How Pharmacy Deserts Impact Communities
Key takeaways:
Pharmacy deserts are locations where access to pharmacies is especially difficult.
Decreased access to pharmacies negatively impacts access to medications and care and adds to existing health disparities.
Barriers that contribute to the growth of pharmacy deserts include profit-related pharmacy closures, insurance plans dropping pharmacies, and issues with equitable vaccine distribution.
When interacting with patients in the community pharmacy setting, it’s important for HCPs to consider the lengths that patients may have gone through in order to visit the pharmacy for care. It’s easy to take the accessibility of pharmacies for granted, since community pharmacists are often thought of as the most accessible healthcare professionals.
Though community pharmacists generally are accessible, there are areas throughout the U.S where access to pharmacies is especially more difficult. These pharmacies may be located far away from local neighborhoods. This poses difficulties for those who may lack the money, ability, and time to spend traveling to a distant pharmacy. These kinds of areas are often described as pharmacy deserts, and you may even live in one of them.Here, we’ll look at what pharmacy deserts are, the factors that contribute to them, and how to decrease their negative impacts.
What are pharmacy deserts?
Pharmacy deserts are typically classified as neighborhoods with an average distance to the nearest pharmacy of 1.0 mile or more. In low-income neighborhoods that have at least 100 households with no vehicle, this distance is dropped to half a mile or more.
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Over 40% of U.S. counties are considered pharmacy deserts, with most people having to drive more than 15 minutes to reach nearby pharmacies.
Studies done in California, Pennsylvania, and Illinois have described additional pharmacy desert determinants, including:
The percentage of residents living below the federal poverty level
The percentage of residents without health insurance
The area’s rates of home ownership
The area's crime-risk scores
How pharmacy deserts highlight existing health disparities
A health disparity is a type of difference in health outcomes that is closely connected to a social, economic, or environmental disadvantage. Structural inequities like racism, classism, and sexism often drive these disparities. These factors contribute to the formation of pharmacy deserts in rural and urban areas, resulting in less access to medications and care and altered health outcomes.
Some cities with distinct disparities in access to pharmacies include: Chicago, Los Angeles, Baltimore, Philadelphia, Milwaukee, Dallas, Boston, and Albuquerque. One in three neighborhoods in these cities were found to be located in a pharmacy desert, affecting about 15 million people. Pharmacy closures in these cities were also found to be more prevalent in Black and Hispanic neighborhoods.
Community members in low-income Black and Hispanic urban communities were found to experience more cost-related underuse of medications. In an international survey for healthcare quality improvement, adults with incomes below the national average were more likely to report problems with access to care due to costs.
Heightened barriers to accessing pharmacies during the pandemic
Throughout the COVID-19 pandemic, there continued to be closures of pharmacies that were not profitable enough. Pharmacies typically get the lowest reimbursements for filling Medicaid prescriptions, which can make it more difficult for pharmacies to remain open in low-income neighborhoods with large Medicaid populations.
Another concern is the practice of insurance plans dropping certain pharmacies or pharmacy chains as providers, leaving patients with pharmacy-provider options like small independent pharmacies.
While small independent pharmacies often offer more of a patient-centered focus, some may not offer the convenient hours and large, readily available medication stock that chain pharmacies typically offer. This practice of dropping certain pharmacies adds another barrier for patients, who now have to spend additional time and energy in finding a different pharmacy to get their medications filled in a timely fashion.
Pharmacy deserts have also impacted the administration of COVID-19 vaccines to vulnerable communities. Because of this, mass-vaccination efforts have been led by leaders in the healthcare community. Locations like Major League Baseball stadiums, often located in urban areas, have been pivotal in helping community members get vaccinated. Vaccine clinics also continue to be set up in different kinds of community-access points like churches, community clinics, hospitals, and even parking-lot pop-ups.
Addressing pharmacy deserts in our own communities
Some direct actions that can be completed by pharmacists, pharmacy students, and prescribing providers alike include encouraging mail-order and delivery options for patients and incorporating prescription drug lockers in clinics. These actions would allow for those who live in pharmacy-desert areas to avoid commuting as long, or as frequently, and still be able to conveniently access their medications and pharmacy personnel.
Mail-order and delivery options
According to the 2022 CoverMyMeds Medication Access Report, 36% of surveyed patients confirm using mail-order, home delivery, or online pharmacies to receive their medication. This displays an opportunity for pharmacies, independent and chain alike, to work toward increasing the reach of these services to those living in pharmacy deserts.
Prescription drug lockers
One example of this service is the Asteres ScriptCenter, the industry leader in 24/7 automated pharmacy pickup. These lockers handle storage, tracking, pickup, and payment, allowing for patients to pick up medications safely and securely at any time.
A study on the impact of this drug-locker service on prescription abandonment, patient experience, and pharmacist consultations was conducted in 2020. The study demonstrated a lower prescription abandonment rate with the lockers and continued quality patient-pharmacist interaction. Implementing lockers like these in pharmacy deserts would likely be a beneficial intervention in increasing accessibility and encouraging proper medication adherence.
Legislative and policy changes
At the legislative level, people and policymakers alike should encourage policies that address equity and raise reimbursement rates for low-income Medicaid patients. This would also incentivize the growth of small independent pharmacies in rural populations.
Pharmacies that serve vulnerable patient populations should be protected by staying in network with insurance plans. This protection would ensure that the pharmacy continues to be reimbursed for offering pharmacy services to this patient population. This way, these patients will also continue to have a steady and reliable pharmacy to go to fill their prescriptions.
The bottom line
Although pharmacists are often seen as some of the most accessible healthcare providers, the existence of pharmacy deserts throughout the U.S. points to inequities. And with increased barriers to accessing pharmacies comes increased chances of medication nonadherence and disparities in health outcomes. Mail-order and delivery, prescription drug lockers, and policy changes are potential key areas for much-needed intervention. By working to address barriers, pharmacists can continue to be caring healthcare advocates for patients who need it the most.
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