The Corner Drug Store
Last month, the drug store in my neighborhood closed. As part of its bankruptcy and reorganization, Rite Aid closed 181 stores across Ohio. Fifteen of those stores were in Cuyahoga County, including the one that was within walking distance from my home. Walgreens recently announced it may close as many as 2,150 underperforming stores by 2027. CVS has also closed hundreds of stores in communities across the country. Industry analysts point to a variety of reasons for this: the entry of big-box stores into the industry, a trend toward consolidation and fewer independent operators, the expanded use of telemedicine and mail-order delivery of medications, and the rising influence of pharmacy benefit managers (PBMs), all have contributed to the reduction in the number of neighborhood pharmacies across the country. The loss of drug stores is felt most in rural communities and low-income neighborhoods, where “pharmacy deserts” lead to reduced access to care.
Operators of drug stores and pharmacies attribute the decisions to close stores to thin operating margins and rising costs of business. Drug prices have risen at a higher rate than the overall rate of inflation. Prescription medications continue to play a larger role in health care, and related costs of care. Higher costs adversely impact older adults. A recent study reported in the Journal of the American Medical Association (JAMA), noted that one in five people aged 65 and older reported “cost-related medication nonadherence,” meaning they “did not to fill a prescription, skipped doses, took less medicine, or used someone else’s medication due to cost.” Since many medications are used to manage chronic health conditions, the consequence of nonadherence is an increase in the overall expense of healthcare. Medicare addresses this in part by limiting the out-of-pocket costs for medications for older adults (the Medicare “donut hole”). The Inflation Reduction Act of 2022 seeks to further address this phenomenon through negotiation of drug prices for medications covered under Medicare Part D.
The loss of local brick and mortar drug stores comes at a time when pharmacies and pharmacists play an expanding role in routine healthcare. In 2022, the Columbia University Mailman School of Public Health reported pharmacists’ current professional activities include dispensing medications, communicating with health professionals and patients about potential adverse drug interactions, counseling patients on their medications, and administering vaccines. Retail pharmacies saw increases in these activities during COVID, as more patients and healthcare providers relied on telehealth services. Finding a convenient (and available) provider for a vaccine often meant finding a local pharmacist. And pharmacists were well positioned within the service delivery system to address the complicated medication lists of their clients with multiple doctors, diagnoses and health conditions.
Beyond the role of the pharmacist, many drug stores implemented healthcare clinics in their stores, (think MinuteClinic at CVS) adding the services of nurse practitioners to expand non-emergency healthcare offerings. Walgreens invested heavily in VillageMD to broaden its presence in health care clinics. Other retailers also entered the space. Amazon added pharmacy services to its online portfolio and opened One Medical, offering in-person primary care. Walmart began offering healthcare services in stores, before exiting the market earlier this year. The expansion and competition among providers contributed to the financial pressures that are causing providers to close stores and reduce their footprint.
The expanded role of the local pharmacy came about in part as a response to the shortage of family care physicians. KFF Health News reported in 2023 that the US is near a tipping point. The percentage of U.S. doctors in adult primary care has been declining for years and is now about 25 percent — meaning many Americans won’t be able to find a family doctor at all. Financial pressures, low reimbursement rates and the perception of primary care as less valuable, have resulted in fewer doctors entering the field. This despite evidence that healthcare built around regular primary care results in better health outcomes. A clinic in a suburban shopping center, with walk-in options and operating hours that catered to working families, helped meet the needs of consumers in finding accessible, in-person care, and filled the void in primary healthcare.
The impact of the corner drug store goes beyond the pharmacy counter. In addition to prescription and over the counter medications, health and beauty products and first aid supplies, the inventory of my local Rite Aid included batteries and school supplies, replacement chargers for mobile phones, a small selection of grocery items (including ice cream), household and hardware items. My recent purchases included a child-size toothbrush (when my grandson couldn’t find the one he packed in his suitcase), a poncho (when a summer storm interrupted our weekend walk) and a tube of Super Glue. Pharmacies have long been more than mere drug dispensaries. The line between five-and-dime stores and drug stores has always been a little blurred. Walgreens and Woolworth’s inventories overlapped, and both may have had a lunch counter in your hometown. Coca-Cola and Dr. Pepper were invented by druggists. Hollywood legend Lana Turner was supposedly discovered at Shwab’s Pharmacy on the Sunset Strip where she was a soda jerk. Drug stores are part of our commerce and our community. Store closures, often in highly visible areas raise economic, as well as health concerns.
Healthcare in the US is complex and expensive. Regulations, payer sources and market forces impact healthcare access, treatment options and patient outcomes. Consumers and providers can get lost in the process. As advocates, we need to raise awareness of health disparities in our community, and look for ways to address the health, comfort and dignity of older adults and the people who care about them. And we should look for opportunities to collaborate in promoting the livability and economic vitality of our communities and enhancing the quality of life for residents of all ages.
Need more information about medical and pharmacy benefits?
For older adults, the open enrollment period for Medicare is an opportunity to review your health and healthcare needs and consider changes in your health coverage. Have your health needs changed in the past year? Does your current plan cover your medications? Is your health provider in your network? Open enrollment begins on October 15th and runs through December 7th. For help with exploring our coverage options, visit the www.medicare.gov for fact sheets on Medicare Advantage and Medicare Drug Plans.
Need help finding a plan that is right for you?
The Ohio Department of Insurance provides Medicare beneficiaries with free, objective, health insurance information and one-on-one counseling through the Ohio Senior Health Insurance Information Program (OSHIIP). OSHIIP’s hotline experts, speaker’s bureau, and trained volunteers educate consumers about Medicare, Medicare prescription drug coverage (Part D), Medicare Advantage options, Medicare supplement insurance, long-term care insurance, and other health insurance matters.