Rural communities lost 10% of their retail pharmacies in the last 20 years, and most were independents', not chains'

Change in count of independent pharmacies, 2003-21: rural in red, micropolitan
(10,000-50,000 city pop.) in green (RUPRI Center for Rural Health Policy Analysis)

"Rural America is losing pharmacies, especially independently owned drug stores that are mainstays of rural communities," Liz Carey reports for The Daily Yonder. "Challenged by slow payments, decreasing reimbursements from insurance companies and Medicare, and growing competition, nearly 600 independent rural pharmacies have closed since 2003, a study from the RUPRI Center for Rural Health Policy Analysis at the University of Iowa found. During the same period, the number of franchise pharmacies fell by about 70, while chain pharmacies like CVS and Walgreens grew by about 90 stores."

In that time frame, the number of rural retail pharmacies fell 9.8% while the number in metro counties grew 15.1%. "Of the retail rural pharmacies, independently owned pharmacies declined by 16.1%, while the number of independently owned metropolitan pharmacies increased by 28.2%," Carey reports. "There were 3,698 independently owned rural pharmacies in 2003. By 2021, there were only 3,102. Nearly half of the pharmacies located in rural areas are sole, independently owned retail stores, researchers said."

Negotiated pricing is a major reason for the closures, said one of the study's authors. When pharmacies' costs go up, reimbursements from insurance providers, Medicare and Medicaid sometimes don't keep pace. Delays in those reimbursements are a problem too. "Additionally, competition from not just the chain pharmacies, but mail-order pharmacy services works against the independent retail store," Carey reports. "Another challenge, researchers said, is the aging rural population, and the difficulties handling these more complex patient cases."