Nearly half of U.S. counties contain at least one pharmacy desert. I’ve written about pharmacy deserts in the past. Pharmacy deserts are places where you must drive more than 10 miles to fill prescriptions because no pharmacies exist nearby. I grew up in a pharmacy desert. My rural county only had one pharmacy, which was 20 miles away. We just assumed living in a rural area means you must drive farther to see the doctor, visit the pharmacy, shop for groceries and shop for Christmas. I have fond memories as a child shopping on Christmas Eve on the streets of Dodge City, Kansas (yes, that Dodge City). The streets were lit up and Christmas music blared on loudspeakers throughout the downtown area. Dodge City was 100 miles from home, but it was one of the few regional towns with better shopping. Things have only gotten worse in the past half century in terms of rural depopulation. It should come as no surprise that rural residents often must drive miles from their homes to visit a pharmacy.
Sixty percent of Texas counties lack a pharmacy. The Texas Tribune wrote about small town pharmacies struggling, saying rural Texas pharmacies use novel strategies to stay afloat.
Independent rural pharmacists are starting other businesses or selling baby shower gifts to keep their stores operating. Pharmacy deserts affect 4 million Texans.
The novel strategies mentioned are not particularly novel. They sell other items besides drugs. My local CVS has a vast selection of wine and beer besides candy and chocolate. Growing up, the pharmacy in town sold small toys, gifts, greeting cards and had a soda fountain along one wall. It was all standard stuff. The Texas Tribune interviewed a pharmacy owner who subsidizes her dwindling pharmacy income with a family cattle operation. Both her pharmacies are struggling but she keeps them open partly because her friends and neighbors count on her. I am familiar with the two towns where her pharmacies are located. They are Wheeler and Shamrock, Texas on highway 83 about 100 miles east of Amarillo. Over the years I have driven through both towns dozens of times on my way home for Christmas. I am surprised any business other than a convenience store selling gas could stay in business there.
Besides the usual problems, which include rural depopulation, poverty, and lack of pharmacists willing to live in the middle of nowhere, are pharmacy benefit managers (PBMs). PBMs are the bane of small, independent pharmacies. The three biggest PBMs control 80% of the drug market. When patients fill a prescription, they often rely on drug benefits from Medicaid, Medicare, Medicare Advantage, or private health insurance. These types of health coverage often utilize the services of a PBM. While state Medicaid programs tends to overpay for pharmacy services, private insurance underpays because they use PBMs that drive down reimbursements. It is common for small pharmacies to dispense drugs at a loss due to PBM reimbursements that are below cost. The problem with PBMs goes beyond the profits of rural pharmacies. Patients in cities often discover that they were steered to an expensive drug because their health plan’s PBM receives bigger rebates for selling higher prided drugs.
Pharmacies are the health care facility that Americans encounter the most. We rarely go to the hospital, despite nearly 35% of health care expenditure spent on hospital care. Americans see their doctors about 1 billion times a year (three per capita) but that is heavily weighted for older, sicker people. Most Americans probably see their doctors only once a year if that. Yet, most of us visit the pharmacy multiple times a year. Often, it is just the pharmacy at Walmart or Kroger, but sometimes it is a standalone chain drugstore like CVS or Walgreens. Consumers visit the pharmacy not just to pick up prescriptions but also to buy over the counter medications, bandages, crutches and so on. The CVS stores near me also sell milk, bread, and convenience food.
The problems associated with dwindling rural populations having to drive farther to pick up prescriptions is not something that is easy to fix. Neither is it easy to break the power of PBMs. Furthermore, this is not just a Texas problem.
Read more at Texas Tribune: Rural Texas pharmacies use novel strategies to stay afloat