One-Third of Neighborhoods in Major U.S. Cities Are Pharmacy Deserts

In some cities, it may seem as if there is a pharmacy on nearly every corner. But residents in one-third of neighborhoods in major U.S. cities experience difficulty accessing pharmacies, according to a new study.

These so-called “pharmacy deserts” exist predominantly in Black and Hispanic/Latino neighborhoods, compared with White or diverse neighborhoods.

In a study published last week in the journal Health Affairs, researchers write that inequitable access to pharmacy services could have important consequences for racial and ethnic disparities in prescription medication adherence, use of essential health care services, and even COVID-19 vaccination rates.  

“The key point with this research is that segregation does impact health, and this is just another way that it does,” senior study author Dima Qato, PharmD, MPH, PhD, associate professor at the USC School of Pharmacy, tells Verywell. “Pharmacies are not exempt from this problem and we need to take care and pay attention to that if we want to really reduce disparities in medication adherence.”

The researchers studied data from the 30 most populous U.S. cities between 2007 and 2015. There were varying degrees of disparity in these cities, with the most pronounced inequities in:

• Chicago
• Los Angeles
• Baltimore
• Philadelphia
• Milwaukee
• Dallas
• Boston
• Albuquerque

In Chicago, for instance, about a third of Black neighborhoods lacked accessible pharmacies, compared with 1% of predominantly White neighborhoods in the city. The study is likely the first to examine pharmacy accessibility across the U.S. by racial or ethnic make-up of cities.

“I think the goal there was to demonstrate that it's a problem that's affecting all minority communities across the board in urban areas,” Qato says.

High Pharmacy Closure Rates

The researchers defined the most populous cities as those with a population of 500,000 or more between 2007 and 2015. They studied more than 10,000 neighborhoods comprising a total of 42 million residents. More than three-quarters of these neighborhoods were segregated by race or ethnicity.

Though pharmacies are more common in urban spaces compared to rural areas, they are also more likely to shut down and are less likely to meet the Centers for Medicare and Medicaid Services' convenient access standards. Additionally, more than 80% of the Black and Hispanic/Latino populations in the U.S. live in cities.

Between 2010 and 2015, only 11% of the newly opened pharmacies were in Black or Hispanic neighborhoods that did not have at least one pharmacy already. Closure rates were also higher in these neighborhoods: White and diverse neighborhoods experienced an 11% closure rate, compared with 14% in Black neighborhoods and nearly 16% in Hispanic ones. 

Why Access to Pharmacies is Crucial

Pharmacies are important centers for medication distribution, and diagnostic, preventative, and emergency services.

“It's an issue for health in general when we're talking about food deserts, lack of access to places for people to exercise, or places that give exposure to violence,” Thomas Huggett, MD, a family physician at the Lawndale Christian Health Center in Chicago, tells Verywell. “Lack of access to pharmacy services also goes into affecting people's health.”

The researchers defined pharmacy deserts as areas where the nearest pharmacy was one mile or further away. However, in some neighborhoods with additional barriers to accessibility, the distance was reduced to half a mile. The researchers accounted for the portion of the neighborhood population that didn’t own a car or was low-income.

In Black and Hispanic/Latino communities, which already have lower rates of medication adherence, having to travel further for medication can have grave implications.

Huggett and his team serve many patients who are experiencing homelessness or other barriers to accessing medication. When a pharmacy in his neighborhood shut down, he said it became much more difficult for his patients to obtain their medications—sometimes requiring them to take multiple buses or walk a mile to the next closest pharmacy.

During the COVID-19 pandemic, Medicare and Medicaid began promoting home delivery, waiving restrictions on mail orders, and reimbursing pharmacies so they could easily deliver more medications. Qato says it may be useful to maintain some of these systems after the pandemic to make medications more physically and financially accessible for those in pharmacy deserts. However, Huggett says this is not a catch-all solution for everyone.

“Many of my patients do not like mail order because perhaps, for even the few people who are housed, their mailboxes may not be very secure,” he says.

 Quality of the Pharmacy Matters

Accessing pharmacies is important, but so is the quality and breadth of services they offer. Large pharmaceutical chains, like Walgreen’s and CVS, tend to remain open for 24 hours, offer a drive-through pick-up option, and provide a whole suite of services. But in some predominantly Black and Hispanic neighborhoods, it’s more likely that residents will live near an independent pharmacy with limited services.

The west side of Chicago, where Lawndale Christian Health Center is located, has one of the highest rates of opioid deaths in the country. And yet, Huggett says some of the pharmacies in that area don’t always have medications like buprenorphine and naloxone needed to treat opioid use disorder on hand.

In 2015, about 35% of all pharmacies in White neighborhoods were independently owned, rather than part of large chains. Comparatively, more than 53% and 57% of pharmacies in Black and Hispanic neighborhoods, respectively, were independent.

“Independents are not offering as many services, not because they don't want to, but because they oftentimes can't,” Qato says.

In many states, they are not included in partnerships with the state or federal government which would allow them to distribute the COVID-19 vaccine. Qato says excluding independent pharmacies from distributing the vaccine in some states may contribute to the racial and ethnic disparities in vaccination rates.

Looking Toward Solutions

In predominantly minority communities, a disproportionately high percentage of residents are insured through Medicare and Medicaid. Pharmacies typically receive higher reimbursements from private insurers than public ones, meaning they are incentivized to cater toward communities insured by private companies. As independent businesses, large pharmaceutical chains are not compelled to serve communities’ needs, but rather turn a profit.

“They serve public health needs and provide public health services and medications, but they do so through a business structure,” Qato says.

On the federal level, Qato says that policymakers could support pharmacies that are at risk of closing and increase Medicaid pharmacy reimbursement rates. Locally, officials should try and drive pharmacies to areas that need them most. “City and county officials could target certain neighborhoods that we've identified as pharmacy deserts and provide some tax incentives or credits,” Qato says.

Another option may be to better integrate pharmaceutical services with primary care practices or to allow federally qualified health centers to distribute medication and vaccinations.

Huggett says it’s important for policymakers to consider how pharmacy access affects communities and use structural means to mitigate the problem.

“Why is it that disadvantaged communities or economically challenged communities always have to try to fill the gap?” Huggett says. “Of course we do the extra work because we want to be helping our patients, but it seems like it's a systemic structural issue that could be remedied so a person with fewer resources can just get their medication like anybody else—they would have a choice of where they could get their medications, and that they wouldn't have to take two buses to pick up their medicines.”