Walgreens Pharmacy. (AP Photo/ Nam Y. Huh –File)
Guadalupe Hayes-Mota is director, bioethics at the Markkula Center for Applied Ethics. Views are his own.
This article, "Families Like Mine Depend on Their Local Pharmacy for Medicine — and for Survival" , originally appeared on STAT News and is reprinted with permission.
When my father needs insulin, he drives 25 miles round trip to the nearest Walgreens in a remote corner of California. That trip takes him about 50 minutes, nearly an hour every time he needs his medication, if he has a car available. It is the only pharmacy within that distance where he can get his medication, a flu shot, or basic health advice.
Walgreens has announced that it’s closing 1,200 stores by 2027. If my father’s pharmacy closes, it’s not a mere inconvenience. These closures are a slow-motion public health emergency. Across rural America, families like mine depend on their local pharmacy not only for medicine, but for survival.
These closures reflect an ethical failure: choosing investor profits over the duty to keep people healthy. Addressing this crisis requires three urgent steps: supporting underserved areas with targeted incentives and mobile or telepharmacy services, investing in the workforce through safe staffing and career pathways, and granting pharmacists provider status with expanded scope of practice.
Between 2010 and 2021, the United States lost more than 26,000 pharmacies, nearly one-third of all retail locations — almost one pharmacy for every town in America, gone. Nearly 45 million Americans now live in “pharmacy deserts,” places where the nearest pharmacy is more than 10 miles away. Closures are accelerating. Rite Aid filed for bankruptcy in 2023, and Walgreens announced its closures. CVS announced earlier this year that it would close 270 stores. Rural communities, low-income neighborhoods and communities of color are hit hardest.
This is not ordinary belt-tightening. In July 2025, the private equity firm Sycamore Partners acquired Walgreens Boots Alliance in a $10 billion deal. When private equity enters health care, closures are not side effects. They are the business model. Extracting value for investors comes at the cost of extracting access from patients.
Pharmacies anchor our public health system. They deliver flu shots, Covid-19 vaccines, and medication counseling. For many people without regular access to doctors, they are the only point of care.
Decisions to close stores are not just financial; each closure widens disparities. For my father, losing his Walgreens would mean missed insulin doses. For others, it means untreated hypertension, skipped vaccines, or delayed care for minor infections until they become emergencies. Justice demands a system that closes care gaps, not deepens them.
Here are four forces breaking America’s pharmacies:
A broken reimbursement model. Pharmacy benefit managers (PBMs) often reimburse pharmacies less than the cost of dispensing, pocketing the difference through “spread pricing.” Delayed direct and indirect remuneration fees erase already thin margins. In a 2025 survey, 96.5% of independent pharmacists said PBMs and plan reimbursement for Medicare Part D threatened their survival. This is not market inefficiency. It is a deliberate distortion that destabilizes care.
A burned-out workforce. More than half of pharmacists report burnout, fueled by crushing prescription volumes, short staffing, and hours of insurance paperwork. Technician turnover exceeds 30% percent in some regions. These conditions heighten risks of medication errors and drive professionals from the field. Failing to protect caregivers ultimately harms patients.
Pharmacy deserts created by closures. Each closure pushes families farther from care. For my father, a closure would double his driving distance for insulin. For others, it means choosing between groceries and gas to reach medication. Geographic inequities in access are not accidents. They are injustices.
Limits on pharmacists’ scope. In many states, pharmacists cannot prescribe for minor conditions or adjust chronic medications, even when they are the most accessible professional in town. A Washington state pilot expanding pharmacist authority showed improved patient access and reduced public health costs. Ignoring trained professionals while patients go without care wastes expertise and denies beneficence.
All four forces converge into the same failure: a health system that leaves people behind while solutions sit in plain sight. Several changes could address this failure.
Pharmacy deserts don’t fix themselves. Federal and state governments should step in with grants, tax credits, and incentives to keep pharmacies open where margins are thin. Where brick-and-mortar stores can’t be sustained, mobile and telepharmacy models can step in. In Arizona, for example, telepharmacy kiosks and mobile vans have extended access to thousands of patients. The principle of justice demands that resources flow to where need is greatest — not just where profits are easiest.
No pharmacy can function without people behind the counter. Technicians face 30% turnover rates and pharmacists report exhaustion levels comparable to intensive care unit nurses during the pandemic. We need enforceable staffing ratios, national training standards, and mental health resources for workers. Just as hospitals can’t operate without safe nurse-to-patient ratios, pharmacies can’t operate without safe pharmacist-to-prescription ratios. Protecting caregivers like my father’s pharmacist is inseparable from protecting patients like him.
Pharmacists are among the most accessible health professionals. Yet in many states, they remain confined to dispensing pills. Recognizing pharmacists as providers at the federal level would allow them to bill Medicare and Medicaid for clinical services like chronic disease management, preventive screenings, and immunizations. States should also expand scope of practice so pharmacists can prescribe for minor ailments and adjust chronic medications. Ethically, failing to use trained professionals to their full ability wastes expertise while patients go without care.
The stakes could not be higher. Walgreens’ closures and Rite Aid’s bankruptcy are not acts of fate. They are business choices. Every closure erases a point of care, leaving patients to shoulder the health consequences alone.
If my father’s Walgreens closes, his insulin will require a 50-mile round trip. That means fewer trips, more missed doses, and a higher risk of hospitalization. Multiply his story by millions and the national picture is clear: pharmacy deserts expanding, inequities deepening, lives at risk.
We already know the solutions. These are not only operational fixes. They are moral imperatives.
Failing to act is a choice to let lifelines like my father’s disappear. And that is a choice no just society should accept.