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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."
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.
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.
Dollar General used to have Rexall-branded OTC stuff, but dunno if they still do. With most people in mail-order RX programs, the need for pharmacies decreases. As with brick & mortar banks, their persistence baffles me. Haven't been in a CVS in years, and I went to Walgreens about 6 months ago to buy something allegedly on sale, but didn't ring up correctly. Neither store has anything that can't be acquired somewhere else much less expensively.
ReplyDeleteI was thinking about this but didn't mention it. There are two types of pharmaceutical purchases. The stuff you need right now versus drugs you take ongoing.
ReplyDeleteAfter your first prescription, the latter can easily be purchased by mail, and when not covered by insurance, Canada or the UK for big discounts (That's what is done for my FILES eye medicine).
It's the former where you need the store. And in smaller communities there might not be enough of that kind of business to make the store viable without subsidy.
In DC and probably other dense cities, CVS stores (Walgreens too, obviously Duane Reade in NYC) are also convenience stores. Here in Salt Lake, there's not enough density and the stores aren't stocked frequently enough to function that way.
ReplyDeleteWe've used Walgreens (actually the one on East West Highway in Takoma Park) for the FIL and it was fine.
CVS has announced they will be closing 900 stores over the next three years, although they haven't disclosed any of the locations.
ReplyDeletehttps://www.bostonglobe.com/2021/11/18/metro/cvs-close-900-stores-over-three-years
"CVS Health announced Thursday morning that the company plans to close 900 stores nationwide over the next three years because of what executives described as changes in consumer shopping behavior, population, and the future of health care needs."
CNN: CVS had every advantage, but it lost the pandemic. Here's what happened.
ReplyDeletehttps://www.cnn.com/2021/11/20/business/cvs-closings-pharmacy-retail/index.html
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2753258
ReplyDeleteOctober 21, 2019
Assessment of Pharmacy Closures in the United States From 2009 Through 2015
Despite the growing number of pharmacies in the United States, findings from this study indicate that 1 in 8 pharmacies had closed between 2009 and 2015, which disproportionately affected independent pharmacies and low-income neighborhoods. Although efforts to promote pharmacy access have focused on addressing pharmacy closures in rural areas,6 we found that pharmacies located in low-income, urban areas are at greater risk of closing. These findings suggest that policies aimed at reducing pharmacy closures should consider payment reforms, including increases in pharmacy reimbursement rates for Medicaid and Medicare prescriptions. The findings also suggest the importance of understanding the influence of preferred pharmacy networks in order to protect independent pharmacies most at risk for closure, especially in urban areas. Such efforts are important because pharmacy closures are associated with nonadherence to prescription medications, and declines in adherence are worse in patients using independent pharmacies that subsequently closed.1