There are more US pharmacies than ever, but geographic gaps to access are common

Between 2007 and 2015, the number of pharmacies in the United States grew slightly, but the characteristics associated with easy access to prescriptions varied greatly across local areas, according to a recent study published in the journal PLOS One.

This study is also the first to document trends in the availability of pharmacies and their service provision by pharmacy type (retail chain, independent, food store) at the national and local level.

“Numerous studies examine patients’ access to health care, but few have explored patients’ access to pharmacies,” said lead author Dima Qato, PharmD, MPH, PhD, assistant professor of pharmacy systems, outcomes and policy, University of Illinois at Chicago. “Pharmacy accessibility may be an overlooked contributor to non-adherence, which is an important public health concern.”

In the United States in 2015, over 4 billion prescriptions were filled, which is 12.7 per capita. But in addition to dispensing medications, pharmacies today play an increasingly important role in providing other types of care as well. For example, many facilities offer health screening and immunizations, while others provide emergency contraception and naloxone for narcotic overdose emergencies.

“Despite their increasingly important role in healthcare delivery, there is limited information on the prevalence, distribution, and characteristics of pharmacies in the US,” said Dr. Qato.

Dr. Qato and colleagues conducted this study to assess any trends between 2007 and 2015 associated with access to prescription medications in the availability of community pharmacies and pharmacy characteristics, such as 24-hour, drive-up, home delivery, e-prescribing, and multilingual staffing.

They also sought to assess whether and how these patterns differed by type of pharmacy, including retail chain, independent, mass retailer, food store, government, and clinic-based pharmacies, as well as how they differed across counties.

Using annual data from the National Council for Prescription Drug Progams, researchers conducted a retrospective analysis, in which pharmacy locations were mapped and then linked to the publically available data to gather information on county-level population demographics such as annual total population, as well as percentages of non-English speaking individuals, and those with an ambulatory disability and aged 65 years and older.

Dr. Qato and fellow researchers found that during this time frame, the number of community pharmacies increased by 6.3%, from 63,752 in 2007 to 67,753 in 2015. In all, 40% of pharmacies were with a retail chain, and 35% were independent. The remaining pharmacies were mass retailers (12%), food stores (10%), clinic-based (3%), or government (less than 1%).

The only pharmacy characteristic that changed over time was e-prescribing. At the national level, the number of pharmacies per 10,000 people did not change (2.11). The number of pharmacies across counties, however, did vary substantially, and ranged from 0 to 13.6 per-capita in 2015. In the Southwest and the Pacific West, there are fewer pharmacies.

Most pharmacies did not offer accommodations that facilitated access to prescription medications, such as home delivery, which was offered by only 25% of pharmacies. This varied considerably, however, by pharmacy type and across counties. Providing home delivery services ranged from less than 1% of mass retailers, to 67% of independent stores. This service was not associated with county demographics such as the percentage of people with ambulatory disabilities or those aged 65 years or older.

These researchers also found that independent pharmacies were more likely to have a multilingual staff and offer home delivery services. Furthermore, independent pharmacies accounted for over one-third of all community pharmacies, and are more common in the Southwest and Plains states, where they are often the only pharmacy servicing the local population.

These findings highlight the need for improved access to pharmacies and improved availability of accommodations befitting local population needs. Dr. Qato and colleagues recommend that any national efforts to improve access to prescription medications also include measures to improve ways to identify and address pharmacy shortage areas.

“The potential role of pharmacies, including pharmacy accessibility, in promoting access to prescription medications is not fully understood and may be an overlooked contributor to non-adherence. Pharmacy retailers should consider monitoring population demographics to better ensure that they offer services and accommodations that specifically target the needs of the local population,” concluded Dr. Qato.

This study was funded by grant number R21AG04923 from the National Institutes of Health, National Institute on Aging.