Understanding the widespread impacts of pharmacy deserts

What Are Pharmacy Deserts?

According to an article in the US Pharmacists, community pharmacy closures nationwide have exacerbated “pharmacy deserts.” Pharmacy deserts, similar to food deserts, are defined as communities without nearby pharmacies, requiring residents to travel farther to access pharmacy services.

In many rural towns, patients must travel over 10 miles to access a pharmacy or pharmacy services.

Pharmacy deserts can be characterized by multiple common features, including, but not limited to, a smaller number of retail pharmacies, longer distances to access a pharmacy, limited public transportation options that make it more difficult to reach a pharmacy, lower-income populations, and challenges for vulnerable populations.

Pharmacy deserts are increasingly recognized as a public health concern, as limited pharmacy access can create barriers to obtaining essential medications and healthcare services.

“Pharmacy deserts — or the widening areas without community pharmacies — are a growing public health concern.  People are impacted negatively when access to their neighborhood pharmacist is gone,” Paige Clark, RPh, VP of Pharmacy Programs & Policy at Prescryptive, told PharmaNewsIntelligence in an interview.

“With great respect to public health departments and public health workers, they cannot respond to a healthcare crisis without the partnership of community pharmacies. If we learned nothing else from the COVID worldwide healthcare disaster, we learned that.”

What Causes Pharmacy Deserts?

Multiple factors have been thought to contribute to pharmacy deserts, including pharmacy closures, economic challenges, geographic isolation, demographic characteristics, and workforce shortages. The US Pharmacist notes that one in eight pharmacies nationwide shut down between 2009 and 2015, perpetuating pharmacy deserts.

Throughout her discussion with PharmaNewsIntelligence, Clark implied that the pharmaceutical drug price negotiation landscape, which hinges on the participation of pharmacy benefit managers (PBMs) in negotiations, may contribute to the increased number of pharmacy closures and subsequent pharmacy deserts.

“Financially predatory business practices employed by several verticalized, very powerful PBMs (who control over 80% of managed care prescriptions in our nation) have driven the skyrocketing trajectory of community pharmacies closing,” explained Clark. “Because these mega-corporations control the contract terms offered to pharmacies and thereby their reimbursement, they can steer drug utilization via formulary control; they can steer patients into their own verticalized pharmacies, drive profit back into their verticalized brick and mortar pharmacies or their wholly owned mail-order pharmacies while under-paying all other community pharmacies.”

Although PBMs were formed to aid in drug price negotiations between insurance companies, pharmaceutical companies, and pharmacies, many criticize these entities for making pricing negotiations more challenging and pocketing profits from both sides of the negotiation.

“Recent studies show that they pay other non-affiliated community pharmacies less and, in some cases, even below the cost of the medication itself.  Pharmacy deserts are the growing outcome of such unregulated and unchecked business practices.  Our national pharmacy ecosystem must be deconstructed and rebuilt with transparency as the cornerstone of business practices,” she continued.

What Do Pharmacy Deserts Mean for Healthcare?

Pharmacy closure and the resulting pharmacy deserts pose many challenges in healthcare, impacting individual patients, public health, and the greater healthcare system significantly.

As demonstrated and highlighted throughout the COVID-19 pandemic, pharmacists and community pharmacies play a critical role in individual healthcare and public health, offering access to various resources and healthcare services.

“Pharmacists provide important immunizations and immediate access to medications via either initial prescription fills, upon change of dose or dosage form, or for refills of established essential medications.  Pharmacists are the most accessible healthcare providers nationwide in our greater healthcare ecosystem.  They are often the only healthcare professional readily available to some families,” explained Clark.

Without access to community pharmacies, many patients cannot or will not get the care they need, including preventative care such as immunizations that help protect the broader community and prevent infectious disease spread.

“If you don't think this reduction in community pharmacies will lead us to another pandemic, you've got another thing coming. Because without vaccination, without herd immunity, without access to medication, without access to testing [a pandemic may be unmanageable].”

Beyond the public health implications, Clark also explained that pharmacy deserts and closures may disproportionately impact vulnerable communities.

“While pharmacy deserts are dramatically increasing in rural communities, it is also true that independent pharmacies located in underserved patient populations or communities where multiple languages are spoken, sometimes in urban settings, find themselves in the identical dire situation of struggling to remain open.  This leaves vulnerable patient populations struggling to access pharmacy care, medications, and essential health information.”

What Solutions Have Been Explored?

Multiple healthcare organizations and leaders have explored different solutions to pharmacy deserts to provide residents in these communities access to the necessary pharmacy services.

Some of the solutions include the following.

• Mobile Pharmacies: Mobile pharmacies can travel to serve communities in pharmacy deserts and offer services to residents.
• Telehealth and Remote Pharmacy Services: Telehealth has grown in popularity since the COVID-19 pandemic. Telehealth pharmacy services can connect patients with a pharmacist virtually.
• Financial Incentives: Some state and local governments have offered financial incentives for pharmacists opening locations in pharmacy deserts

“The outcome of community pharmacies being driven out of business, and the resulting upswing of pharmacy deserts, is a result of a highly sophisticated, opaque, verticalized and complex financial configuration involving employers, pharmacies, payers, pharmaceutical companies and patients — all of whom are at the mercy of a system plagued with opacity. This is being driven by several of the largest PBMs who have control of all elements in the pharmacy landscape.  They are positioned to extract billions of dollars from the pharmacy ecosystem while claiming to save patients and employers (or governments in the case of public dollars) money,” concluded Clark.

“In the pharmacy lane, we are at a point of crisis and no return. It's a sentinel moment for pharmacy and, therefore, a sentinel moment for community care.”