Opening stores used to mean everything for pharmacy chains.
CVS Health has previously boasted that it has opened or purchased more than 2,900 locations in a five-year period. Now is closing hundredswhile Walgreens, Help ritual and independent drugstores are also retreating.
An industry that saw waves of store growth before the COVID-19 pandemic faces headwinds such as declining prescription reimbursements, persistent theft and changing shopping habits. But as drugstores right-size their physical presence, experts say they may leave behind communities that have come to depend on them as reliable sources of care and advice — both of which can be hard to find in many urban and rural.
“This trust simply cannot be quantified,” said Omolola Adepoju, a health services researcher at the University of Houston. “And I don’t think it’s talked about enough when we talk about pharmacy closures.”
There is a pattern to who has access to pharmacies, with gaps forming in urban and rural neighborhoods.
Residents of predominantly black and Latino neighborhoods have fewer pharmacies per capita than people who live in predominantly white neighborhoods, according to an analysis by the Associated Press from licensing data from 44 states, data from the National Council for Prescription Drug Programs, and the American Community Survey. It is consistent with previous research documenting where urban “pharma deserts” are most likely to be concentrated.
The AP also analyzed data from 49 states and found that those with the lowest number of retail pharmacies per capita include Alaska, Oregon and New Mexico. About two-thirds of retail 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 largest sources of care in recent years, sometimes by design or necessity – especially for clients who work multiple jobs and can’t easily reach a doctor. Many pharmacies, including the two biggest chains, offer clinics and more than a dozen vaccines to treat patients. They also encouraged pharmacists to provide more advice to patients about managing conditions such as diabetes or hypertension.
Prakash Patel of Bert’s Pharmacy in Elizabeth, New Jersey, said sometimes the pharmacy is a sick customer’s “first stop.”
“There is no easy access to a doctor’s office. You need a consultation. They have limited hours,” said the store owner and pharmacist. “So whenever any child or adult – whoever is sick – where will they go first? To the pharmacy.
In rural areas, drug stores often serve multiple functions in their communities, with pharmacists serving more regular customers than a doctor, said Megan Undeberg, a community pharmacy expert at Washington State University. This means they may be the first to notice signs of diseases such as Alzheimer’s or Parkinson’s and suggest that the patient seek help.
“You are the smoking cessation counselor, you are the suicide prevention counselor,” she said. “You know almost everything about everyone, but it’s confidential.”
A few weeks before the CVS in Herscher, Illinois, closed in early March, farmer Kip Harms bought 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 about 80 miles south of Chicago, but it won’t be the same.
“You can stay here and talk,” said Harms, 56, from nearby Cullom. “You go to the big giant where there are 40 people in line, you feel like you are bothering the person who is helping you.”
Large drugstore chains still have thousands of locations, and the AP analysis counted more than 24,000 independent pharmacies. But drugstores routinely close because they aren’t doing well or because the population has declined — 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. Rite Aid is expected to close hundreds as it works a judicial recovery.
In the US, more than 7,000 pharmacies have closed since 2019, according to data from researcher Lucas Berenbrok, from the University of Pittsburgh, who considers this estimate conservative. Of those pharmacies, 54% were independent drugstores, an AP analysis of Berenbrok data found.
“I think what (drugstores) have realized over the last couple of years is that they are a little spread out,” said Keonhee Kim, an analyst at research firm Morningstar.
The closures are blamed on problems such as a drop in revenue and an increase in expenses. For years, the reimbursement drug stores receive for filling most prescriptions has declined, while things like utilities and employee wages continue to rise.
Robbery too it’s a problem, and Walgreens cited this as one of the many reasons it closes stores. Drugstores often sell small, expensive items like beauty products, batteries and baby formula that are easy to steal and resell, said Burt Flickinger III, managing director at retail consulting firm Strategic Resource Group.
New pharmacies can take up to three years to build a customer base and break even, said Jeff Jonas, a portfolio manager at Gabelli Funds who follows the sector. That’s difficult when customers are also less reliant on drugstores now than in decades past.
He said shoppers buy more things online or during larger trips to Costco or Walmart, and discount stores look even more attractive when inflation drives up prices.
“I don’t think (consumers) go into the pharmacy two or three times a week and make those little impulse purchases at the front of the store that often,” Jonas said.
Drugstores say they haven’t forgotten the communities left behind when a store closes. Walgreens, for example, delivers some prescriptions for free within a 15-mile radius.
But deliveries do not involve consulting a pharmacist or pharmacy staff. And pharmacy technicians and other people behind the counter often look like their customers or may speak a dominant language in the neighborhood.
At least one in six retail pharmacies reported offering services in Spanish, according to AP analysis of pharmacies in 49 states and data from the National Council on Prescription Drug Programs.
That connection can’t 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, with some states planning to study pharmacy closures, according to the National Conference of State Legislatures. Adepoju would like to see more regulation, given the growing role pharmacies play in providing care.
“If health care is seen as a right, not a privilege,” she said, “then you shouldn’t be able to just shut it down because you filed the paperwork and put a notice in front of your door.”
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AP Health writers Kenya Hunter and Devi Shastri and AP video journalist 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 Science and Educational Media Group and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
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