A new study published in the May issue of Health Affairs found that 1 out of 3 urban neighborhoods is in a pharmacy desert. Initially coined in 2014 by Dima M. Qato, PharmD, associate professor at the University of Southern California School of Pharmacy in Los Angeles and senior author of this study, a “pharmacy desert” is an urban neighborhood that is more than a mile away from the nearest pharmacy. The distance is reduced to half a mile for neighborhoods with at least 100 households with no vehicle access or 20 percent of households below the federal poverty level. For the study, researchers focused on the 30 most populated cities using the U.S. Census Bureau’s American Community Survey, categorizing neighborhoods by its predominant resident ethnicity. Pharmacies were identified using data from the National Council for Prescription Drug Programs and the Health Resources and Services Administration from 2007 to 2015. Although there was an overall increase in the number of pharmacies over the eight years, fewer pharmacies were located in Black and Latino neighborhoods. Study author Jenny S. Guadamuz, PhD, postdoctoral research fellow at the University Southern California Leonard D. Schaeffer Center for Health Policy and Economics, says this is due to a combination of a lack of new pharmacies opening in nonwhite neighborhoods and the rise of independent pharmacy closures. Independent pharmacies comprise about 35 percent of pharmacies in the country but are disproportionately located in minority neighborhoods and are at a greater risk of closing compared with their corporate counterparts due to tighter margins of operation and exclusion from insurance companys’ preferred pharmacy networks. Cities that showed the widest disparity of pharmacy deserts in Black neighborhoods compared with white neighborhoods included Chicago (32.6 percent versus 1.2 percent), Dallas (86.3 percent versus 20.6 percent), and Milwaukee (54.3 percent versus 15.8 percent). Similar patterns also existed for Latino neighborhoods in these cities. Dr. Guadamuz says that the original hope for the study was to identify a city without pharmacy deserts that could be a model for the rest of the country. But evidence suggests the disparity is getting worse since 2015, with closures creating pharmacy deserts that didn’t previously exist. “The disparities are so stark in every city,” says Guadamuz. “It just speaks to how entrenched segregation is in urban areas and the lack of investment in these neighborhoods throughout the country.” According to Sandra Leal, PharmD, president of the American Pharmacists Association, the absence of pharmacies with these services widens the health disparity already experienced by Black and Latino neighborhoods. “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," says Dr. Leal. This barrier becomes most problematic when pharmacies are tasked with critical roles, such as providing vaccinations against COVID-19. While the Federal Retail Pharmacy Program touts this arrangement as providing relief for the most affected communities, it does not account for the limited distance some people can travel. The program states that 90 percent of Americans will have access to a vaccine within five miles of where they live. For those in a pharmacy desert, that can be four miles too many. Some pharmacy chains declare the commitment to serving minority communities but show only varying degrees of success. A spokesperson from Rite Aid says that the pharmacy chain overwhelmingly serves diverse communities. However, the Philadelphia Inquirer reported that the second-largest vaccine provider in Philadelphia only vaccinated 4 percent of Black customers in a city where only one-third of residents are white. In July 2020, CVS Health announced that it is investing nearly $600 million over five years to assist disenfranchised communities. While this includes free health screenings and funding affordable housing efforts, there is no mention of opening pharmacies to serve these communities. A spokesperson from CVS Health said that 77 percent of the U.S. population already lives within five miles of a CVS pharmacy, and 10,000 are located in communities that rank high or very high on the Center for Disease Control and Prevention’s Social Vulnerability Index.
The Opportunity for Change Through Policy
Government policies could encourage new pharmacies to open through tax and development incentives. For independent pharmacies that already exist in minority neighborhoods, reimbursements could be provided by lifting restrictions over the type of pharmacies a household can access under a healthcare plan. In Illinois, Representative La Shawn K. Ford introduced House Bill 591, which addresses these restrictions. If passed, the bill would prevent Medicaid managed care organizations contracted by Illinois’s Department of Healthcare and Family Services (DHFS) from restricting access to pharmacies, as long as the pharmacy is licensed under the Pharmacy Practice Act and accepts fees from the DHFS. House Bill 591 was created after CVS Health acquired Aetna, then required Aetna customers to use CVS as their pharmacy. This was a problem for Medicaid clients located in the predominantly Black and Latino neighborhoods of West Side and South Side of Chicago, where there isn’t a CVS nearby. “There are people that really cannot travel outside of their home community and may live right next to a Walgreens,” says Representative Ford. “They can’t use that Walgreens because it’s out of network, and that’s a travesty for people that don’t have a car.” Representative Ford is waiting for the bill to go up for a vote during the current Illinois legislative session, believing it will pass once the Speaker of the House calls the bill. Dr. Qato was consulted on this bill. If you are living in a pharmacy desert, Leal suggests locating your nearest health center and inquire if they have a pharmacy. If you have access to the internet and a credit card, another option is to get prescriptions through a mail-order service. However, policy needs to address this problem to enact change.
