Senior Vice President of Community and Specialty Pharmacy at Cencora, and President of Good Neighbor Pharmacy.

Jenni Zilka

In recent years, the landscape of retail pharmacy has changed significantly due to massive financial, legislative, and social pressures, creating a challenging environment for both large and small pharmacies, and resulting in some having to close their doors.

With news of pharmacy closures frequently making headlines, questions have arisen about the consequences for communities that rely on pharmacies for care. Moreover, there are growing concerns that continued closures will lead to an increase in pharmacy deserts—or areas where access to essential pharmacy and healthcare services is severely limited—particularly in underserved communities.

Pharmacy deserts are defined as areas where residents live more than a mile away from the nearest pharmacy in cities, more than two miles in suburbs, and over 10 miles in rural areas. According to data aggregated by Cencora, approximately 35 million people in the US live in pharmacy deserts.

In communities with pharmacy deserts, people cannot easily access a pharmacy to fill prescriptions and obtain necessary health services. These deserts, found in both rural and urban settings, are located in areas that are up to 40% more likely to have fewer primary care providers

 and higher social vulnerabilities, such as poverty and lack of access to transportation. In short, the absence of pharmacies in a community most likely means a synonymous lack of other care options.

The rise of pharmacy deserts contrasts starkly with the reputation of pharmacists as accessible healthcare providers (HCPs), especially in underserved communities. Independent pharmacies, in particular, are known for their organic care of underserved and socially vulnerable populations, due to the high-touch nature of their services and their natural presence in these communities. For example, 20% of Good Neighbor Pharmacy stores directly serve or are adjacent to pharmacy deserts, according to data from the National Council for Prescription Drug Programs, CDC Social Vulnerability Index, and the US Census and American Community Survey.

In underserved communities, where other HCPs may be scarce, patients depend on their pharmacies not only for prescriptions, but also for comprehensive health advice and services. Pharmacists in those settings serve as a critical resource, addressing health questions and concerns that extend well beyond dispensing medications. But this perception of pharmacists as care providers isn’t limited to these communities. The pharmacist’s role was highlighted during the COVID-19 pandemic, when local pharmacists played a pivotal role in testing, treatment, and vaccination services. Today, their role extends beyond medication dispensing to address a broader range of public health needs, with patients increasingly relying on them for various care services.

 nearly half (45%) of Americans regularly visit their local pharmacy for care, and 58% are likely to turn to pharmacies as their first stop for non-emergency medical issues. Pharmacies remain the most common sites for COVID vaccinations,

 administering 31.3 million doses between September 2023 and April 2024, compared to 2.5 million doses administered by physician medical offices during the same period. There is a similar trend for flu vaccinations, with pharmacies administering 38 million doses, compared to 26 million by physicians’ offices between August 2023 and May 2024.

Beyond vaccines, pharmacists have also shown they can effectively address other gaps in medical care, consultation, and education for various health conditions. A 2020 national study

 found that pharmacists improved medication adherence for diabetes patients, increased the use of statin medications, ensured annual flu vaccinations, completed HbA1c tests, and helped patients maintain a tobacco-free status. Their interventions closed 79.8% of care gaps, suggesting that collaboration between physicians and local pharmacists can be an effective strategy to engage patients and deliver essential care.

Despite their accessibility and proven ability to provide essential patient care services beyond dispensing medications, pharmacies are struggling to remain financially viable, primarily due to inadequate reimbursement rates for the medicines they dispense and the care services they provide. As these reimbursement rates decline—or even disappear altogether with the expiration of the COVID public health emergency—pharmacies are finding it increasingly difficult to remain financially solvent and maintain the high level of care they provide to patients.

For example, on the national level, Medicare Part B does not currently recognize or reimburse pharmacists as providers. With the expiration of the public health emergency status from the pandemic, Medicare beneficiaries are no longer covered for services provided by pharmacists. Congressional legislation to remedy this—the Equitable Community Access to Pharmacist Services Act—had been introduced last Congress with robust bipartisan support, aiming to ensure Medicare beneficiaries’ prompt access to essential services for vaccination, testing, and treatment of common infectious diseases by establishing Medicare Part B reimbursement for pharmacists to deliver these services. However, the bill was not included in the end-of-year health package passed by Congress in December 2024. As a new Congress convenes this year, Cencora will be engaged as part of a coalition to address this important reform.

Overall, with positive industry changes not guaranteed, pharmacists, along with their industry peers and trade organizations, must actively advocate for changes in scope of practice and reimbursement legislation at both state and national levels. Such advocacy is essential to ensure accessible healthcare for patients nationwide. This effort is unquestionably the industry’s primary defense against the spread of pharmacy deserts.

Diversifying revenue and meeting patient needs

Although dispensing medications was once the primary source of income for pharmacies, declining reimbursement rates have necessitated the diversification of their revenue streams. A significant opportunity to increase revenue and enhance patient care lies in offering additional clinical services, such as expanding vaccination programs and point-of-care testing, thanks to the organic proximity and accessibility of pharmacies. Despite variations in the authority to provide certain services and receive reimbursement across states, pharmacists are skillfully navigating these inconsistencies to identify and deliver more care services to their communities.

Many pharmacies have excelled in compounding prescriptions, providing nutritional counseling, and stocking over-the-counter (OTC) products such as cold medications and nutritional supplements. These OTC products, part of the pharmacy’s front end, can help diversify revenue amid reimbursement challenges and cater to patient needs.

The importance of maintaining a robust front-end store presence—stocking consumable products in a sustainable way for the pharmacy, while catering to the unique wants and needs of their patient base and demographic—is a prominent industry topic and distinct area of focus for us.

As the industry faces financial, legislative, and social pressures leading to closures and the rise of pharmacy deserts, it is crucial for pharmacies, organizations, advocates, and other peers to relentlessly push for legislative changes that protect and enhance the profession.

1. Pharmacy Deserts: Identifying Challenges and Addressing Gaps in Access to Healthcare. Cencora. 

https://www.cencora.com/resources/pharmacies/addressing-pharmacy-deserts

2. Catalano G,; Khan, M.M.M.; Chatzipanagiotou, O.P.; Pawlik, T.M. Pharmacy Accessibility and Social Vulnerability. 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822776

3. Wolters Kluwer’s Pharmacy Next Survey Shows 58% of Americans Likely to First Seek Non-Emergency Healthcare at Pharmacies. Wolters Kluwer. May 17, 2023. 

https://www.wolterskluwer.com/en/news/survey-shows-americans-seek-non-emergency-healthcare-at-pharmacies

4. COVID-19 Vaccinations Administered in Pharmacies and Medical Offices*, Adults 18 Years and Older, United States. US Centers for Disease Control and Prevention. January 15, 2025. 

https://data.cdc.gov/Vaccinations/Weekly-Cumulative-Estimated-Number-of-Updated-2023/w76m-r924/about_data


5. Impact of Pharmacist Interventions to Close Care Gaps tor Patients With Diabetes. MN Community Measurement. December 9, 2020. 

https://mncmsecure.org/website/Reports/Spotlight%20Reports/2020%20Pharmacy%20Public%20Report%20-%20Chartbook.pdf

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