By NextBestFitPharmacy closures and pharmacy deserts
Independent and chain pharmacies are closing, squeezed by PBM reimbursement; rural and low-income urban areas lose access.
Evidence
- About 1.08M people work in health & personal care retailers (pharmacies).Sources: Bureau of Labor Statistics (2026)
Who's affected
Who is hurt
- Rural residents: Pharmacy closures reduce access to medicines, especially without transportation.
- Older adults: Pharmacy closures reduce access to medicines, especially without transportation.
Who gains while it lasts
- Pharmacy benefit managers and their pharmacies: Affiliated mail and specialty pharmacies benefit as local pharmacies close.
Under your mix of paths
Paths that fix or soften it
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Root causes
- PBM reimbursement below cost
- Shift to mail order
Related costs
Open questions
- How should pharmacies be paid (dispensing fee, cost-plus)?
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Pay pharmacies a transparent dispensing fee covering costs, with extra payments in underserved areas.
- +Pharmacy closures and pharmacy deserts
- −Raises spending or loosens control over it
- −Adds paperwork, coordination, or complexity
Allow remote pharmacist supervision and expand mail delivery.
- +Pharmacy closures and pharmacy deserts
- −Solves only part of the problem
- −Medical errors and poor care coordination