Pharmacy deserts: Community access less likely for minorities


Minorities less likely to have community access to pharmacies

People living in underserved areas of the United States tend to be sicker and in need of more medications, especially to manage chronic conditions. Naturally, pharmacies play the role of giving these individuals access to medications. 


But according to a study published in November 2014 in the journal Health Affairs, pharmacy deserts exist in poor and underserved communities, leaving residents with limited community access to pharmacies. While the impact of pharmacy deserts is still unknown, the issue is gaining attention and raising concern. 


Researchers examined communities in Chicago that varied by race and ethnicity. They found that pharmacy deserts, or low-access neighborhoods, were most prevalent in segregated black and Hispanic communities compared with segregated white and integrated communities. 


“This is expected given what we know about medically underserved areas and the fact that pharmacies are not part of the public health system,” said Dima M. Qato, PharmD, MPH, PhD, Assistant Professor in the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago, and author of the study. “There is currently no incentive for them to locate in medically underserved areas.”


She said Chicago was a good laboratory for testing pharmacy access issues given the extent of segregation there and the myth that pharmacies are everywhere. 


“It’s not a problem that just affects Chicago. I expect our findings could represent other large urban areas,” said Qato. 


What you pay and where you live


The Health Affairs study also found that more independent pharmacies than chain pharmacies exist in underserved communities, which can contribute to inadequate access issues because independent pharmacies oftentimes don’t have the capability to offer affordable prices, particularly on generic drugs, that chain pharmacies do. 


“The generic drug discounts pretty much follow chain pharmacies. Although occasionally independents will try to match prices, they often can’t,” said Steven R. Erickson, PharmD, Professor and Clinical Pharmacist at University of Michigan’s College of Pharmacy.


A study in the November/December 2014 issue of JAPhA, which Erickson coauthored, looked at out-of-pocket costs and pharmacy services in a diverse county in Michigan and compared characteristics of residents by 63 ZIP codes where pharmacies were located. They found that ZIP codes with a majority of white residents with higher household incomes not only had access to pharmacies that were open more often, but also had a greater percentage of pharmacies with discount generic drug programs. They could also offer customers a lower price for levothyroxine—the generic drug chosen in the study for price comparison. 


Legislators have caught on to related issues. A bill introduced by Reps. Morgan Griffith (R-VA) and Peter Welch (D-VT), H.R. 793, would grant lower copayments to seniors in medically underserved areas at any pharmacy that accepts a Medicare Part D plan’s preferred network pharmacy, and could be useful for patients in underserved areas who rely on independent pharmacies. 


The National Community Pharma-cists Association has observed that more pharmacists today have expressed interest in opening independent pharmacies in underserved areas. 


Immunizations: Overlooked issue


In the JAPhA study, Erickson also looked at pharmacy-based immunization services. He said what surprised him most was the lack of pharmacies in underserved areas offering immunizations. One pharmacist they surveyed said that because his patients don’t ask for immunizations, they don’t provide them.


“Some of my colleagues are talking about going to those ZIP codes with low immunization availability and surveying the pharmacists to see what their perceived barriers are. If it’s training, we might attempt developing a program for them,” said Erickson. He thinks this would be more feasible to fix than cost barriers—at least for now.


Next steps


Incorporating pharmacies into federally qualified health centers (FQHCs) could be one solution, according to both Qato and Erickson. FQHCs are federally funded safety net providers located in medically underserved areas. Erickson plans to look into FQHC locations in the ZIP codes he examined and comparing those to areas where pharmacies are located.


Understanding the impact of pharmacy deserts is an important next step, Qato said. “The policy and public health challenge is: How do we use current pharmacies that exist in these communities and maximize their use to make them high quality and affordable?”