“A mile may not seem like much, but if you don’t have a car and have problems walking, bus connections are bad, the weather is inclement, the neighborhood is dangerous, you have a child who needed that antibiotic yesterday for a raging infection, a mile can be impossible,” says Qato, assistant professor of pharmacy and public health at the University of Illinois at Chicago.
“Chicago’s pharmacy desert population is undoubtedly higher today following years of pharmacy closures by chain and independent operators,” she says. Researchers have identified similar pharmacy deserts in Los Angeles, Philadelphia, and other urban areas from coast to coast.
If Chicago’s pharmacy desert population is representative of other urban areas, more than 99 million of the country’s 268 million urban residents may lack adequate pharmacy access. Add the 2.4-plus million rural residents in pharmacy deserts and more than 100 million Americans have problems getting to a pharmacy.
Qato coined the term “pharmacy desert” in 2014, building on the U.S. Department of Agriculture concept of food deserts—areas without adequate access to food markets. She stumbled into the realities of pharmacy access while working for two major pharmacy chains in Chicago.
As a floater, Qato quickly recognized that some neighborhoods had fewer pharmacies. If a prescribed drug was out of stock, she could easily transfer prescriptions to another store. But going to another pharmacy wasn’t always practical, even if it was only a mile or two away.
“There were neighborhoods where patients told me that just wouldn’t work,” she says. “They’d tell me they would have to take two more buses to get to that other pharmacy and more transfers to get home again. When I moved to academia, it was natural to look at why some neighborhoods had good pharmacy access and others didn’t.”
There are multiple factors driving disparities in pharmacy access, Qato says. Poor neighborhoods have fewer pharmacies than better off neighborhoods. Minority neighborhoods have fewer pharmacies than white neighborhoods with similar income levels. The key factor seems to be insurance coverage and the resulting pharmacy reimbursement.
“At least in Chicago, neighborhoods where residents have more Medicaid and Medicare coverage or are uninsured are much less likely to have adequate pharmacy access,” she says. “It’s a business problem specific to pharmacy. Those pharmacy desert neighborhoods have a thriving consumer business scene. Pharmacies can’t make a sufficient profit on Medicaid and Medicare to keep the doors open. Public policy needs to focus on pharmacy access, not just on pharmacy prices.”
Creating Pharmacy Deserts
Difficult access to healthcare services is not new in rural areas, (sparse rural populations don’t easily support healthcare providers any more than they support multiple retail businesses); however, pharmacy deserts are relatively new, spawned by recent pharmacy closures.
The Rural Policy Research Institute at the University of Iowa College of Public Health found that 1,231 independently owned rural pharmacies closed between 2002 and 2018, 16.1% of the total rural store count. The most dramatic decline occurred between 2007 and 2009, but closures continue.
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