K.B. Brown, a resident of north Minneapolis, has faced a significant challenge since Walgreens closed its West Broadway store last year. This closure left just one pharmacy to serve the area’s 67,000 residents. Brown, who also runs a graphics design business, has found himself driving employees, family members, and older neighbors to pharmacies in nearby Robbinsdale and other suburbs multiple times a week.
“It’s tough. Many of them can’t get around by themselves,” Brown shared. Reflecting on the past, he noted, “When I was younger, we had everything we needed right here on the North Side—grocery stores, clothing shops, and pharmacies. Now, we have just one grocery store and one pharmacy.”
### Limited Choices
North Minneapolis is not alone in facing a growing issue known as “pharmacy deserts.” This term describes areas with limited access to pharmacies as both small and large chains are closing locations, leaving residents with fewer options for obtaining their medications quickly. The closures are expected to increase, especially as major chains continue to downsize. CVS recently shut down 600 stores between 2021 and 2023 and has announced plans for 300 more closures later this year. Meanwhile, Walgreens has proposed to close 1,200 unprofitable stores, starting with 500 in 2025.
Currently, about half a million residents in Minnesota live in these pharmacy deserts, according to a recent report from the state Department of Health. Many more are at risk if even a single pharmacy in their area closes.
Brown and other residents express their concerns as we await details on more closures from CVS and Walgreens. They worry about how much more their community can handle.
Disputes over responsibility for the situation exist among pharmacists, pharmaceutical companies, and pharmacy benefits managers (PBMs), the entities overseeing prescription benefits. The Department of Health estimates that over one-third of individuals in Minneapolis, St. Paul, and nearby suburbs are living in pharmacy deserts.
The number of independent pharmacies in Minnesota has plummeted from 478 to just 156 in the last two decades. Many surviving pharmacies are operating at a loss and seeking new ways to generate income, while larger chain stores have dwindled from 552 to 451. In the Twin Cities alone, independent pharmacies decreased from 142 to 48 within the same timeframe.
### Growing Concerns
Cities like Hinckley, Clarkfield, and Avon have lost their only pharmacies this year, contributing to the 17% of the state’s population living in areas without access to a pharmacy, according to pharmacist and activist Luke Slindee.
“This is heartbreaking,” said Jill Phillips, the executive director of the Minnesota Board of Pharmacy. “The significant drop in pharmacies is alarming, especially over the last decade. Something needs to be done.”
The rise of pharmacy deserts is troubling for individuals like Brown. “We’re a community that supports each other,” he said. “But it’s not easy.” The closure of Walgreens, CVS, and Cub Foods’ pharmacy has compounded the problem.
James Peacock, a chronic disease epidemiologist, has researched this issue with the University of Minnesota. He warns that while 8% of the population currently lives in a pharmacy desert, that number could increase to 11.7% if the one pharmacy left in a region shuts down.
“We’ve lost vital pharmacies,” he said, referring to places like the former CVS and Walgreens locations in St. Paul.
### Seeking Solutions
To address these growing concerns, Slindee and other pharmacists are advocating for change at the legislative level. State Senator Melissa Wiklund is sponsoring legislation aimed at supporting the pharmacy industry.
“People are worried about losing local Walgreens and CVS locations,” she mentioned. “If a pharmacy closes near a senior housing facility or diverse neighborhood, it creates more challenges for residents to access their prescriptions.”
The crisis stems from several factors, including low reimbursement rates from insurers as middlemen like PBMs increase their role. These organizations negotiate drug prices and manage prescription benefits, but many independent pharmacists feel they are increasingly squeezed out.
PBM officials argue that they provide necessary services and cost savings for patients, claiming that many independent pharmacies receive higher reimbursement rates than chains.
Critics, however, contend that PBM policies, especially those favoring mail-order pharmacies, put considerable pressure on local pharmacies, particularly smaller ones. Frequent changes in price lists also complicate matters, leaving pharmacists uncertain about reimbursement rates and what medications to stock.
### A Challenging Environment
“It’s a chaotic situation right now,” said John Hoeschen, owner of St. Paul Corner Drug Store. He recently faced pressure from the Express Scripts PBM to sign a new contract with reimbursement rates that fell below his operating costs. Unable to accept the terms, he risks losing access to a large portion of his customer base.
Despite these challenges, Hoeschen has diversified his offerings. On a recent afternoon, he noted a steady stream of customers receiving flu and COVID-19 vaccines, which now account for half of his revenue.
Deborah Keaveny, who runs a family-owned pharmacy in Winsted, echoed similar sentiments, stating that her business is struggling to stay afloat. With only three independent pharmacies remaining in a large radius, she worries about the future viability of her pharmacy.
“It’s never been this tough. I’m questioning how long I can keep this going,” she explained. To make ends meet, she has taken on additional roles, such as becoming a Medicare insurance agent.
Slindee’s motivation to advocate for change is personal. After watching his parents sell their pharmacy and then see it close just a few years later, he understands the importance of access to local pharmacies.
As Brown stands outside his business in north Minneapolis, he reflects on the urgent need for solutions. “People around here really need help,” he said, pointing to nearby senior housing. “They need rides, and they need access to their medications.”
