When the Pharmacy Closes, Everything Closes With It

In many small rural American towns, when hospitals and clinics close and clinicians leave, the local pharmacy still stands, at least for awhile. It is where people pick up blood pressure medications, get flu shots, and ask quick questions. For many rural residents, it is the most reliable point of contact they have with the entire healthcare system. But, that too is disappearing.

The Numbers

The scale of pharmacy closures in recent years is staggering. According to data from NielsenIQ and Coresight Research, 2024 was the single worst year on record, with 2,437 pharmacies closing nationally. The trend has continued: IQVIA analysis found that nearly 8,000 fewer retail pharmacies operated in the U.S. in 2025 compared to 2018. Major chains including Walgreens, CVS, and Rite Aid have closed their pharmacies, but in cities there are often nearby alternatives. In rural areas, there are no alternatives. Since 2021, annual closures occurring in rural areas have more than doubled, from 4% to 9%, and a single rural pharmacy closure affects 54% of local patients, compared to just 15% in metro areas.

Why It Is Happening

The business of running a rural pharmacy has become nearly impossible. According to the National Rural Health Association, 80% of rural independent pharmacies receive reimbursement below the cost of getting and distributing medications, driven largely by pharmacy benefit managers (PBM), the intermediaries between pharmacies and insurers who set reimbursement rates that have not kept pace with costs.

The policy environment has made things worse. The One Big Beautiful Bill Act was passed on July 4, 2025, and cut approximately $1.15 trillion in federal health spending over the next decade, largely through Medicaid cuts, according to AMCP. The National Rural Health Association estimates these Medicaid cuts alone could reduce spending in rural areas by $155 billion over ten years. While the bill includes $50 billion in rural hospital relief, it didn't include reforms for PBM that could have helped independent pharmacies remain viable, including a ban on spread pricing in Medicaid, as noted by Faegre Drinker. The pharmacies most at risk were further hindered rather than helped. 

What a Pharmacy Provides Beyond Medication

It is easy to underestimate what a community loses when its pharmacy closes. As IQVIA notes, for patients living far from primary care providers and hospitals, the local pharmacy is often the initial point of contact with the healthcare system. People get medication counseling, vaccines, and support in managing chronic disease.  When it closes, adherence to medical advice and protocols falls. Pharmacy Times reports that reduced pharmacy proximity correlates with lower medication adherence and increases in hospitalizations and mortality risk. A study published in JAMA Network Open found that pharmacy closures led to a significant drop in the number of older adults taking their cardiovascular medications. Mail order is often proposed as the solution. But according to Amazon Pharmacy, as of 2025, only 45% of the U.S. was eligible for same-day delivery, with rural areas consistently not prioritized.

The Specific Cost for Rural Women

For rural women, pharmacy closures carry consequences that extend beyond what most people imagine. Between 2003 and 2021, independently owned pharmacies in the most rural counties declined by 16.1%, and 630 communities lost their last retail pharmacy entirely, according to a 2026 study published in the journal Pharmacy. Each closure removes not just a dispensing site but a potential access point for contraception, counseling, and referral. As ScienceDirect reports, pharmacy deserts adversely affect access to both prescription and nonprescription contraceptive products, with closures disproportionately affecting rural and low-income communities. For women managing chronic conditions like hypertension or diabetes, a pharmacy closure can mean delayed refills, skipped doses, and worsening health over time, on top of the later diagnoses and more limited care access that rural women already face.

What Needs to Change

PBM reform remains an urgent policy issue. Pharmacies cannot survive when reimbursement falls below the cost of dispensing a prescription. And removal of reform provisions from the OBBBA is unfortunate. Telepharmacy offers a partial solution: a CDC study in Preventing Chronic Disease found that medication adherence was significantly higher in rural telepharmacy settings compared to areas that lost pharmacy access altogether. But these solutions are incomplete. Rural communities have had to survive decades of underinvestment in healthcare, while populations grow older and sicker. A pharmacy closing in a small town is a crisis with long-term health consequences.