Pharmacy Deserts

**Stanton Shanedling:** Hello, everybody! Welcome to Health Chatter. It's just a day or so before Christmas and Hanukkah this year—they both fall on the same day, which is quite unusual.

First, happy holidays to everyone. Thank you to our listening audience for tuning in to all our shows. We hope you enjoy them. Today, we're discussing an interesting topic: pharmacy deserts. This idea came to me a few years ago, and I’ve been curious about how it developed. We have a great guest with us, and a fantastic team behind the scenes—Matty Levine, Wolf, Aaron Collins, Deandra Howard, Matthew Campbell, Sheridan Nygaard—they’ve been with us since the beginning. They help with research, recording, production, marketing, and more. Many of them also chime in during the show. Thanks to all of you. Dr. Barry Baines is our medical advisor and provides valuable medical insights on these topics. And of course, there's Clarence Jones, my friend, colleague, and co-host, who was the one who suggested we do this podcast. I remember that breakfast well—thanks again, Clarence.

Today, we’ll be talking about pharmacy deserts, and we’re pleased to have Dr. Christian Pereira with us. He’s an Associate Professor at the University of Minnesota College of Pharmacy, in the Department of Pharmaceutical Care and Health Systems. He’s also the Director of Interprofessional Education at the college and a faculty member at the Smiley’s Family Medicine Residency, where he practices as a pharmacist and trains others. He’s also part of the Center for Interprofessional Health at the University of Minnesota.

Welcome, Christian. It’s great to have you. The concept of a pharmacy desert is a bit of an enigma to me. When I think about it, I remember corner drugstores—fondly—and when they disappeared, I was honestly saddened. Those small community pharmacies felt like an important part of the neighborhood, and their loss might have implications for community health. So, Christian, let’s start with a simple question: what exactly is a pharmacy desert?

**Christian Pereira:** Thank you, Stanton. And just to clarify, my name is pronounced Christian Pereira.

A pharmacy desert, as my team and I have defined it in Minnesota, refers to a loss of a pharmacy resource in a community or neighborhood. It’s a situation where a community no longer has easy access to a pharmacy, which can impact the health and well-being of residents. When that resource disappears, it leaves a vacuum, and I think about what happens in that vacuum—how it affects the community and its access to essential medications and health services.

**Stanton:** That makes sense. Clarence, I think you wanted to chime in?

**Clarence Jones:** Yeah, I just want to share a quick memory. My first experience with a pharmacist was in my community—my pharmacist gave me some books. His daughter had grown up, and I got a bunch of books like *The Black Stallion* and Cinderella. I have fond memories of pharmacists—they can really make a big impact on how people perceive and handle their medications. I just wanted to put that out there first.

**Christian:** That makes me very happy to hear.

**Stanton:** Christian, when did this idea of a pharmacy desert first start to gain attention? It seems like one day it just appeared on the scene. When did we really begin noticing it?

**Christian:** Great question. The term “pharmacy desert” was coined around 2012. Initially, it was used to describe densely populated metropolitan areas like Chicago and New York, where pharmacies seemed to be disappearing. The idea is that pharmacies are businesses, and like any business, they can come and go. You might remember, in many neighborhoods, the corner drugstore was a staple, but over time, many of these disappeared. In Minnesota, for example, we see that certain words or signage—like “drugs”—are restricted to actual pharmacies, so old buildings with “drugs” stained glass or signage are relics of the past. 

While small pharmacies have always opened and closed, what’s alarming is the acceleration of this trend since around 2012—particularly in Minnesota, where the number of pharmacies leaving the state has increased significantly since 2017. This isn’t just a Minnesota issue; it’s national.

**Clarence:** I want to ask about the role of pharmacy benefit managers (PBMs). There’s a lot of talk about how they’ve affected the industry. Can you explain what PBMs are and how they factor into pharmacy deserts?

**Christian:** Absolutely. PBMs, or pharmacy benefit managers, are organizations that work on behalf of insurance companies to negotiate drug prices and formulary lists—essentially deciding which medications are covered and at what cost. They act as middlemen between insurers, pharmacies, and drug manufacturers. 

Over time, PBMs have become major players in how drugs are dispensed and which pharmacies get reimbursed. They negotiate contracts and set reimbursement rates, often influencing which pharmacies stay open or close. Because of their role, many independent pharmacies struggle to survive when PBMs push for lower reimbursements, leading to closures. This impacts access, especially in vulnerable communities.

**Clarence:** So, when large chains or PBMs consolidate, community pharmacies often have to close, and people have to travel further for their medications. This can be a hardship, especially for those with limited transportation or resources. Is that correct?

**Christian:** Exactly. Larger pharmacy chains tend to close stores based on business metrics rather than community needs. When they consolidate or close stores, the community often suffers because they lose local access. Some states, like North Dakota, have laws that restrict chain ownership to protect local pharmacies, but Minnesota doesn’t have such laws. As a result, communities are vulnerable to closures driven purely by business decisions, not community health.

**Barry:** I’d like to add a story. I had a friend who used to service community pharmacies across Minnesota, Wisconsin, and Iowa. Over the years, he saw the rise of large pharmacy chains like CVS and Walgreens, which led to consolidation. Smaller, independent pharmacies couldn’t compete, and many closed. This forces community members to travel farther, which can be difficult, especially for those with limited transportation. The consolidation reduces competition and accessibility, creating pharmacy deserts.

**Christian:** That’s a very important point. When large organizations close pharmacies, the community often has no say—they’re closing stores based on profit, not community health needs. Some states have policies to prevent this, but many do not. And it’s not just retail chains; hospitals and health systems are also closing pharmacies, which can impact vulnerable populations.

**Clarence:** So, what does the future hold for pharmacy? Given all these trends, what’s the outlook?

Clarence Jones: Some schools have decided they no longer want to maintain a school of pharmacy—they're closing them down. Do you think we'll see more pharmacists being produced? What do you see happening in the future regarding this issue? I know this is a non-politically correct question, but seriously—what's the future for pharmacy?

Clarence: And, Christian, what’s the situation at the University of Minnesota? What are you guys planning?

Christian Pereira: Wait, Clarence, I want to clarify your question. Are you asking how many pharmacists we’re producing, or more broadly—what’s the state of pharmacy for the future?

Clarence: Both, actually. How many pharmacists are we graduating? And what’s the future of pharmacy overall? I’m especially curious because I hear some schools are closing their pharmacy programs. And yes, I snuck in a question about the University of Minnesota, just to see what’s happening there.

Christian: Great questions. Right now, I wake up thinking about students, and I go to sleep thinking about them too. When I graduated in 2001, pharmacy was booming. It was an exciting profession, with lots of positive media coverage. Parents encouraged their kids to go into pharmacy, and we had a steady influx of talented applicants. The number of pharmacy schools in the U.S. increased dramatically—about a third more within roughly 10 to 15 years.

In Minnesota, the University of Minnesota was strategic in how it expanded, opening a Duluth campus due to high demand. But nationwide, this expansion led to a surplus of pharmacists around 2010–2012, causing concern about an oversaturated job market.

Since then, admissions have declined nationally, including in Minnesota. Some states, like Missouri and Illinois, have closed campuses or consolidated programs. Yet, overall, we still graduate a healthy number of pharmacists each year.

However, students are now more anxious. When I graduated, a speaker at a national conference joked that job security was guaranteed if you could feel your pulse—meaning there were plenty of jobs. Today, that’s no longer the case. The number of pharmacy jobs has decreased, and competition is fierce. We graduate nearly 100 students annually, all highly qualified, but not everyone will find a community pharmacy job immediately. Many go into hospitals, research, or other health sectors. Only a few become pharmacy owners.

Stanton: I volunteer at a hospital, and I often ask patients about their access to a pharmacy—especially after surgeries. I ask if they have easy access to a pharmacy near their home. If they say no, we coordinate with social workers or community health workers to help them. I’ve found this to be troubling because I never thought about it before—access isn’t just about location anymore, but about how easily people can reach a pharmacy and get their medications. Christian, can you talk about what access really means today?

Christian: Absolutely. When pharmacists ask patients about access, I think that’s a sign of high-level care—one I’m proud of. Access can mean many things. To some, it’s simply driving a few miles to a nearby pharmacy. To others—especially those without transportation—it might mean something very different. For example, I have a family member with a disability who can’t drive, so I pick up their medications. It’s not always easy, and it’s not always convenient.

For some, access might mean being able to get their prescriptions filled quickly, especially for acute needs like post-surgery pain management or urgent therapy changes. It’s a relative concept—distance, transportation, and individual circumstances all play roles.

And, of course, face-to-face communication with a pharmacist adds another layer. If someone doesn’t have a contract with a pharmacy—perhaps due to insurance or other reasons—they might not be able to get their medications. Clarence, you’re right—these issues are interconnected.

Barry: That’s a good point. Access isn’t just about location; it’s about the resources and relationships involved. Pharmacies now do much more than dispense medications—they provide immunizations, minor medical advice, and chronic disease management. Pharmacies are vital community health resources, especially in rural or underserved areas. When access diminishes, it impacts health outcomes, increasing morbidity and mortality. Mail-order can help, but it doesn’t replace the face-to-face, immediate support pharmacies provide.

Christian: I agree. Delivery and mail services are part of the solution, but they have limitations—package theft, delays, or people living in facilities that don’t accept deliveries. Plus, some medications need to be dispensed quickly or require in-person consultation.

Stanton: Right. And I’ve noticed that pharmacists now focus more on public health than in the past—training patients on healthy living, collaborating with grocery stores for healthier choices, and being the “canaries in the coal mine” for outbreaks or health crises. For example, during the Milwaukee diarrhea outbreak, pharmacists recognized the issue early and alerted public health officials.

Christian: That’s a great example. Pharmacy students today are learning about preventative health, lifestyle counseling, and community engagement, not just counting pills. They see themselves as part of the broader health system—more than just dispensers of medication.

Stanton: I truly believe pharmacists are vital healthcare team members. They often have a bigger picture view than primary care physicians because they’re more embedded in the community.

Barry: I have a simple question for everyone: who is working on addressing pharmacy deserts in Minnesota? Who’s actively trying to solve this problem?

Christian: There are some efforts. The Minnesota Pharmacists Association advocates for pharmacists and pushes for better policies. There’s also a new national organization representing independent pharmacies, lobbying for protections against unfair contracts. Recently, there’s been movement around PBM regulation and pricing controls, but it’s ongoing. Much of the change depends on state policies.

Sheridan: I want to add—public health in pharmacy has always been important. Historically, pharmacists served as trusted community touchpoints. We need to ensure that pharmacy students are trained to have these conversations and to serve as community health leaders. Even during COVID, pharmacies played a crucial role in immunizations and providing access when other parts of the healthcare system shut down.

Christian: Absolutely. The future of pharmacy involves strengthening these roles—preventive care, health education, and acting as community health hubs. The more we can integrate pharmacy into public health efforts, the better prepared we’ll be to address issues like pharmacy deserts.

Barry: This has been a very enlightening discussion. I see pharmacists as key players, but the issue of access—and the economic and policy factors behind it—is complex. I’m curious—who benefits from the current dysfunction? Who’s really profiting from the consolidation and closures?

Christian: That’s a rhetorical question, Barry. We all know the answer.

Clarence: Exactly. Someone’s benefiting from this chaos—probably those with the most to gain financially. My last word: be kind to pharmacists. They’re under a lot of pressure. But it’s crucial to understand who really benefits from these systemic issues.

Stanton: Well said. Thanks, Christian, for your insights. We’ll definitely have you back for future discussions, including on health insurance and policy impacts. This has been a very hopeful yet urgent conversation. I believe pharmacists are essential players in healthcare, but we need to address access and systemic barriers to ensure everyone can get the care they need.

Christian: Thank you. It’s been a pleasure.

**Stanton Shanedling:** Barry.

**Barry:** Well, you know I’m going to side with Clarence here, and I think this reveals something important: right now, pharmacy deserts and the creation of those deserts serve an economic end, not an end aimed at improving people's healthcare. So I’ll admit I’m a bit pessimistic. This has been a great unpacking of a very complex topic, and it’s really helped me understand it better. 

Maybe it’s the gray weather outside, but I feel a bit pessimistic that we’ve seen the bottom of the barrel when it comes to pharmacy deserts. Because the systems we have in place tend to produce the outcomes they’re designed for—and pharmacy deserts are one of those outcomes. We know who bears the brunt—usually disadvantaged communities in many ways.

Food deserts come to mind as well. It’s all interconnected. But what’s really helpful about this discussion is that, although we don’t have ready solutions, you can’t develop solutions without understanding the problem more deeply. This conversation has expanded my perspective on how complex creating pharmacy deserts really is. 

Hopefully, raising awareness will help move things forward. Thank you, Christian—it's been great to meet you and have you on the show. 

**Stanton:** So, my last two thoughts are these: First, I believe pharmacists are healthcare gems in our communities. They have strong connections with people, and I hope that, despite the issues we discussed today, this connection with people and their health is not compromised. 

Second, I really appreciate Christian’s recognition of the problem and the solid background research, some of which is available on our website. This kind of knowledge can be shared with decision-makers to benefit everyone moving forward. 

Christian, I’ll turn it over to you for a final comment.

**Christian:** Oh, thank you. I really appreciate the conversation and everyone’s perspectives. I endorse the research that’s posted on your website—those numbers and points are excellent. I invite all listeners to review them. 

The last thing I want to emphasize is that pharmacists are coming into communities with a passion for improving health. They’re ready for the challenge and eager to help. 

This year, I believe it’s crucial to pay close attention to what’s happening. Changes in policy and how they’re formed can significantly help address these problems. I encourage everyone to consider that. 

Thank you so much for your time.

**Stanton:** Thank you for being on Health Chatter. To everyone out there, happy holidays! Our next show will focus on health insurance, which will connect interestingly with today’s topic. Until then, keep health chatting!