Need a pharmacy? These states and neighborhoods have less access
Opening stores used to mean everything for pharmacy chains.
CVS Health once boasted that it had opened or purchased more than 2,900 locations in a five-year period. Now it is hundreds closewhile Walgreens, Ritual aid and independent drugstores are also retreating.
An industry that saw waves of retail growth before the COVID-19 pandemic is facing headwinds such as declining prescription reimbursements, persistent theft and changing shopping habits. But as drugstores properly size their physical footprint, experts say they could leave behind communities that have come to depend on them as reliable sources of care and advice — both of which are difficult to find in many urban and rural areas.
“You just can’t quantify that trust,” says Omolola Adepoju, a health care researcher at the University of Houston. “And I don’t think it’s talked about enough when we talk about pharmacies closing.”
There is a pattern in who has access to pharmacies, with gaps emerging in urban and rural neighborhoods.
Residents of neighborhoods that are majority black and Latino have fewer pharmacies per capita than people living in predominantly white neighborhoods, according to research. an Associated Press analysis of licensing data from 44 states, data from the National Council for Prescription Drug Programs and the American Community Survey. It’s consistent with previous research showing where urban “pharmacy deserts” are more likely to concentrate.
The AP also analyzed data from 49 states and found that the states with the fewest pharmacies per capita are Alaska, Oregon and New Mexico. About two-thirds of pharmacies in those states were owned by chains, while independent pharmacies tend to be more concentrated in urban markets or states with larger populations.
Drugstores have become greater sources of concern in recent years, sometimes intentionally or out of necessity – especially for customers who work multiple jobs and cannot easily get to a doctor. Many pharmacies, including the two largest chains, are offering clinics and more than a dozen vaccines to treat patients. They have also encouraged pharmacists to provide more advice to patients on managing conditions such as diabetes or high blood pressure.
Prakash Patel of Bert’s Pharmacy in Elizabeth, New Jersey, said the pharmacy is sometimes a sick customer’s “first stop.”
“There is no easy access to a doctor’s office. You need an appointment. They have limited hours,” the store owner and pharmacist said. “So when a child or adult, anyone is sick, where do they go first? To the pharmacy.”
In rural areas, drugstores often serve multiple roles for their communities, with pharmacists seeing repeat customers more often than a doctor, says Megan Undeberg, a community pharmacy expert at Washington State University. That means they may be the first to notice signs of things like Alzheimer’s or Parkinson’s disease and advise the patient to seek help.
“You’re the smoking cessation counselor, you’re the suicide prevention counselor,” she said. “You know just about everything about everyone, but it’s confidential.”
A few weeks before the CVS in Herscher, Illinois, closed in early March, farmer Kip Harms picked up a muscle relaxant for a back injury. He asked the staff if he could take it with Tylenol.
Harms said he will have other options in the rural area located nearly 80 miles south of Chicago, but it won’t be the same.
“You can stand here and have a conversation,” says Harms, 56, from nearby Cullom. “If you go to the big giant with forty people in line, you feel like you’re bothering the person you’re helping.”
The major drugstore chains still have thousands of locations, and the AP’s analysis counted more than 24,000 independent pharmacies. But drugstores routinely close because they are not doing well or because the population has dropped — and the pace of closures is increasing.
CVS said in 2021 that it planned to close 900 stores over three years; more than 600 have already closed their doors. Rite Aid is expected to close hundreds as it continues to work a bankruptcy reorganization.
In the US, more than 7,000 pharmacies have closed since 2019, according to data from researcher Lucas Berenbrok of the University of Pittsburgh, who considers this estimate conservative. Of those pharmacies, 54% were independent drugstores, according to an AP analysis of Berenbrok data.
“I think what (drugstores) have realized in recent years is that they’re spread a little thin,” said Keonhee Kim, an analyst at research firm Morningstar.
Blame the closures on problems like declining revenues and rising costs. For years, the compensation drugstores receive for filling most prescriptions has shrunk, while things like utilities and employee salaries continue to rise.
Theft too is a problem, and Walgreens cites it as one of many reasons it is closing stores. Drugstores often have small, expensive items, such as beauty products, batteries and baby formula, that are easy to steal and resell, says Burt Flickinger III, director of the retail consulting firm Strategic Resource Group.
It can take up to three years for new pharmacy locations to build a customer base and break even, said Jeff Jonas, a portfolio manager at Gabelli Funds who tracks the sector. That is difficult if customers are now less dependent on drugstores than in recent decades.
He said shoppers are buying more things online or on longer trips to Costco or Walmart, and discount stores look even more attractive when inflation drives up prices.
“I don’t think consumers walk into the pharmacy two or three times a week and make small impulse purchases for the store,” says Jonas.
Drugstores say they haven’t forgotten the communities left behind when a store closes. For example, Walgreens delivers some prescriptions for free within a 15-mile radius.
But deliveries do not require a visit to a pharmacist or pharmacy staff. And pharmacy technicians and others behind the counter often look like their customers or may speak a language that is dominant in the area.
At least one in six pharmacies report offering services in Spanish, according to AP’s analysis of pharmacies in 49 states and data from the National Council for Prescription Drug Programs.
That bandage cannot be easily replaced “by telling patients, ‘Go to the next pharmacy,’” said Adepoju of the University of Houston.
Governments are also starting to pay attention, as some states plan to study pharmacy closures, according to the National Conference of State Legislatures. Adepoju would like to see more regulation, given the growing role that pharmacies play in healthcare delivery.
“If health care is viewed as a right and not a privilege,” she said, “then you shouldn’t be able to just cut it off because you filed paperwork and put a notice on the front of your door.”
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AP Health Writers Kenya Hunter and Devi Shastri and AP videojournalist Shelby Lum contributed to this report. Shastri reported from Herscher, Illinois.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.