The United States’ diverse population, geography, and demographics create equally diverse levels of availability to healthcare resources. Not unlike the recently popularized term “food deserts”, “pharmacy desert” describes a disparity in access to essential services that provide a reasonable quality of life.
On November 18th, 2021, CVS announced the company would close 900 stores in the next 3 years in response to “changes in consumer-buying pattern.” (CNN Business) Although they have not released a list of the stores that are closing, this does not bode well for both urban and rural environments.
For example, the over 400,000 Illinois residents who use Medicaid lost the ability to fill their prescriptions at the state’s most prevalent drugstore chain Walgreens when rival CVS secured a partnership with Aetna, a common contractor for Medicaid in the state. (Axios) Reportedly, CVS does not have a single store in the lower-income West Side neighborhoods of Chicago. This issue is circular- Medicaid prescriptions warrant the lowest reimbursements for prescriptions, therefore the neighborhoods that utilize Medicaid the most (low-income) are more vulnerable to store closings.
Rural areas are also in peril due to lack of pharmacy access. According to the Rural Policy Research Institute’s Center for Rural Health Policy Analysis, 1,231 independent rural pharmacies closed between 2003 and 2018. The COVID-19 pandemic squeezed an already struggling industry in 2020, and the number of independent pharmacies in the US (both urban and rural) fell below 20,000. (Drug Channels Institute) These independent pharmacies provide personalized, critical care in communities with little healthcare infrastructure and resources. Their closings also mean COVID-19 vaccine access is more difficult. In April of 2021, the Rural Policy Institute found that 111 rural counties in the US have no pharmacy that can distribute vaccines at all.
Independent pharmacies are located disportionately in minority and low-income communities, and their closures further exacerbate health disparity in both urban and rural populations. Additionally, drugstore closings, chain or not, means that the closest pharmacy could get further and further away. Dr. Leah, President of the American Pharmacists Association said to Everyday Health, “If a pharmacy is closed in your neighborhood, and now you have to take public transportation, that creates barriers for people to be able to pick up their medications, and we know people are experiencing worse health outcomes.”
While the term ‘pharmacy desert’ may mean a community, or neighborhood, that does not have a pharmacy present it also refers to communities with pharmacies present but with significant transportation deficiencies and other barriers to true accessibility. This map identifies the former and answers the following questions:
Which communities, at the county level, either have no pharmacy, one pharmacy, or multiple pharmacies? The number of pharmacies in a county is not an adequate metric on its own as counties range greatly in area and population.
How many pharmacies per person does each county have? On average there exist 2 pharmacies per 10,000 people. In a suburban, or urban, region that ratio might suffice. However, in rural America you may need to add the populations of numerous counties in a single area to achieve a population of 10,000. This metric alone may be deceiving because of the small populations throughout many rural counties.
How many pharmacies are there per 100 square miles? The density of pharmacies in a set area does not tell you where in the area the pharmacies are located but will suggest regions where pharmacies are few and far between.
The pharmacy desert map, as illustrated above, is not all encompassing, but it is the tool we may use to ask more detailed questions about all of the communities that make up the United States. The map helps to identify those regions where further research needs to be undertaken. Research such as: What is the population dispersion in counties with only one pharmacy? How many people live within 5 miles of the pharmacy? 20 miles? For counties with more than one pharmacy, are they all within the same town or are they dispersed throughout the county? Also, it is important to understand the capacity that an individual pharmacy may have – can a particular pharmacy meet the prescription needs of the surrounding population.
Identifying these pharmacy desert areas are key to understanding the underlying causes and symptoms of health inequity. Both the public and private sectors can utilize a pharmacy desert map to identify how to allocate resources and improve health outcomes across communities. As the landscape of healthcare infrastructure evolves in the US, entities must adjust to these changes to ensure the path towards health equity.