Pharmacy closures are increasing in the U.S., with about 1 in 3 U.S. retail pharmacies closing (opens a new window) since 2010.
This decline has left many neighborhoods, particularly those with predominately Black and Latinx residents (opens a new window), in a “pharmacy desert,” with limited access to pharmacy services. While there are a number of factors contributing to the closures, primary drivers include reduced front-of-store sales, shrinking reimbursement rates from PBMs, pricing strategies and the structure of PBM network contracts, and staff shortages.
In addition to concerns around prescription access, pharmacy closures also disrupt an important healthcare touchpoint, impacting preventive care, ongoing medication adherence, and chronic disease management support.
Pharmacy closures are expected to continue throughout 2025, and as more pharmacy deserts emerge, it’s important for employers to assess the potential impacts on their workforce, explore opportunities to help plan members in affected areas maintain access to care, and proactively manage pharmacy benefit costs.
Pharmacy closures are widespread, and more pharmacy deserts are emerging
Nationally, 15.8 million (opens a new window) people in the U.S. live in pharmacy deserts, spanning urban and rural settings. Of the more than 88,000 retail pharmacies operating from 2010–2020, about 29% (opens a new window) had closed by 2021.
Major retailers are continuing to scale back. Walgreens is in the process of closing around 1,200 (opens a new window) locations. Rite Aid, which once had over 2,000 locations, has closed hundreds of stores over the past couple of years and is in the process of closing (opens a new window) all its remaining stores. CVS is closing 270 stores (opens a new window) in 2025 following more than 800 closures over the past three years.
Although 90% of surveyed (opens a new window) independent pharmacy owners with a store located near a chain pharmacy that was closing or cutting hours said they could provide care for affected patients, low PBM reimbursements were the top concern that would make it harder for them to accept chain pharmacy patients.
Source: Health Affairs Scholar, Volume 2, Issue 4, April 2024, qxae035, https://doi.org/10.1093/haschl/qxae035. For more detail, an interactive Tableau version of this map is available at https://tinyurl.com/PharmacyDesertsMap2022.
While New Mexico, Alaska, and Arizona have the highest proportion of their adult population living in pharmacy deserts, these areas are not confined to one geographical region of the U.S. and can vary by neighborhood.
Reduced pharmacy access could affect health outcomes and increase costs
According to Infolock®, 65% of plan members had at least one prescription in the past year, and 47% had at least one maintenance medication, with 89% of these being filled at a retail pharmacy.
Retail pharmacy closures make it more difficult for individuals to access these medications and care, worsening health disparities. For plan members managing chronic conditions, these barriers could disrupt prescription adherence and reduce opportunities for pharmacy-based guidance on disease management.
For example, a study found (opens a new window) that pharmacy closures are associated with clinically and statistically significant reductions in adherence to essential cardiovascular medications. When those with chronic conditions aren’t adhering to medications, they’re more likely to need hospital and emergency care. As access declines, we could see a rise in preventable, high-cost care utilization.
Beyond prescriptions, pharmacies provide a range of health services, including vaccinations, screenings, and other preventive care. In areas with limited access to primary care, pharmacies help fill essential healthcare gaps, and their loss leaves these communities more vulnerable to worsening health outcomes.
Employer solutions for addressing pharmacy closures’ impact
As access to pharmacy services declines, employers could feel downstream effects on employee health outcomes and healthcare costs.
In addition to potentially higher utilization of costly services, employer costs could increase due to changes in retail pricing and shifts in pharmacy reimbursements as pharmacies demand better reimbursements from PBMs in an effort to stay in business.
Some potential strategies employers can implement to help mitigate pharmacy access issues to sustain care could include:
Onsite immunizations
Pharmacies are a common site for vaccinations. As closures limit availability, offering workplace immunizations can help maintain vaccination uptake.
Mail order pharmacy
By delivering medications directly to members' homes, mail order pharmacy benefits can help with continuity of medication adherence for those without convenient pharmacy access, although they are not a solution for time-urgent medications such as antibiotics. Many mail order pharmacies will allow patients to split their copay into three equal segments to help with affordability.
For those who already offering mail order, proactive communication to plan members around the availability and benefits of these programs can help mitigate the risk of medication nonadherence due to retail pharmacy closures and support continuity of care.
As retail pharmacy closures continue to impact access to care, employers should be proactive in addressing member needs to support long-term health and wellbeing. Contact us (opens a new window) to learn more about tailored strategies that can improve access to care, support positive health outcomes, and help manage pharmacy benefit costs.
