Urban Pharmacy Deserts Characterized By Racial Health Disparities

Black and Latino neighborhoods are disproportionately located in pharmacy deserts, according to a Health Affairs study that highlights care access concerns that may compound racial health disparities.

Pharmacy deserts can be dangerous because they impact medication adherence. When a patient lives in an area without convenient access to a pharmacy, it can keep her from filling her medications, putting her chronic disease management and overall wellness at risk.

The study investigated the availability of pharmacies across neighborhoods in the thirty most populous US cities from 2007 through 2015, finding that these pharmacy deserts disproportionately impact communities of color.

In 2015, one-third of all neighborhoods studied were pharmacy deserts, affecting prescription medication access, and in many cases medication adherence, for almost fifteen million people.

Overall, 26.7 percent of White and 28.2 percent of diverse neighborhoods were pharmacy deserts, compared with 38.5 percent and 39.5 percent of Black and Hispanic/Latino neighborhoods, respectively. The researchers also found that neighborhoods that experienced racial health disparities in pharmacy access were not always federally designated as Medically Underserved Areas.

In 2015, Black neighborhoods had an average of 0.85 pharmacies and Hispanic/Latino neighborhoods had 0.97 pharmacies. On the other hand, White and diverse neighborhoods had 1.15 and 1.23 pharmacies on average, respectively.

Racial care access disparities between Black people and White people were most significant in Chicago, Illinois. Over 32 percent of Black neighborhoods were in pharmacy deserts compared to 1.2 percent of White neighborhoods. Dallas had a high rate of pharmacy access disparity as well, with 86.3 percent of Black neighborhoods defined as pharmacy deserts versus 20.6 percent of White neighborhoods.

Pharmacy access disparities were also significant in Los Angeles, California; Baltimore, Maryland; Philadelphia, Pennsylvania; Milwaukee, Wisconsin; Boston, Massachusetts; and Albuquerque, New Mexico.

The researchers found that in addition to having fewer pharmacies to begin with, Black and Hispanic/Latino neighborhoods were more likely to experience pharmacy closures.

In White and diverse neighborhoods, pharmacy closure rates were 11.0 and 11.7 percent, respectively. In contrast, Black and Hispanic/Latino neighborhoods saw pharmacy closure rates of 14.1 percent and 15.9 percent, respectively.

What’s more, Black and Hispanic/Latino neighborhoods were less likely to be home to newly opened pharmacies. Of the 2,663 pharmacies that opened between 2010 and 2015, only 301 (11.3 percent) were in Black or Hispanic/Latino neighborhoods that did not have at least one pharmacy already.

While the implementation of Medicare Part D and the Affordable Care Act’s private insurance subsidies and Medicaid expansion aimed to mitigate ethnic and racial disparities in medication adherence by making pharmaceutical prices more affordable, these efforts have not been successful in closing the gap, the study authors wrote.

That’s likely because no matter how low the cost is, a patient cannot buy a drug if there is nowhere to buy it.

Additionally, the provision of essential health care services at pharmacies such as contraception, COVID-19 testing and vaccination, and opioid overdose treatment, have been publicized as a health disparity mitigation strategy.

However, expanding access to these services at pharmacies may actually worsen health disparities, as the study findings indicate that minority groups in US cities are more likely to live in pharmacy deserts. Again, propping up these healthcare services isn’t effective if there isn’t a pharmacy close by.

The new research points to an alternative approach.

“Our findings suggest that addressing disparities in geographic access to pharmacies is imperative to improving access to medications and other essential health care services in predominantly minority neighborhoods,” the study authors wrote.

“Therefore, federal, state, and local governments should consider incentivizing, through targeted grants and tax benefits, pharmacies to locate in pharmacy deserts,” they continued. “These efforts could also incentivize pharmacies to offer services that may improve access in pharmacy deserts, such as home delivery.”

Increasing Medicaid pharmacy reimbursement rates for prescription medications may also encourage pharmacies to open in pharmacy deserts, the researchers noted. Additionally, they said that Medicare Part D reforms may also be necessary to achieve health equity in pharmacy access, as low pharmacy reimbursement is considered a core cause of pharmacy closures.

“Existing Medicare Part D regulations that require plans to meet convenient access standards could also mandate increased reimbursement rates for critical access pharmacies and require broader preferred pharmacy networks,” the study authors wrote. “These reforms should ensure that independent pharmacies are not excluded, as they are at greater risk for closure and, as we demonstrate, are more likely to serve Black and Hispanic/Latino neighborhoods.”