Access for All


As pharmacy deserts proliferate, more must be done to examine barriers to access and prepare future pharmacists to address the needs of underserved communities.

By Jane E. Rooney

The term “pharmacy deserts” is popping up with greater frequency as pharmacy closures become more widespread and independent pharmacies struggle to survive in some areas. Even chain drugstores are not immune from the changing healthcare landscape. Late last year, CVS announced that it would be closing 300 stores a year across the country in the next three years, and Rite Aid said it plans to close at least 63 stores in the next several months. The implications are most striking for minority populations: A 2021 University of Southern California study revealed that Black and Latino neighborhoods in the 30 most populous U.S. cities had fewer pharmacies than white or diverse neighborhoods in 2007–2015.

In an effort to address concerns about barriers to pharmacy access, the National Community Pharmacists Association partnered with the University of Southern California School of Pharmacy and Leonard D. Schaeffer Center for Health Policy and Economics to launch the Pharmacy Access Initiative in 2021. The multiyear effort will produce research to help identify communities lacking pharmacy access. The goal is to help national, state and local policymakers and industry leaders ensure equitable pharmacy access for all communities in the United States.

“This is an ongoing problem that is only getting worse. More needs to be done and needs to be done soon,” said Dr. Dima M. Qato, associate professor of pharmacy and director of the Program on Medicines and Public Health, University of Southern California School of Pharmacy. “We are seeing frequent announcements that pharmacies are closing, and reimbursement rates aren’t getting better. The closure problem is getting worse and it affects minority communities more than others. We really can’t address medication access and health disparities if we’re not addressing pharmacy access.”


We need more data and evidence on the impact of pharmacy access on health outcomes and on medication use outcomes. From what we know so far, we should at least ensure equitable access to pharmacies. There shouldn’t be fewer pharmacies in neighborhoods that need them more. Policies that encourage pharmacies to stay open should be a priority.

Dr. Dima M. Qato

She said that the Initiative was motivated by a need to translate academic research for policy audiences and to develop tools that enable change. “The collaborative will identify pharmacy deserts and areas at risk for closures and provide recommendations for effective policy solutions at the local, state and federal levels,” she continued. “We are partnering with public agencies and community organizations so we can better ensure that these solutions are effective and equitable.”

Qato emphasized that it is crucial to identify the extent of the problem so policymakers can prioritize the communities that need interventions. “It gets down to creating a current—not outdated—evidence base that captures in detail at the community level for all communities in the United States and identifying those that are pharmacy deserts affected by closures so we can direct policymakers to informed decision making.”

Lacking Critical Services

Pharmacy deserts are defined as areas that have no pharmacy within a one-mile radius or limited vehicle access (within a half hour or more radius). Dr. Cheryl Wisseh, assistant clinical professor, Department of Clinical Pharmacy Practice, University of California Irvine School of Pharmacy & Pharmaceutical Sciences, authored a study last year, published in the Journal of Racial and Ethnic Health Disparities, examining pharmacy deserts in the state of California in terms of social determinants of health.

“Based on what we found there were two distinct types of pharmacy deserts. We found it speaks to some structural inequity and structural racism that are in the foundation of these communities,” Wisseh noted. “Type 1 pharmacy deserts had more social determinant of health factors that would negatively affect having access to a pharmacy. We looked at census-level population data on social determinants of health indicators, statistics on crimes against property and people and HRSA data on Health Professional Shortage Areas. We found that more people who live in these communities didn’t have vehicles, there were higher crime rates, there were more people with no health insurance coverage, English was not their first language…all of that can contribute to that distance they have to travel to get to a pharmacy. Residents in these communities were living under the federal poverty level, which imposes more barriers to getting to a pharmacy, especially in a pandemic. Do you want to go to the pharmacy after work if it’s an hour ride on the bus? You’re also not going to walk to a pharmacy if your community is not as safe. In a Type 2 desert, such barriers do not compound the distance and thus, distance to the pharmacy is not as much of an issue. One of the things that continuously proves true is that residential segregation is shaping what we’re seeing.”


We should be training students to understand structural competency. Health is not just biology. We need to do more to integrate some of those social and structural aspects that shape different communities’ health.

Dr. Cheryl Wisseh

Early on in the pandemic, access was an issue in these Type 1 pharmacy deserts, which led to lower vaccination rates in those communities. The pandemic impacted closures as well, Qato pointed out. “There were more temporary closures but also many pharmacies that closed permanently,” she said. “At the same time, pharmacies are playing a more important role in providing and responding to the covid pandemic with testing and vaccines. The importance of pharmacies was underscored during covid—they have always been important in addressing public health emergencies.”

Even prior to the pandemic, Qato continued, pharmacies offered key services such as immunizations, point-of-care testing and access to things like contraceptives and naloxone. “Anything you can get at a pharmacy is less accessible if you don’t have a pharmacy nearby. It’s a real problem with real health impacts. It was reinforced during the pandemic. The communities that really need vaccines don’t have a pharmacy to go get them. That’s important because 80 percent of covid vaccines are administered at retail pharmacies. Minorites are most affected and disproportionately die from covid but have the hardest time getting the vaccine.”

Wisseh’s study found that a pharmacy shortage often equates to fewer clinical pharmacy services, such as health screenings and medication management. “In regards to medication adherence, access becomes an issue,” she said. “It can lead to primary medication nonadherence where people don’t fill the prescription at all. If you are not filling prescriptions for chronic conditions such as high blood pressure, diabetes, asthma and COPD, you run the risk of them being uncontrolled. That’s one of the key things I would think would be an issue for not being able to get medication. Another one is not having insurance—are you going to spend your money on medication when you have to pay rent or buy food?” As Qato noted, getting prescriptions filled on time is often not related to personal choice but rather a function of living in minority neighborhoods, which can make it more difficult to get to the pharmacy.

“We need more data and evidence on the impact of pharmacy access on health outcomes and on medication use outcomes,” Qato said. “From what we know so far, we should at least ensure equitable access to pharmacies. There shouldn’t be fewer pharmacies in neighborhoods that need them more. Policies that encourage pharmacies to stay open should be a priority.”

Training Students to Examine Root Causes

One concrete step that can reduce barriers to access is increasing pharmacy reimbursement rates, according to Qato. But she cautioned that any policies aimed at increasing access must address equity. An Illinois program that began two years ago intended to ensure that the state would increase pay to pharmacies for Medicaid prescriptions. However, some pharmacies in urban areas did not meet eligibility criteria, so while rural communities benefitted, many minority neighborhoods with pharmacy shortages did not.

“You need to develop policies that have equity at their core,” she noted. “The distribution of pharmacies is totally inequitable. We have to address the problem focusing on policy changes to prevent closures, to encourage new pharmacies to open. Pharmacy networks and plan requirements don’t allow people to use any pharmacy they want to. Most of the time the ones in networks that are preferred are pharmacies that are chains, and we know that if there’s a pharmacy nearby [in minority communities] the closest one is usually an independent. And they are excluded from these networks. Insurance doesn’t cover the medications if they fill them at that pharmacy.”

To prepare future pharmacists to address access issues, Wisseh said schools must examine social determinants of health and any social identities that have consistently faced systemic discrimination. “We should be training students to understand structural competency. Health is not just biology,” she said. “We need to do more to integrate some of those social and structural aspects that shape different communities’ health.”

Exploring why medication access is the way it is regarding who gets insurance coverage and why certain groups are marginalized is also necessary, she added. “It’s also making sure faculty are prepared to teach on such topics. From what we’ve found in our recent review article on the incorporation of social determinants of health with regards to structural racism, sometimes faculty don’t know how to teach it. Being able to educate students on these issues and partnering with community organizations to work with the underserved would definitely help.”

Qato agreed that while pharmacy school programs that focus on outreach in underserved neighborhoods are a good start, she said it is crucial to expose student pharmacists to community-level barriers in accessing medications. “Getting into those communities and talking to pharmacies that had to close and why they closed. Meeting with community organizations and patients affected by closures. Getting students to understand what’s happening on the ground,” she explained. “Students are trained to focus on clinical care and ensuring that patients get the right medications. What’s missing is before we get there—before we get patients to control their diabetes or hypertension—we need to know why it’s not controlled. Getting at the root causes of medication safety and adherence is important, and we do that by looking at people not just by race but also where they live and how that may impact medication use. We don’t see a lot of that training.”

She acknowledged that this has only recently become a research priority, but it presents an opportunity for student pharmacists to learn how to interact with patients and understand the why behind their situations. “We want students to understand the policy issues that impact these problems that their patients may be reporting,” Qato continued. “What tools do pharmacists and students have to address those problems? For pharmacy schools to equip students with whatever solutions are available and make sure pharmacists and trainees use them would go a long way. If a non-adherent patient comes in or has uncontrolled blood pressure, it’s important to investigate why. Do they experience barriers in getting prescriptions filled? Did their pharmacy close? There should be options for them so they can take the medications they need without that getting disrupted. Maybe it’s making them aware of a mail-order option, but students aren’t trained to ask or respond to those barriers.”

Wisseh said pharmacy schools across the country are at various stages of addressing these issues, but many are working toward building community partnerships and integrating diversity, equity, inclusion and antiracism in the curriculum. “At UCI, I am currently developing a series with an interprofessional education course that looks at deeper understanding of culture and group-based trauma for minority communities so students can have understanding of cultural and structural competencies,” she said. “We’re trying to be more aware and move toward cultural humility.” She echoed Qato’s sentiment that a major step toward greater understanding involves working with populations that lack access. “On a population level it has to do with working within the community and having programs that would help. We need more data to understand how this is affecting communities.”

Jane E. Rooney is managing editor of Academic Pharmacy Now.