The Decline of U.S. Drugstores: What It Means for Underserved Communities

A recent study reported by the Associated Press highlighted a startling trend: nearly 30% of U.S. drugstores closed between 2010 and 2021. This decline is not evenly distributed across communities — Black and Latino neighborhoods have been hit the hardest, exacerbating existing healthcare access disparities.

As drugstores vanish from underserved communities, so do critical healthcare services like medication access, vaccinations, chronic disease management, and health counseling. This decline, alongside the growing complexities of programs like 340B, paints a worrying picture for health equity across the country.

Why Are Drugstores Closing?

Several factors contributed to this widespread loss of pharmacies, including:

1. Declining Prescription Reimbursements

• Pharmacies rely heavily on prescription reimbursements, but over the past decade, these reimbursements have steadily decreased—especially for independent pharmacies.

• Pharmacy Benefit Managers (PBMs), the middlemen that negotiate drug prices and reimbursement rates, have come under fire for their opaque pricing practices.

• Many pharmacies operate on razor-thin margins, and declining reimbursement rates make survival increasingly difficult.

2. Rising Operational Costs

• From rent and labor costs to compliance and technology investments, running a pharmacy has become more expensive.

• Smaller, community pharmacies—often lifelines in underserved neighborhoods—have been hit especially hard because they lack the economies of scale that national chains can leverage.

3. Shifting Consumer Behavior

• With telehealth, mail-order prescriptions, and online pharmacies growing in popularity, traditional brick-and-mortar drugstores face declining foot traffic.

• This shift is especially challenging for independent pharmacies that rely on local, walk-in customers.

The Impact on Underserved Communities

Pharmacy Deserts Are Expanding

The closures are creating what experts call pharmacy deserts—areas where residents must travel long distances to access basic medications and pharmacy services.

This hits low-income, Black, and Latino neighborhoods hardest, where transportation barriers, economic hardships, and pre-existing health inequities make regular pharmacy access even more critical.

Chronic Disease Management Becomes Harder

Many residents of these communities rely heavily on pharmacies for ongoing management of chronic conditions like diabetes, hypertension, and asthma.

• With fewer local pharmacies, adherence to medication regimens drops, leading to worse health outcomes over time.

Loss of Health Services Beyond Medications

Modern pharmacies don’t just dispense drugs—they also provide:

• Vaccinations

• Health screenings

• Medication counseling

• Preventative care referrals

Losing these services further weakens community health infrastructure, particularly in areas already underserved by hospitals and clinics.

How 340B Ties Into This Trend

For safety-net hospitals and community health centers, the 340B Drug Pricing Program is a vital tool for ensuring affordable medications reach patients. However, with fewer pharmacies—especially independent ones willing to partner as contract pharmacies—the ability to distribute discounted medications directly to patients becomes strained.

Independent pharmacies are often the most willing to partner with 340B-covered entities, especially in underserved areas. As these pharmacies disappear, hospitals and clinics relying on contract pharmacies for 340B medication distribution are left with fewer options—further limiting patient access to affordable medications.

The Bigger Picture: A Public Health Crisis

The loss of neighborhood pharmacies is about much more than convenience—it is a public health crisis that reflects broader inequalities in the healthcare system.

Key Consequences:

• Delayed treatment and worsening health outcomes

• Higher healthcare costs as preventable conditions become emergencies

• Increased reliance on already overburdened emergency rooms

What Can Be Done?

1. Policy Reform for Fair Reimbursements

• Policymakers need to rein in PBM practices and establish fair reimbursement rates, particularly for pharmacies in underserved areas.

2. Support for Community Pharmacies

• Grant programs, tax incentives, and loan forgiveness could help keep independent pharmacies afloat, especially in healthcare deserts.

3. Strengthen 340B Partnerships

• Hospitals and community health centers could proactively partner with remaining independent pharmacies, ensuring that 340B-discounted medications are available where they are needed most.

4. Expand Mobile and Telepharmacy Services

• In areas where physical pharmacies have closed, mobile pharmacy programs and telepharmacy consultations could help bridge the gap.

Conclusion: Preserving Pharmacies as Critical Health Hubs

The loss of nearly one-third of the nation’s pharmacies—disproportionately affecting Black and Latino communities—should serve as a wake-up call. Pharmacies are not just stores; they are essential healthcare access points for millions.

As policymakers, healthcare providers, and community leaders confront this crisis, the focus must be on ensuring that the most vulnerable populations are not left behind. Whether through 340B program enhancements, reimbursement reform, or community-focused pharmacy models, action is needed to preserve pharmacy access and safeguard community health.