Expert Discusses Pharmacy Deserts, Expanding Pharmacy Access

Jenni Zilka, senior vice president of Good Neighbor Pharmacy Field Programs and Services at Cencora, discusses the growing challenge of pharmacy deserts, which are areas where retail pharmacies, both chain and independent, are struggling and at risk of closure. This is driven by factors like lower reimbursement rates and decreased foot traffic since the pandemic. Pharmacy deserts disproportionately impact underserved communities, with definitions varying by location.

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Q: What are some of the primary drivers of pharmacy deserts?

Jenni Zilka: So when you think about pharmacy deserts, candidly, retail pharmacies of all sizes in the US are struggling with both chain and independent pharmacies at risk of going out of business and causing these pharmacy deserts for a number of reasons. A couple of those reasons include lower reimbursement for prescription drugs and a slowdown in foot traffic since the pandemic, which saw millions of customers coming into the pharmacies seeking care and vaccination, screenings, etc. So the risk of pharmacy closures is real. It is happening, and that is what's driving these pharmacy deserts. Just to also note, they're particularly occurring in underserved communities.

Q: Are there specific regions or demographics that are disproportionately affected by the increase in pharmacy deserts?

Jenni Zilka: It is underserved markets, typically, in underserved areas. But I also think it's important to note that it's not necessarily an urban issue or a rural issue. It's really everywhere, and we think about how we define a pharmacy desert in an urban area, it's where the nearest pharmacy is more than a mile away from the people that live there. In the suburbs, it's 2 miles, and in rural areas, it's more than 10 miles. So we do change the scale a little bit, as you think about defining it, but it really is prevalent in all different types of settings, and we have some data, and I know John's going to jump into the data even more, but it shows that an estimated 35 million people live in pharmacy deserts currently.

Q: What are some of the challenges that pharmacies are facing today that are driving closures?

Jenni Zilka: I'll kind of probably go back to my response to your first question, because it's really centered around our pharmacies maintaining their financial viability so that they can continue to care for their patients. So that's centered around reimbursement, and as reimbursement declines, financially, they have a hard time remaining solvent and being able to be in those markets to care for their patients. Then I think there's also an opportunity around expansion of practice, right? So a lot of our pharmacies provide a lot of services, but right now, there's not a pathway to be reimbursed, and when I think about COVID-19, and as as you know, all pharmacies in all communities did a phenomenal job of ensuring that patients had access to the COVID-19 vaccine, and at that time, they were fairly reimbursed. A lot of those safeguards are no longer in place for our pharmacies. So it really kind of centers around financial viability and being able to continue to provide that high level of care and be appropriately reimbursed for it.

Q: What are the consequences of pharmacy closures for patients and communities?

Jenni Zilka: This is something I'm so passionate about. When you think about pharmacists and their relationships with their patients, oftentimes, the pharmacists know their patients and their family members on a first name basis, and they provide such personalized care that goes the extra mile, right? In many cases where we have a pharmacy desert, we also have a health care desert, meaning there's no provider anywhere within that market to be able to care for patients. So they lean on their pharmacies for health advice and services, not only on their prescriptions, but they also serve as a critical resource to patients by fielding these health questions well beyond just their prescriptions. So we're talking about a typically underserved, perhaps socially vulnerable patient populations due to their locations and their high-touch need of of a high level of care, and when that resource is no longer there, they are not able to access the care that they need. And they also really trust their pharmacists. There's a lot of studies out there on on how trusted the pharmacist is. So they lose that personalized care with someone who's willing to go the extra mile with them and care for not only them, but their entire families and, in turn, their communities.

Q: How can pharmacies diversify their services to improve revenue and meet evolving patient needs?

Jenni Zilka: There's many ways our pharmacies can expand their services, and they're trying, and many of them are doing a phenomenal job of either compounding prescriptions for their patients, perhaps they're providing nutritional dietitian advice, and linking them to community services that are available to them. But I also think an amazing opportunity for our pharmacies to continue to diversify is to provide services, clinical services, beyond just filling prescriptions, and when I think of that, I'm thinking about that continuing to expand on vaccinations due to the due to the proximity and the access that our pharmacies provide. Also perhaps testing right and screening for common infectious diseases, where the patients are already walking in the pharmacy, and we know that they see their pharmacist considerably more than they see their health care providers. So allowing that easy access to some of these tests and vaccinations is important. There's a ton of legislation right now centered around that, but challenges remain. Currently, Part B does not recognize or reimburse pharmacists as providers and the pandemic's public health emergency status that I mentioned earlier has expired. So Medicare beneficiaries are not covered for the services that pharmacists are currently providing. And also, there's another act in in Congress right now. It's called the Equitable Community Access to Pharmacist Services Act. We call it ECAPS for short, because that's a mouthful, but that would ensure Medicare beneficiaries have prompt and accessible access to essential services, like I mentioned, the vaccinations, testing, treatment of common infectious diseases that established by establishing Medicare Part B reimbursement for pharmacists to continue to deliver such essential services. So when you think about this need for access, and some of the bills and the legislation that's sitting out there that we hope will be passed. It will really allow our pharmacies to expand the level of care and the services that they're able to provide to their patients in their communities.