Less than two years ago, neighbors near Brush Creek Boulevard and Troost Avenue had the option of picking up a prescription or a carton of milk when they needed to pick up a prescription.
The CVS Pharmacy was located on the northeast corner of the intersection. Its retail rival, Walgreens, was located one block just south of Troost and Emanuel Cleaver II boulevards.
But now the beauty supply store is located in the old CVS space. This pharmacy closed in April 2023. Additionally, the Walgreens relocated five months ago and the store remains vacant. Weeds are growing through cracks in the parking lot and graffiti is painted on the drive-through window.
Now, people in this part of Kansas City, home to some of the poorest neighborhoods, may have to take a bus just to fill a prescription. Even if the bus was on time and it only took 10 minutes to get to the drugstore, it would take nearly two hours round trip to get to the nearest CVS or Walgreens.
“When you don’t have anything close to where you live, it makes life even more complicated,” said Alana Henry, former executive director of the Ivanhoe Neighborhood Council.
Retail pharmacies are closing across the country, including in Kansas City and Wichita, raising concerns among medical experts. The problem is most acute in low-income areas, such as urban areas and small towns, where pharmacies act as convenience stores for health systems.
“When these local pharmacies close, the community loses critical access,” said Lucas Berenbrock, an associate professor at the University of Pittsburgh School of Pharmacy, who is mapping the closures.
Why is it important to lose pharmacies?
Kansas City has lost nearly 100 pharmacies in the past decade. CVS closed at least 11 stores this summer, including one on Independence Avenue. Walgreens is closing five stores and plans to close another one on East 63rd Street at the end of September.
Nationwide, about 7,000 pharmacies have closed since 2019, according to Berenbrock’s map. His analysis doesn’t yet include stores that are likely to have opened in even fewer stores.
“It’s important that someone loses access to care,” Berenbrock said.
The closures come at a time when residents in predominantly Black and Latino neighborhoods and rural residents already have the lowest number of pharmacies per capita, according to an Associated Press analysis in June. Pharmacies also tend to be an important source of medical care, and in some cases, the only source.
Some chain stores also operate urgent care clinics where patients can be tested for strep throat and prescribed antibiotics.
When Walgreens and CVS pulled out of the Troost store, residents said goodbye to two important anchors in the community, said Bill Drummond, a glass artist who lives in the nearby Manheim neighborhood.
“Community health is what it’s all about,” he said.
Yes, it’s a prescription. But it’s also a place to check your blood pressure, get flu and other shots, and get a coronavirus test. Most importantly, someone there can answer your medical questions.
Russell B. Melchert, dean of pharmaceutical sciences at the University of Missouri-Kansas City, said pharmacists have always had that role. The coronavirus outbreak made this even more clear.
Pharmacies have taken over some of the work normally done by crowded hospitals and temporarily closed clinics. Additionally, the need for pharmacists continues to grow as a shortage of primary care providers increases wait times for appointments.
“There is a gap in primary care services,” Melchert said. “That’s for people who have health insurance. What about the hundreds of thousands of people who don’t? They have nothing.”
The Walgreens at 4630 Troost Avenue closed at the end of 2022. (Born Wheat/The Beacon)
Why are pharmacies closing?
To understand why pharmacies close, it helps to understand the circumstances that shaped them. There is a steep rise in the number of prescription drugs available and a deep valley in the benefits they provide.
Until the 1960s, pharmacies sold medicines directly to consumers. The patient left the clinic with the prescription, took it to a local pharmacy, and paid the amount charged at the pharmacy.
After that, prescription insurance coverage began. It started small 60 years ago and quickly expanded. Medical insurance became nearly universal in 2006 when Medicare added drug coverage. The industry supported the launch of a large number of new drugs and gradually determined what drugs were available and how much money pharmacies made from sales.
In 1950, every American took an estimated 2.4 prescription drugs each year. By 2015, that percentage had risen to 17.3, according to a textbook written by Lawton Robert Burns, a business professor at the University of Pennsylvania.
Currently, just under 10% of U.S. health spending is spent on drugs. This equates to $13,493 per person out of the $4.5 trillion spent on overall health care. In 1970, per capita health spending was only $353, or about $2,000 in 2022 dollars.
The profit potential of prescription drugs has led pharmacy chains like CVS and Walgreens to purchase mom-and-pop drugstores and build new stores, often within blocks of each other.
But the chain construction boom of the 1990s and early 2000s has receded in the last decade. (It doesn’t help that the chains are also absorbing billions of dollars in settlements from lawsuits over their roles in the opioid crisis. In 2022, CVS agrees to pay $5 billion and Walgreens agreed to pay $5.7 billion.
Prescription profits began to decline for reasons that involved the complicated way that insurance companies reimbursed pharmacies for drugs. In many cases, prices have plummeted to the point where pharmacists can no longer cover their costs.
On top of that, purchasing habits have also changed. People started getting medicine through the mail and buying shampoo, toothpaste, and other over-the-counter products online.
So the drugstore in your town has closed or is likely to close next.
The situation is especially dire for small independent shops. The National Community Pharmacists Association estimates that one independent pharmacy closed every day in 2023 and expects a similar trend this year.
Chain stores are also feeling the pinch.
Prescriptions are ready and waiting at CVS pharmacies across Northland. (Scott Cannon/The Beacon)
CVS has closed 850 stores since 2022 and expects to close 50 more this year. Walgreens has closed 2,000 stores over the past decade. The company is currently deciding whether to close another 2,150 companies that it describes as “underperforming.” This equates to 1 in 4 remaining retail stores.
Executives at Walgreens Boots Alliance, the owner of Walgreens, told analysts during a stock earnings call in June that the company would stick to only profitable stores. The rest must go.
lose access to care
Tessa Schnell, a pharmacist who has studied pharmacy deserts in rural Kansas, worries people are underestimating the impact on the health care system.
According to her research, 210 towns in Kansas are in rural pharmacy deserts, which she defines as having residents living more than 10 miles from a pharmacy. These desert dwellers live, on average, about 21 miles from a pharmacy. But she expects the situation to get worse as more pharmacies are forced to close.
Schnell, a past president of the Kansas Pharmacists Association, often hears people dismiss concerns about pharmacies being far away. After all, people can get drugs through the mail. Or from pre-stocked vending machines, as is being done in limited capacity.
But such solutions can easily fall apart without sufficient scrutiny, she says.
“What should I do if I get an ear infection?” she said. “So you’re going to prescribe antibiotics? I don’t have anywhere to get them, and it takes days to get them online. … And if I’m buying them[from a vending machine]someone who can educate me. There is no one.”
Home delivery pharmacies are similarly becoming more common, Schnell said. Even though these services can deliver medicines to patients, there are drawbacks to obtaining medicines without a pharmacist.
Pharmacists play a much bigger role than just counting pills and putting them in bottles, she said. They are looking for dangerous drug interactions and allergies. Or you’re listening to the patient’s symptoms and realizing that they may have a reaction to the medication.
“Pharmacists are the brakes,” she said. “They’re there for a reason.”
Two counties in Missouri do not have pharmacies: Knox and Schuyler counties in the northeastern part of the state. And 16 counties in the state have only one.
James Johnston added another county to his list as zero when he closes the Knox County dispensary in 2022. He had opened the pharmacy 10 years earlier when he was already running Johnston Drug in Clarence, Missouri.
The 58 miles between the two stores was too long.
“All of our employees were on the verge of exhaustion,” he said. “I don’t go out very often, and I almost never get home on time.”
He said the Knox County stores were “doing well.” However, it is difficult for pharmacies to sell in today’s market, where drug reimbursement rates are very low. And selling a pharmacy in a remote town is even more difficult.
“No one will bite,” he said. “When you’re a one-man band, you never take time off from work.”
Johnston sold patient files to a grocery store pharmacy 50 miles away in Kirksville. But he also knows that’s not ideal for his customers.
a difficult job to sell
Meanwhile, pharmacies in general are finding it harder to find pharmacists, especially in rural areas.
There aren’t enough pharmacists to meet demand, and the problem is expected to get worse. (Suzanne King/Beacon)
“This is a crisis,” Melchert said. “But tell me how bad it would be.”
In 2023, the country will have 14,000 pharmacy graduates.
“Within four years, that number will be around 8,000,” he said.
This is significantly lower than the 13,500 new pharmacists estimated by the U.S. Bureau of Labor Statistics to be needed each year to replace those who retire or leave the profession.
The UMKC School of Pharmacy typically has less than 70% capacity. Despite pharmacists being able to achieve six-figure grades immediately after graduation, enrollment at pharmacy schools across the country is declining. You can also receive scholarships and student loan forgiveness. Some chains also pay a signing bonus.
2023 Average Annual Salary – Pharmacist Average Annual Salary – Technician KC Metro $134,310 $42,750 Missouri $132,570 $39,960 Kansas $129,300 $39,820 National $134,790 $43,330 Source: U.S. Bureau of Labor Statistics
Enrollment numbers were declining even before the pandemic. The coronavirus has made the situation even worse. Melchert said some candidates experience the profession too much, like exhausted pharmacists making phone calls, administering vaccines and scrolling through computer files after a trip to a crowded chain store. I suspect that there are some people who do not view it positively.
“People don’t know what we do,” Melchert said.
He and other pharmacy deans argue that people don’t realize how big a role pharmacists play in modern health care. They are doing everything they can to bring more people into the profession. This includes consulting with managers at large companies like CVS and Walgreens on how to improve working conditions and training high school students to get jobs as pharmacy technicians.
Nate Lockers, owner of Lockers Pharmacy in Paola, Kan., said he would never dream of asking either of his two sons to join the company and take over the family business.
“I can’t imagine staying in business for another 20 years and retiring as a pharmacy owner,” he says. “If we don’t do anything, we don’t know if pharmacies will still be around in five years. Once the ship goes down, it never rises again.”
This article was first published in Beacon: Missouri and is republished here under a Creative Commons license.
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