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Jan. 7, 2025
Pharmacy Deserts
Stan, Clarence, Barry, and the Health Chatter Team chat with Dr. Chrystian Pereira, an accomplished leader in pharmaceutical care and health systems, to discuss the pressing issue of pharmacy deserts and their impact on community health.
Dr. Chrystian Pereira, Pharm.D., is an Associate Professor at the University of Minnesota College of Pharmacy in the department of Pharmaceutical Care and Health Systems. As the Director for Interprofessional Education, Dr. Pereira spearheads initiatives that enhance collaborative care across health professions. In addition to his role at the College of Pharmacy, he practices as a clinical pharmacist and trains diverse healthcare learners at Smiley’s Family Medicine Residency. Dr. Pereira’s expertise extends to the Center for Interprofessional Health, where he has been a key faculty member since its inception in 2021.
With a unique lens on healthcare accessibility and education, Dr. Pereira delves into the factors driving pharmacy deserts, the challenges they pose for underserved communities, and innovative strategies for improving medication access and health outcomes.
Join us as Dr. Pereira shares his journey as an educator and clinical pharmacist, his perspectives on policy and community partnerships, and his vision for fostering equitable healthcare through interprofessional collaboration.
Join the conversation at healthchatterpodcast.com
Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.
More about their work can be found at huemanpartnership.org.
Research
Pharmacy Desert: There are many definitions of a pharmacy desert but in basic terms a pharmacy desert is a community with limited access to a pharmacy.
- Urban area: If most people in an urban neighborhood live more than a mile away from the nearest pharmacy, it’s a desert.
- If that neighborhood is low income and few households own a car, then that threshold drops to half a mile.
- Suburban area: If that neighborhood is low income and few households own a car, then that threshold drops to half a mile.
- Rural area: A pharmacy desert in a rural area constitutes people living farther than 10 miles from the nearest pharmacy.
Pharmacy Significance:
- Nearly 7 in 10 adults between 40 and 79 years old take at least 1 prescription drug, and approximately 1 in 5 adults take 5 or more prescription drugs.
- In addition to dispensing medications for acute and chronic illnesses, a wide variety of health services are offered at pharmacies, including routine vaccination, opioid and addiction management therapy, contraception, and patient counseling on medications.
- The COVID-19 pandemic highlighted the importance of community pharmacists and pharmacies as points of access for providing essential health products and services, including administering half of all COVID-19 vaccines.
- In 2016, ineffective medication therapy, including nonadherence, cost the US about $528.4 billion, or 16% of the total US healthcare spend, a study found.
- Nationally, 15.82 million (4.7%) of all people in the United States live in pharmacy desert communities.
- Populations residing in pharmacy deserts are more likely to face multiple known social, political, and demographic barriers to accessing health, including lower educational level, lower health insurance coverage, a higher proportion identifying as racial or ethnic minorities, a higher proportion with difficulty speaking English, and a higher proportion with ambulatory disabilities.
- Consumers also rely on pharmacies for basic hygiene products, so when a pharmacy closes, customers lose access to more than medications
- Pharmacies aren't being paid enough to stay open and make a profit
Pharmacy Benefit Managers
- A pharmacy benefit manager (PBM) is a third-party company that manages prescription drug coverage for a health care service plan
- Pharmacy benefit managers (PBMs) play a big role in pharmacy closures.
- They create pharmacy networks for insurers, which direct patients to visit specific pharmacies.
- Often, the closest pharmacy in a pharmacy desert is an independent pharmacy rather than a chain—and that independent pharmacy is often not part of pharmacy networks
- PBMs also decide how much a pharmacy gets reimbursed for dispensing a prescription, and rates can be less than what it costs the pharmacy to dispense the drug.
- According to a 2021 study from Yale Law School, some pharmacies report that up to 80% of their reimbursements are less than what it costs to dispense the drugs.
Pharmacy Deserts Minnesota:
- Minnesota has lost hundreds of pharmacies in a little over a decade, creating "pharmacy deserts" that are forcing people to travel a lot further or rely on mail service to obtain their prescription medications.
- Rural areas are impacted more, creating "pharmacy deserts".
- Pharmacists, as well as state and federal regulators, partly blame large Pharmacy Benefit Managers.
- Minnesota had 406 independent pharmacies in 2012. That number has been whittled down to just 156 today.
- In some cases, the largest benefit managers were accused of giving "higher reimbursement rates" to their own pharmacies.
- In Minnesota, it is illegal for a PBM (Pharmacy Benefit Manager) to require a patient to use a pharmacy that it owns. CVS Caremark was fined $1.5 million in 2022 for requiring members to use their own pharmacies to get maintenance drugs for conditions like diabetes and high blood pressure.
Sources
https://sites.usc.edu/pmph/2023/03/20/how-pharmacy-deserts-are-formed/
https://www.fox9.com/news/healthcare-insurance-companies-blamed-pharmacy-deserts-minnesota
https://www.usatoday.com/story/money/2024/10/18/what-is-a-pharmacy-desert/75700235007/
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