Pharmacies are closing at an alarming rate in 2024, and the consequences are shaking the very foundation of healthcare in this country. Nearly 2,300 pharmacies have shut their doors since the start of the year, with closures happening at a pace of around eight pharmacies a day. While a 3% drop in the number of pharmacies across the country might not seem significant on the surface, imagine if 3% of schools or hospitals closed. The impact would be deafening, and yet, this crisis is going largely unnoticed.

This mass closure affects both large chains like CVS, Walgreens, and Rite Aid, as well as smaller independent pharmacies that serve rural and underserved communities. The closure of these pharmacies isn’t just about the businesses themselves — it’s about the thousands of pharmacy staff left without jobs and the communities left without vital access to healthcare. And this isn’t a problem isolated to one or two companies. It’s industry-wide, with major layoffs happening at corporate offices and pharmacies struggling to stay afloat.

It’s eerily reminiscent of the railroad expansion in America’s history. As railroads connected communities and spurred economic growth, monopolies grew, and smaller players were swallowed up. Over time, the system began to retract, pulling back services and isolating people. We’re seeing the same pattern now with pharmacies. Large corporations have dominated the space, buying up smaller businesses, and as the economic environment shifts, they’re pulling back. The result? People in rural areas lose access to essential services, and the industry suffers as a whole.

There are several key factors contributing to this crisis. First, the reimbursement rates for medicines are low, and pharmacy benefit managers (PBMs), acting as intermediaries between pharmacies and insurance companies, determine what pharmacies get paid for filling prescriptions. Unfortunately, PBMs often don’t provide pharmacies with a clear picture of how much they will be reimbursed, leaving pharmacies to lose money on many prescriptions. One pharmacist shared how she had to turn away patients because she knew filling their prescriptions would result in a financial loss.

Another factor is the rising costs associated with specialty drugs. Medications for complex diseases like cancer or autoimmune disorders are becoming a larger part of pharmacy revenues, but they are also expensive and difficult to obtain. The high costs eat into pharmacy budgets, leaving smaller margins for profit. Independent pharmacies also face higher costs for the same medications that larger chains receive at a discount due to their buying power. It’s a tough environment for small businesses to survive.

Consumer behavior is another driving force. Online and mail-order pharmacies are becoming more popular due to their convenience and lower costs. While this shift makes sense for patients, it adds even more pressure on smaller pharmacies, who are forced to offer additional services at a higher cost. And then there’s theft, which is an increasingly significant issue in urban areas. Many pharmacists have faced dangerous situations with robberies or even violent attacks, causing them to abandon their pharmacies, further contributing to health disparities in these communities.

Regulation also plays a role. While increased oversight in response to the opioid epidemic is necessary, it has led to more complex processes, higher insurance costs, and added pressures on pharmacies. This regulatory burden is exacerbating the financial struggles many pharmacies face.

The closure of pharmacies is not just an economic issue — it’s a public health issue. As pharmacies close, communities lose access to healthcare. This is especially critical for the aging population, many of whom live in rural areas where pharmacies are more likely to close. The remaining pharmacies are overwhelmed with additional patients, leading to longer wait times, increased stress on pharmacy staff, and higher turnover. This creates a cycle of burnout that affects the entire profession.

As pharmacy deserts begin to emerge, it’s clear that access to healthcare is at risk. However, the rise of mail-order pharmacies and telehealth services could help bridge the gap, though it’s still essential for patients to have in-person access to a pharmacist for consultations and evaluations. But the crisis in pharmacy isn’t just about closures — it’s also about the loss of interest in the profession itself. With layoffs and the increasing challenges in the industry, many new pharmacists are questioning whether they even want to pursue this career. This lack of interest could lead to a staffing shortage in the future, further compounding the challenges in pharmacy.

But it’s not all doom and gloom. Hard times often lead to innovation, and that’s what we’re seeing in pharmacy today. Pharmacies are investing in automation, AI, and technology to improve efficiency. In some cases, pharmacies are diversifying their services, offering clinical consultations, medication management, and partnering with healthcare systems to provide more comprehensive care. New legislation, such as HR 1996, is also working to level the playing field for independent pharmacies by addressing unfair reimbursement practices.

Some pharmacies are pivoting entirely, focusing on high-margin specialty medications or even exploring alternative medicine. It’s clear that the pharmacy landscape is changing, but that doesn’t mean it’s going away. We’re witnessing a transformation that could ultimately create a better, more sustainable profession.

As pharmacists, we can advocate for ourselves, support our associations, and raise awareness about these issues. We must also be proactive in taking control of our careers. If you’re someone who’s going through a layoff or struggling with burnout, it’s crucial to seek support, whether through a coach, mentor, or professional network. It’s possible to rebuild your career and thrive in this evolving landscape. The Great Pharmacy Closure of 2024 isn’t just a business shift — it’s a wake-up call for change in the healthcare system.

Together, we can help shape the future of pharmacy. The road ahead may be challenging, but by coming together, supporting one another, and driving change, we can ensure that our profession continues to evolve and thrive.