If a hospital shut down in your town, it would make headlines. If the last primary-care clinic closed, local leaders would hold emergency meetings. But when a pharmacy closes — even though pharmacies provide more day-to-day health care than almost any other institution — it often disappears quietly. Today, that silence is masking a national health-care failure. As The National Desk reported, nearly 50 million Americans now live in “pharmacy deserts,” where access to medication and essential health services has become severely limited. That’s about one in seven people suddenly facing deeper barriers in managing chronic illness, getting immunizations, or simply picking up antibiotics for a sick child.

This crisis didn’t emerge overnight. Between 2010 and 2021, the U.S. lost roughly one-third of its pharmacies, according to data cited by The National Desk. PBS NewsHour reports that closures have accelerated sharply since 2019, as both small independent pharmacies and large national chains struggle to stay afloat. Rite Aid, CVS, and Walgreens collectively have closed hundreds of stores in the past few years — a retrenchment that Newsweek warns may push entire counties into “pharmacy desert” territory.

Behind the closures is a deeply broken model. Pharmacies — especially independents — operate on razor-thin margins, heavily dependent on inconsistent and often shrinking reimbursement rates from pharmacy benefit managers (PBMs). PBS NewsHour highlights that many pharmacies are reimbursed for medications at levels below their acquisition cost, effectively forcing them to lose money on every prescription filled. Add rising labor costs, supply-chain instability, and intensifying competition from mail-order giants, and the result is predictable: shuttered storefronts from rural hamlets to urban neighborhoods.

But the consequences reach far beyond inconvenience. Pharmacies are the most accessible health-care facility for millions of Americans, especially in communities with limited primary-care access. They provide vaccinations, rapid testing, medication counseling, and everyday clinical triage. In many rural areas, a pharmacist may be the only provider within miles capable of delivering same-day care. When these pharmacies close, patients don’t just face longer drives — they face worse health outcomes. Research cited by The National Desk shows that living in a pharmacy desert increases rates of medication non-adherence, which in turn drives higher rates of hospitalization and preventable complications such as heart attacks and strokes.

The communities hit hardest are the ones already disproportionately burdened by health inequities. Neighborhoods with higher shares of Black, Latino, or publicly insured residents often depended on independent pharmacies long before national chains entered the market. As reported by The People’s Pharmacy, these independents serve as hyperlocal safety nets — delivering prescriptions, offering payment flexibility, and maintaining personal relationships that corporate chains simply cannot replicate. When they close, no equivalent support system steps in.

So what can be done? First, we must confront the structural failure of the reimbursement system. PBMs — the middlemen that negotiate drug prices and reimburse pharmacies — wield enormous power but operate with minimal transparency. Reform must start with enforcing fair reimbursement practices that ensure pharmacies are paid at or above the cost of the medications they dispense. States such as Arkansas and West Virginia have already passed laws to hold PBMs accountable; federal policymakers should expand on these models and strengthen oversight nationwide.

Second, we need to rethink the role of pharmacists within the health-care ecosystem. Pharmacies can and should do more than dispense medications. During the COVID-19 pandemic, pharmacists proved they could vaccinate, test, and manage certain chronic conditions safely and effectively. Many states have expanded pharmacists’ scope of practice, but reimbursement hasn’t kept up. Payment models must reward pharmacies for clinical services — medication therapy management, chronic-disease monitoring, preventive care — not just for pill-counting. That means Medicare, Medicaid, and private insurers must begin reimbursing these services consistently, the same way they do for clinics.

Third, we need targeted support for pharmacies in vulnerable communities. Similar to the incentives offered to rural hospitals and community health centers, policymakers could establish “Pharmacy Access Zones” — areas where pharmacies receive financial support or tax incentives for staying open. Rural pharmacies in particular may require direct subsidies comparable to rural telehealth or broadband programs. The alternative is to accept expanding health deserts at a time when chronic disease, aging populations, and complex medication regimens are rising sharply.

Fourth, we must invest in hybrid models — blending brick-and-mortar pharmacies with telepharmacy and delivery services — to ensure access even in the most remote regions. For example, a state could fund telepharmacy hubs staffed by clinical pharmacists who supervise remote dispensing kiosks. This approach has already shown promise in parts of North Dakota and Alaska. But convenience alone cannot replace the value of a physical pharmacy; rather, telepharmacy should complement, not supplant, in-person access.

Finally, large pharmacy chains should not be let off the hook. While corporate restructuring may be necessary for their profitability, closures that eliminate essential health access should trigger community-impact reviews — similar to requirements placed on hospital systems. When a pharmacy closes in a rural or underserved area, chains should be required to coordinate with state health departments to ensure continuity of care, whether through transitional delivery services, pop-up vaccination clinics, or partnerships with local health providers.

The pharmacy-closure crisis is a warning — one we cannot afford to ignore. Pharmacies are a backbone of everyday health care. Their disappearance erodes the most fundamental element of public health: accessible, timely medication. To protect the health of millions of Americans, policymakers must act swiftly, insurers must reform broken payment systems, and communities must champion their local pharmacies before they vanish. This isn’t just a business problem — it’s a public-health emergency in slow motion.