prominent. For patients in these communities, the closure of a local pharmacy often means additional costs and time to access care, exacerbating existing health care disparities.

Impact on pharmacists and the pharmacy profession

Pharmacy deserts do not just harm patients, they strain the pharmacy profession. Behind this growing issue lies an unsustainable pharmacy business model driven by challenges such as declining reimbursement rates and complex payment systems. These pressures make it increasingly difficult for pharmacies to remain financially viable, leading to closures that limit opportunities for pharmacists to practice in communities where they are most needed.

The loss of pharmacies undermines the role pharmacists play in providing accessible care, including essential acute and maintenance medications, medication management and counseling, vaccinations, and chronic disease management.

As pharmacy deserts grow, it becomes clear that systemic change is needed to address the root causes, such as the role of pharmacy benefit managers (PBMs), reimbursement models and insufficient incentives for pharmacies to operate in underserved areas. These topics will be explored further in upcoming issues.

Policy considerations to address pharmacy deserts

To combat pharmacy deserts and ensure equitable access to pharmacy services, several policy solutions have been proposed. Each comes with potential benefits and challenges that must be carefully weighed.

1. Incentive program for pharmacies in pharmacy deserts

One proposed policy solution is the creation of an incentive program that provides a supplemental dispensing fee to pharmacies that open in pharmacy deserts or to existing pharmacies at risk of closure that would otherwise create a pharmacy desert. This supplemental payment, combined with fair and sustainable ingredient cost reimbursement and professional dispensing fees, would financially incentivize pharmacies to remain in and expand into underserved areas.

Pros:

• Directly supports pharmacies in areas with limited access to care.
• Encourages sustainability by providing financial relief to struggling pharmacies.
• Helps maintain in-person pharmacist services in underserved areas.

Cons:

• Requires ongoing funding and oversight to ensure effective implementation.
• Could face resistance from payers or PBMs if they are required to contribute to supplemental payments.
• May not be sufficient to sustain pharmacies in extremely low-population areas.

2. Investment in remote dispensing pharmacies

Another potential policy solution is the expansion of remote dispensing pharmacies. These locations operate without a pharmacist physically present but utilize video and other remote technologies to allow a pharmacist to oversee the work of pharmacy technicians. This model could enable pharmacy access in areas where maintaining a full-scale pharmacy may not be financially viable.

Pros:

• Expands pharmacy access in remote and rural areas without the financial burden of hiring full-time pharmacists on-site.
• Allows pharmacists to oversee multiple locations and provide oversight remotely.
• Uses technology to ensure patients still receive necessary counseling and medication safety checks.

Cons:

• May reduce patient-pharmacist interactions, potentially diminishing patient trust and adherence to medication regimens.
• Raises concerns about undermining the role of pharmacists in direct patient care.
• Requires robust technological infrastructure, which may not be available in all pharmacy deserts.

3. Expansion of mail delivery prescriptions

Investing in and expanding mail-order pharmacy services is another potential strategy. By ensuring that patients in remote or underserved areas have access to mail-order prescriptions, policymakers can help bridge the gap created by pharmacy closures.

Pros:

• Ensures medication access even in areas where it is not feasible to operate a traditional pharmacy.
• Can be a cost-effective solution for providing maintenance medications to chronic disease patients.
• Reduces transportation barriers for patients in pharmacy deserts.

Cons:

• Limits patient access to pharmacist consultations, potentially impacting medication adherence and safety.
• May not be suitable for urgent medication needs or acute care services.
• Does not provide additional pharmacy-led services such as immunizations, point-of-care testing or chronic disease management.

A Call to Action: Ensuring Access to Care

Addressing pharmacy deserts through policy change and advocacy is not just about saving pharmacies, it’s about protecting patients and empowering pharmacists to do what they do best: keeping their communities healthy.

The time to act is now. Pharmacists, future pharmacists and advocates can unite to build a health care system where no patient is left without access to essential medications and care. Together, we can reverse the trend of pharmacy closures, strengthen the pharmacy profession and ensure healthier outcomes for all.

Stay tuned for future installments of this email series where we will tackle complex and relevant policy issues and demystify topics such as pharmacy benefit managers, reimbursement reform and innovative solutions to strengthen the role of pharmacies in the health care system.