As more pharmacies close in Minnesota, communities have become “pharmacy deserts,” reducing access to medication and putting disease management at risk. 

Like the more commonly known “food desert,” a pharmacy desert is about scarcity of the resource. Eight percent of Minnesota’s population — or 463,000 people — lives in a pharmacy desert, an increase from 6.2% in 2009, according to research presented at an APHA 2024 pharmacy session on Tuesday. Another 12% of the population — or 670,000 people — lives in an area at risk of becoming a pharmacy desert. 

The situation is even worse in the Minneapolis-St. Paul urban core, said presenter Chrystian Pereira, a clinical pharmacist in South Minneapolis and an associate professor at the University of Minnesota. In the Twin Cities, about 34% of people live in a pharmacy desert, and almost 29% are at risk of living in one. The numbers are much lower and more stable in the other metro areas and lower in the rural areas — although 15% of rural areas are at risk of becoming a pharmacy desert, Pereira said. 

“We’re losing the ability for people to receive prescription medications, over-the-counter products (and) medical supplies,” he said. “But more than that, we’re not just losing a building; we’re losing a trusted health care professional.” 

To define the deserts, Pereira’s research team used geolocation to identify community pharmacies across Minnesota between 2009 and 2024, looking at five points in time. The researchers calculated the driving distance from the population center to the nearest pharmacy. 

Pereira said a desert is about more than geographic location; it’s also about proximity and accessibility. For example, a pharmacy five miles from home in a large urban city is typically less accessible than a pharmacy five miles from a rural home with a car, he said. 

Therefore, the team recognized it was important to have more than one definition of a pharmacy desert. They developed three thresholds: pharmacies that were within one mile of the Minneapolis-St. Paul urban core, those within five miles of other metro areas and those that were 15 miles away in rural areas. 

The team also calculated driving distance between a pharmacy and its two nearest pharmacies to determine which communities were at risk. 

“If the second pharmacy was outside of (our) definition, that means that there is only one pharmacy keeping that community from being a pharmacy desert — they are just one pharmacy (closure) away from being considered a pharmacy desert,” Pereira said. 

Pharmacies close for a variety of reasons, but presenters said an independent pharmacy is difficult to run financially. During the session’s Q&A, pharmacist presenters and audience participants pointed to struggles related to community demographics, social risk factors, pharmacists feeling overburdened and social unrest that targeted pharmacies.

Some independents sold to chain pharmacies in recent decades, and now those chains are closing. Two weeks ago, Walgreens announced it would close 1,200 stores over the next three years. CVS has announced hundreds of planned closures and thousands of corporate job cuts. Rite Aid filed for bankruptcy last year.

Another burden that was mentioned was low prescription drug reimbursement. Drug formularies, costs and reimbursements are negotiated by pharmacy benefit managers. According to the Brookings Institution, three PBM firms control 79% of the market. The Federal Trade Commission published an interim report in July that found the largest PBMs have increased the costs of drugs and squeezed independent pharmacies by “imposing unfair, arbitrary and harmful contractual terms that can impact independent pharmacies’ ability to stay in business and serve their communities.”

Next up for Pereira and his fellow researchers is to understand the demographics of Minnesota’s pharmacy deserts, engage with communities to understand their specific needs, and consider statewide policies to support pharmacies at risk of going out of business.

Photo by PixelsEffect, courtesy iStockphoto.