Neighborhoods in cities like Chicago are quickly becoming places where people can’t fill medical prescriptions on the spot because their drugstores are closed or don’t accept Medicaid.
Why it matters: The pandemic has accelerated the growth of “pharmacy deserts” as unprofitable and less profitable stores have closed. It’s a worrying trend for the urban poor, who are less likely to try online pharmacies and more likely to drop their drug regimens if they can’t get drugs locally.
Send the news: As of Dec. 1, Medicaid patients in Illinois — of which there are 400,000, according to the Chicago Tribune — could no longer have their prescriptions filled at Walgreens, a common chain headquartered in suburban Chicago.
- The change came because Aetna, which contracts with the state of Illinois to serve Medicaid recipients, dropped Walgreens as its supplier. CVS — a top rival to Walgreens — owns Aetna, as does pharmacy benefits manager CVS Caremark.
- CVS “does not have pharmacies in five major West Side neighborhoods,” according to the Tribune.
- Illinois State Representative La Shawn Ford called Aetna’s decision “pathetic” and told the Tribune: “It is an attack not only on black people, but also on those who are struggling during the pandemic.”
The Backstory: Researcher Dima Qato coined the term “pharmacy desert” in a 2014 article that found that there were far fewer pharmacies in Chicago’s black neighborhoods than in white and mixed neighborhoods.
- Medicaid policies like the one in Illinois “is all over the country, where Medicaid dictates where and where you can fill your medication,” Qato tells Axios. “And that leads to certain pharmacies having fewer patients, which leads to less profit, which leads to closures.”
- Qato — who recently held a position as a professor at the University of Southern California and is on the cusp of moving from Chicago — said Illinois’ new Medicaid policies are currently “causing a lot of outrage in the community.”
- By Qato’s definition, people live in a “pharmacy desert” if they can’t fill a prescription within half a mile of their home (for low-income people without a car), and a mile for others.
- “We’ve estimated it for Chicago to be one-third of the city’s population, with a significant difference in racial makeup,” Qato says.
Between the lines: Because pharmacies get the lowest reimbursements for filling Medicaid prescriptions, they are more likely to close stores in low-income neighborhoods and open in wealthy neighborhoods, notes Antonio Ciaccia, chief strategy officer of 3 Axis Advisors, a consulting firm focused on medicine supply chain.
- “We’re seeing a general withdrawal from impoverished areas,” said Ciaccia, a consultant to the American Pharmacy Association.
Of interest: Studies draw a direct line between pharmacy closures and people who stop taking their vital medicines – with terrible health outcomes.
- Adults over the age of 50 were more likely to drop their cardiovascular pills after their local drugstore closed, according to a study published in the Journal of the American Medical Association in 2019 (of which Qato is the lead author).
- Benjy Renton, the Middlebury College senior who has been closely monitoring the COVID-19 outbreak, noted on Twitter that pharmacy deserts can stop the administration of vaccines.
What’s next: While “food deserts,” where downtown residents don’t have access to fresh and healthy groceries, are a bigger problem in places like New York City, access to pharmacies is a growing problem. Drugstore numbers have fallen 20% in NYC since 2016, according to Jonathan Bowles, executive director of the Center for an Urban Future.
- “For example, I’ll miss the 70 Duane Reades that closed this year,” was the headline of an article that appeared in New York Magazine’s “Curbed” on December 30. (Duane Reade is owned by Walgreens.)