Pharmacy deserts

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This could be an initiative in keeping with the November 2020 post, "What should a domestic Marshall Plan/21st Century New Deal look like?."

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The Washington Post has a story, "The last drugstore: Rural America is losing its pharmacies," about the dearth of pharmacies in rural areas in particular, because of market consolidation--nationally there are really only three primary firms, CVS and Walgreen's, which have many many thousands of stores, and Rite Aid, which is about 1/4 of the size of either of the other two.  

Note that the Post covered this story in 2018, "The Health 202: Here's why rural independent pharmacies are closing their doors."

And a few months ago, I remember reading this Kaiser Health News story, "How One Rural Town Without a Pharmacy Is Crowdsourcing to Get Meds."

A couple of "general merchandise store chains," Shopko and Fred's, which served smaller communities, included pharmacies or thought that was a point of differentiation (Fred's).

But now both companies are out of business, further reducing the presence of pharmacies in rural areas.

Supermarkets can be a major force in pharmacy, including Walmart, although the stores with pharmacies tend to be in larger communities.  This is much less the case for the much smaller stores that are more likely to serve rural communities.

And some supermarkets are getting out of the business too ("Wakefern to shut 62 ShopRite pharmacies," Supermarket News).

Unfortunately, today's pharmaceutical reimbursement programs penalize independent pharmacies, which is why there has been such consolidation.

Pilcher-McBryde Drug Store in Selma Alabama.  Photo by Michael Harding.

There are independent pharmacies supported by national pharmaceutical and medical supply distributors, run as franchises, like Good Neighbor, Health Mart, and Medicine Shoppes.  

Somehow, Rexall still exists in Canada, but I don't think in the US, although there are still remnant stores, maybe they still have signage up but are otherwise independent.

Here and there hospital groups may operate community pharmacies, but increasingly they are less interested in doing this because of cost and liability, especially the need for higher security.  For example, the Intermountain Hospital Group based in Utah recently closed all its 25 pharmacies ("Intermountain Healthcare to close 25 retail pharmacies across Utah," KUTV-TV).

Five-ish solutions.  Working with the National Community Pharmacists Association, the National Grocers Association, and other organizations...

Supporting the creation of independent pharmacies.  When I first got involved in commercial district revitalization, I remember a story recounted by the Hometown Advantage initiative of the Institute for Local Self Reliance.  A community that lost its pharmacy sent a letter to every registered pharmacist in the state, offering incentives for them to open a store in their city, that they would own.  They got a taker.  ILSR wrote about this a couple years ago as well ("How a Rebirth of Independent Pharmacies Could Cure Rural Ills").

A group like the National Association of Counties could work with the franchise groups and communities to offer an incentive program to address this.

Small supermarkets.  The same thing can be done with small supermarkets.  Just like Ace Hardware has a program to open hardware stores in association with supermarkets especially in small communities, the franchise groups could do this too, in association with a group like the National Association of Counties.

Or independent pharmacies could co-locate with supermarkets, operated independently, but each supporting the other and sharing customers.

State incentive programs.  Pennsylvania has a program to support the opening of supermarkets in underserved communities, called the Fresh Food Financing Initiative, which involves the state and community development and food advocacy organizations ("Success story," Reinvestment Fund; eligibility, application, Food Trust).  

A similar program can be created by states to support the opening of pharmacies in underserved areas, working with independent pharmacies and small supermarkets, backstopped by independent franchise systems

Federal and state insurance supports.  Just as teaching hospitals get a premium payment from federal insurance programs to recognize the greater costs and benefits from their teaching role, state and federal health insurance support programs could provide greater reimbursements for stores located in pharmacy deserts, just as teaching hospitals get a premium for the extra costs of teaching. The National Community Pharmacists Association is suing the federal government over this issue. 

Doctors offices.  Doctors could do this too ("Should physicians dispense drugs to their patients?," Quartz), although it creates a significant cost and security issue.  Most doctors offices aren't constructed to the security level required for dispensing pharmaceuticals.