As pharmacies close, some Western states and Black and Latino communities are left behind

It used to be that opening stores meant everything to drugstore chains.

CVS Health once boasted that it had opened or purchased more than 2,900 locations over a five-year period. Now it’s hundreds of formworkswhile Walgreens, Help with rites and independent pharmacies are also withdrawing.

An industry that saw waves of store growth before the COVID-19 pandemic is facing headwinds such as declining prescription reimbursement, persistent theft and changing shopping habits. But as pharmacies shrink their physical footprint, experts say they may leave behind communities that have come to rely on them as trusted sources of care and advice — which can be hard to find in many urban and rural areas.

“That trust, you just can’t quantify it,” said Omolola Adepoju, a health services researcher at the University of Houston. “And I don’t think we talk about it enough when we talk about pharmacy closures.”

There is a trend in access to pharmacies, with gaps widening in urban and rural neighborhoods.

Residents of predominantly black and Latino neighborhoods have fewer pharmacies per capita than people living in predominantly white neighborhoods, according to an Associated Press analysis licensing data from 44 states, data from the National Council for Prescription Drug Programs and the American Community Survey. This is consistent with previous research that documents where urban “pharma deserts” are more likely to be concentrated.

The AP also analyzed data from 49 states and found that those with the fewest retail pharmacies per capita are Alaska, Oregon and New Mexico. About two-thirds of retail pharmacies in these states were owned by chains, while independent pharmacies tend to be more focused on urban markets or in states with larger populations.

THE PHARMACY AS A PLACE OF CARE

Pharmacies have become greater sources of care in recent years, sometimes by design or necessity, especially for clients who work multiple jobs and cannot easily see 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 advise patients more on the management of diseases such as diabetes or high blood pressure.

Prakash Patel of Bert’s Pharmacy in Elizabeth, New Jersey, said sometimes the pharmacy is a sick customer’s “first stop.”

“It is not easy to access a medical office. You need an appointment. They have limited hours,” said the store owner and pharmacist. “So every time a child or an adult – whoever is sick – where are they going to go first? To the drugstore.

In rural areas, pharmacies often serve multiple roles for their communities, with pharmacists seeing regular customers more 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 illnesses like Alzheimer’s or Parkinson’s and suggest the patient seek help.

“You are the smoking cessation counselor, you are the suicide prevention counselor,” she said. “You know pretty much everything about everyone, but it’s confidential.”

A few weeks before CVS in Herscher, Ill., closed in early March, farmer Kip Harms got a muscle relaxer for a back injury. He asked the staff if he could take it with Tylenol.

Harms said he would have other options in the rural area nearly 80 miles south of Chicago, but it wouldn’t be the same.

“You can stay here and have a conversation,” said Harms, 56, a native of nearby Cullom. “You go to the big giant where there are 40 people waiting in line, you feel like you’re bothering the person who’s helping you.”

RATE OF DRUG STORE CLOSURES

Large pharmacy chains still have thousands of locations, and the AP’s analysis counted more than 24,000 independent pharmacies. But pharmacies regularly close because they are not doing well or because the population has declined – and the pace of closures is accelerating.

CVS said in 2021 it planned to close 900 stores over three years; more than 600 have already closed their doors. Rite Aid expected to close hundreds as it unfolds reorganization in the event of bankruptcy.

In the United States, more than 7,000 pharmacies have closed since 2019, according to data from University of Pittsburgh researcher Lucas Berenbrok, who considers that estimate conservative. Of those pharmacies, 54% were independent pharmacies, according to an AP analysis of Berenbrok data.

“I think what (pharmacies) have realized over the last couple of years is they’re a little bit scattered,” said Keonhee Kim, an analyst at research firm Morningstar.

Attribute the closures to problems such as declining revenues and increasing expenses. For years, the reimbursement pharmacies receive for filling most prescriptions has declined while things like utilities and employee pay continue to climb.

Theft too is a problem, and Walgreens cited it as one of many reasons it is closing stores. Drugstores often carry small, expensive items like beauty products, batteries and infant formula that are easy to steal and resell, said Burt Flickinger III, managing director at retail consultancy Strategic Resource Group.

It 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 industry. It’s difficult when customers rely less on pharmacies today than in decades past.

He said shoppers are buying more things online or on big trips to Costco or Walmart, and discount stores look even more attractive when inflation drives up prices.

“I don’t think (consumers) are walking into the pharmacy two or three times a week and making these little impulse purchases in front of the store as often,” Jonas said.

Pharmacies 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 childbirth does not involve seeing a pharmacist or pharmacy staff. And pharmacy technicians and others behind the counter often look like their customers or speak a language dominant in the neighborhood.

At least one in six retail pharmacies reported offering services in Spanish, according to the AP’s analysis of pharmacies in 49 states and data from the National Council of 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 considering closing pharmacies, 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 considered a right and not a privilege,” she said, “then you shouldn’t be able to shut it down just because you submitted paperwork and put a notice on it. the 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’s Science and Education Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.