Healthcare Deserts Part 4: Philanthropic Solutions

The issue of access to healthcare is now at crisis level in urban, suburban and rural communities nationwide. Whether it’s consolidation and closure of hospitals, elimination of emergency rooms, maternity and mental health services or general surgery departments, Americans are having problems accessing healthcare. In addition to the closure of medical services, there’s a shortage of healthcare professionals and pharmacies.

Local, state and federal lawmakers have drafted legislation to stop the devastating trend of healthcare deserts. However, government moves slowly and more is needed.

Philanthropic organizations like the Pew Charitable Trusts have stepped up to support nonprofit organizations that promote health and well-being. The Pew Fund for Health and Human Services in Philadelphia helps local social services organizations in the region expand their reach and impact in implement promising solutions to gaps in service delivery.

For example, they have awarded Child Guidance Resource Centers $250,000 over two years to address the community-based youth mental health workforce shortage throughout the Philadelphia region. The funding will allow the agency to enhance and expand its professional development center in response to a decline in qualified candidates applying for positions and an increase in youth mental health professionals leaving public health for less-stressful, higher-paying career opportunities.  Pew also funded Philadelphia’s Children’s Alliance $250,000 over two years for a pilot a holistic treatment model that meets the therapeutic needs of children under age 10 who exhibit “problematic sexual behavior,” a group that requires highly specialized care.

Pharmacy Deserts

Pharmacy deserts are also rapidly increasing with the closure of drug store chains like Rite-Aid, CVS and Walgreens and are negatively impacting the delivery of healthcare services nationwide. Low-income communities are disproportionately affected by pharmacy deserts. People don’t realize it, but pharmacists are often the most accessible healthcare practitioners.

Pharmacy deserts are defined as “any area with restricted access to pharmacy services, fundamentally based on a person’s distance from the nearest pharmacy. In urban areas, a pharmacy desert occurs when a patient lives over a mile away from the nearest pharmacy. The distance changes to two miles in suburban settings and 10 miles in rural settings.”

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Urban areas with the most pharmacy deserts include Philadelphia, Chicago, Los Angeles, Baltimore, Milwaukee, Dallas, Boston, and Albuquerque. South Dakota, Montana, Nebraska, and Kansas have the most rural counties with pharmacy deserts.

According to the International Pharmaceutical Federation (FIP), the largest global pharmacist advocacy organization, people visit pharmacies about 12 times more frequently than they do their own primary care provider. Those with multiple health issues report making visits to their community pharmacy up to 35 times per year.  FIP asserts that regular engagement with pharmacists supports routine healthcare management, bridges gaps in care, and promotes preventative health in the communities they serve.

Although pharmacy closures are the primary contributor to the increase of pharmacy deserts, lack of access occurs for a several reasons. The healthcare system is now structured so that pharmacy benefit managers (PBM) manage drug costs. The rise of PBMs has contributed greatly to the increase of pharmacy deserts. According to FIP, PBMs create pharmacy networks for insurers that require patients to use specific pharmacies. As a result, patients may not be permitted to fill their prescription using their insurance coverage at pharmacies closest to their homes. PBMs dictate how much money pharmacies will be reimbursed when filling a prescription and the reimbursement amount may not be enough for the pharmacy to make a profit. Hence, the pharmacy may no longer be profitable and eventually closes down. Without access to a local pharmacy, patients become less compliant in taking their medications as prescribed and may eventually drop the therapy altogether.

Pharmacists play a key role in early diagnosis and treatment. In 2022, the Pharmacy Access Initiative was created by the National Community Pharmacists Association (NCPA) and researchers at the University of Southern California (USC). An interactive mapping tool was developed to determine where pharmacy deserts exist and which areas require the greatest attention. The data can be presented to policymakers to improve regulation, transparency, and equitable reimbursement.

Examples of Innovative Solutions

The Pharmacy Desert Act of 2023 is comprehensive legislation aimed at improving access to essential medications and pharmacy services in the United States, particularly in areas where services are limited. The bill “aims to improve access to essential medications and pharmacy services in underserved communities by funding new construction, relocating existing pharmacies, and preventing closures. It also aims to improve access through telepharmacy and increased reimbursement from Medicaid and Medicare.”

In Washington State almost 3 million residents live in areas that with a shortage of health professionals. According to Washington State University (WSU), nearly 800 new providers are needed to eliminate those gaps in access to care, and many residents in rural communities rely on the services of the local pharmacy for their health care needs.  As a result, WSU Department of Pharmacy and Pharmaceutical Sciences has developed a rural health initiative to recruit more students as a solution to address health disparities in the state. An anonymous $2.2 million donation helped kick-start the Rural Health Initiative, which will train pharmacy students to specialize in rural health care. Students accepted into the program are eligible to receive a $10,000-a-year scholarship. In return, they make a commitment to practice for at least three years in rural Washington after graduation.

 “We believe that students from rural areas are more likely to return to those communities after graduation,” said Angela Stewart, WSU’s associate dean for rural health, in a previous news report. Pharmacists are recognized as some of the most accessible providers. You don’t need an appointment to access pharmacy care or advice. A lot of these rural residents, when they are experiencing something new with their health, the pharmacy might be the first place they go for help and advice, for recommendations in terms of self-care and even perhaps for initiating clinical services or for referral, if necessary.”

“We recognize our students come from all over the country and there are pharmacy deserts all over the county,” Stewart concluded. “I think there’s potential for spreading what we learn and what’s successful beyond Washington eventually.”

In 2023, FIP launched a screening program, called The CKD Pharmacy Toolkit, an unbranded set of educational and practical tactics designed to upskill and empower pharmacists to impact the course of chronic kidney disease (CKD) through early identification and intervention.  Common in Black and Latinx communities, CKD is a vastly underdiagnosed, progressive disease, typically presenting no symptoms in the early stages. The program has already garnered success after being launched and is being accessed by pharmacists globally. Early reports suggest a high rate of adoption in some markets with the results and impact to communities being closely observed over the next several months to years.

More information is available on a state-by-state breakdown of rural health resources and tools for success. The future to eradicating healthcare deserts is promising with philanthropy, nonprofits and educational institutions working collaboratively to develop innovative initiatives to address the dire state of healthcare. The health of our nation depends on it.