Pharmacy Deserts | Everything You Need to Know
By: Aaron Gomez
Tags: Pharmacy, Pharmaceuticals Industry, Disparities, Healthcare Disparities, Pharmaceutical

When it comes to disparities in health care, our problems are many. A recent study published in HealthAffairs has found that one-third of all neighborhoods in the largest U.S. cities are pharmacy deserts.

Pharmacy deserts are a relatively new classification first introduced in 2014 by Dima M. Qato, PharmD, MPH, PhD. The name “pharmacy desert” took direct influence from the food desert classification. Just as food deserts are neighborhoods with low access to nutritious foods, pharmacy deserts are neighborhoods that have poor geographic access to pharmacies.

Pharmacy desserts affect nearly 15 million people, according to the HealthAffairs study, but the problem doesn’t end there. The study, which looked at the 30 most populous cities in the US, found that disproportionately pharmacy deserts exist more in Black and Latino/Hispanic neighborhoods than in White or diverse neighborhoods.

The correlation between Black and Latino/Hispanic neighborhoods and pharmacy deserts may not seem surprising. We have become conditioned to expect healthcare disparities amongst White, Black, and Latino/Hispanic populations. But what makes this study on pharmacy availability so striking is how pronounced these racial and ethnic disparities are and how they persist even when comparing low-income White neighborhoods with low-income Black and Latino/Hispanic neighborhoods.

Some Staggering Statistics (Based on data collected from 2007–2015):

Pharmacies opened less frequently in Black and Latino/Hispanic neighborhoods. Only 301 of the 2,663 pharmacies that opened between 2010 and 2015 (11.3 percent) were in Black or Hispanic/Latino neighborhoods that did not already have an existing pharmacy.

Pharmacy closure rates in pharmacy deserts were higher in Black and Latino/Hispanic neighborhoods. Closure rates in White pharmacy desert neighborhoods were 8.5%, in Black neighborhoods, they were19.9%, and in Latino/Hispanic neighborhoods, they were 17.3%.

Low-income Black neighborhoods and low-income Latino/Hispanic neighborhoods have more pharmacy desert prevalence than low-income White neighborhoods. Of White low-income neighborhoods, 40.3% were pharmacy deserts; that percentage rises to 42.5% in Latino/Hispanic neighborhoods and 47.5% in black neighborhoods.

Not All Disparities are Created Equal

The above percentages represent the averages of the 30 most populous U.S. cities as a whole. Though the percentages of pharmacy deserts vary drastically by city, pharmacy deserts are consistently more common in Black neighborhoods. The HealthAffairs study analyzed that only 2.6% of all neighborhoods in New York, New York were pharmacy deserts while 75.4% of all neighborhoods in Charlotte, North Carolina were food deserts.

The cities with the most pronounced pharmacy desert disparities between neighborhoods were Chicago, Los Angeles, Baltimore, Philadelphia, Milwaukee, Dallas, Boston, and Albuquerque.

The Difference We Can Make

Health equity is not a new issue, and it is the goal of many organizations to improve access to medication and healthcare services for underserved populations. The problem is that the solutions will have to be as layered and nuanced as the problem itself.

The HealthAffairs study also included suggestions to improve access to medication and other healthcare services. The study suggests “such efforts could include financial incentives to encourage pharmacies to locate in pharmacy deserts and targeted increases to Medicaid and Medicare reimbursement rates to prevent pharmacy closures.”

340B Could be the Key

The study also suggests that pharmacies could leverage the 340B Drug Pricing Program to combat pharmacy deserts. The 340B Drug Pricing Program allows safety-net providers relief from high drug prices, so they have the resources to provide more and better services to their clients.

The 340B program costs taxpayers and the government nothing. Pharma companies are required to sell their drugs at a lower price to 340B Program participants, so they are the ones absorbing the “loss.” Pharma companies participate in the 340B program because they want access to the $33.4 billion Medicaid drug market, and they cannot access it unless they participate.

Pharma companies only lose 1.6% of their overall profits because of 340B, but still, they continuously attack the program designed to help underserved communities have better access to healthcare. Organizations like Let it B work to defend 340B from pharma companies working to dismantle the program.

The HealthAffairs Study found that only one in four pharmacies in Black and Latino/Hispanic neighborhoods participated in the 340B program. Increasing the number of pharmacies that participate in the 340B program could be vital to decreasing the racial disparities of pharmacy deserts.

Using AHF Pharmacy as a Model for Success

To bring a world of more equitable pharmacy and healthcare systems out of the realm of fiction, let’s examine a success story.

AHF Pharmacy is a not-for-profit healthcare provider where 96 cents of every dollar earned goes back into providing services to patients and the community. All AHF Pharmacies are part of the 340B program, which allows them to cover medication costs for patients who do not have insurance. AHF Pharmacies are located in cities where pharmacy desert disparities are most pronounced, including eight locations in Los Angeles and three locations in Dallas. In total, there are over 60 AHF Pharmacy locations around the U.S.. AHF Pharmacies also provide free delivery of medications which helps even those patients who live in pharmacy deserts access their medications.

AHF Pharmacies may sound more like the exception than the rule, and they alone are not enough to solve the more significant problem of pharmacy deserts, but they serve as a roadmap for success for other pharmacies. AHF pharmacy also represents proof of the benefits of 340B and free delivery. A better and more equitable pharmacy and healthcare system is possible and necessary. Now is the time to do the work to bridge the racial disparities that divide us and improve the global health of all people.