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Keywords

pharmacy, pharmacies, pharmacy deserts, Pharmacy Benefit Managers, PBM, Act 624, CVS

Abstract

Seven thousand pharmacies have closed throughout the United States since 2019. This number includes both local pharmacies and larger chains. The effect of both types of closures, though, is the same—pharmacy deserts. A pharmacy desert can occur in all types of areas; it simply means that consumers lack “reasonable access” to a pharmacy. The usual standard is a pharmacy located more than one mile away in urban areas, two miles away in suburban areas, and ten miles away in rural areas. However, an objective mile range is not always dispositive of a pharmacy desert. Even if a pharmacy is located within the mile-range, lack of access to pharmacies because of limited hours or public transportation can make pharmacy access unfeasible for lower-income individuals or persons with mobility challenges. Pharmacy deserts pose dire effects for individuals within them, including limited access to vaccines and preventative care, medication non-adherence, increased healthcare costs, less control over healthcare decisions, missed work days, and health equity concerns.

Since 2020, 100 pharmacies have closed in Arkansas. Even a pharmacy in Dumas, Arkansas, that opened its doors on July 4, 1917, closed due to consolidation and higher prices. Rural pharmacy closures have been linked to Pharmacy Benefit Managers, or PBM, influence. PBMs control how pharmaceuticals travel from manufacturers to pharmacies to consumers, affecting the types of drugs consumers can access and for what cost. Local pharmacies allege that PBMs reimburse them at lower rates than what is required to remain in business. To combat PBMs, Arkansas legislators passed Act 624, banning PBMs in the state. Intended to serve rural pharmacies, the legislation seeks to prevent PBM influence in Arkansas. However, though the Act seeks to prevent pharmacy deserts, it could lead to PBM-owned pharmacies in the state using PBMs closing, including all twenty three CVS pharmacies, which would affect 340,000 consumers’ access to prescription medication and worsen the state’s pharmacy desert problem.

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