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The growing challenge of pharmacy access
Over the past decade, the United States has witnessed an unprecedented shrinkage of its retail pharmacy network.
Nearly a third of America’s pharmacies closed between 2010 and 2021, and the closures are expected to continue through 2025.
When chains like Walgreens and Rite Aid shutter hundreds of locations to cut costs, neighborhoods lose a critical health-care touchpoint. Research from the Health Affairs Scholar journal shows that 15.8 million people (about 4.7% of the U.S. population) live in pharmacy deserts: areas where residents must travel long distances to reach a pharmacy. These deserts disproportionately affect rural, low-income, and minority communities. A separate analysis found that people may have to drive 40–60 miles to reach a pharmacy in some rural states.
Pharmacy deserts arise when no retail pharmacy exists within a mile in urban areas, two miles in suburban areas or 10 miles in rural areas. States such as New Mexico, Alaska, and Arizona have the highest proportions of their populations living in pharmacy deserts. With Walgreens planning to close around 1,200 stores over the next three years and rivals like CVS and Rite Aid closing hundreds more, these deserts are likely to expand. Lockton’s analysis warns that pharmacy closures will continue throughout 2025 and urges employers to assess the impact on their workforce and proactively manage pharmacy benefit costs.
How closures undermine adherence and health
Pharmacies do far more than dispense prescriptions; they offer vaccinations, screenings and chronic-disease counselling. When a community pharmacy closes, residents lose convenient access to these services, which can lead to delays or missed doses. A large cohort study of older adults found that patients who filled their prescriptions at a pharmacy that subsequently closed experienced an immediate and sustained decline in adherence to statins, beta-blockers, and oral anticoagulants. There was about a six-percentage-point drop in the proportion of days covered. The decline was even larger for users of independent pharmacies and people living in low-access neighborhoods.
The consequences of poor adherence are sobering. Medication non-adherence contributes to nearly 25% of hospital admissions, 50% of treatment failures, and about 125,000 deaths in the U.S. each year. Estimates suggest non-adherence causes roughly 10% of hospitalizations annually and costs approximately $290 billion. Poor adherence also leads to higher medical costs and more frequent physician visits. These medical events translate into missed workdays and reduced productivity.
Productivity and cost implications for employers
Studies linking medication adherence to workplace productivity reveal a direct business case for employers. In a cohort study of employees with chronic conditions, adherent workers experienced 1.7–7.1 fewer days absent and 1.1–5.0 fewer days on short-term disability than non-adherent workers. Another review of research on adherence and productivity found that improving adherence among employees with diabetes by 10% could reduce disability days by 441 work days in a cohort of 1,000 workers and save an employer about $94,000. Non-adherence can also contribute to 2–10 extra absent days per employee each year, leading to staffing issues, as well as disability and health-care claims.
For self-funded employers, pharmacy benefit costs are a major component of health spending. When local pharmacies close, plan members may face higher dispensing fees, limited choice of pharmacies and delays in filling prescriptions. Retail pharmacy closures can also shift reimbursement dynamics and increase employer costs. Moreover, pharmacy deserts exacerbate existing health disparities; they are most prevalent in communities with lower income, higher unemployment and larger proportions of racial and ethnic minorities. Employers with geographically dispersed or lower-income workforces should recognize that access barriers may be driving gaps in care and productivity.
Strategies to sustain access and adherence
Employers can take proactive steps to mitigate the effects of pharmacy closures and support their employees’ health:
Promote mail-order and home delivery. Mail-order pharmacies help ensure patients receive maintenance medications consistently. They can be particularly valuable for employees in rural or low-access areas where reaching a brick-and-mortar pharmacy requires long travel.
Offer onsite or near-site pharmacy services. Onsite clinics that provide vaccinations and prescription refills reduce the need for employees to travel elsewhere and help sustain adherence. Remote-dispensing kiosks or staffed clinics can also be located at large work sites or distribution centers.
Invest in education and navigation. Many employees do not take medications as directed because of cost, forgetfulness or confusion. Providing health-literacy resources, reminder tools and access to pharmacists for counselling can improve adherence.
Leverage benefit design. Value-based insurance design and copay-assistance programs can lower out-of-pocket costs and reduce financial barriers to medications.
How Aphora Health bridges the access gap
Aphora Health recognizes that pharmacy access, medication adherence and productivity are inextricably linked. Our integrated model combines sourcing, fulfillment and care navigation so employees can get the medications they need, wherever they live, without hassle. By partnering directly with manufacturers and distributors, Aphora ensures supply security and competitive pricing. Our fulfillment infrastructure includes mail-order, specialty pharmacy and temperature-controlled delivery options, giving members multiple ways to receive their prescriptions. And our care navigation team works with members and providers to coordinate refills, manage prior authorizations and offer ongoing support.
This integrated approach means that employees no longer have to drive dozens of miles to fill a prescription or worry about delays caused by pharmacy closures. It helps maintain medication adherence, reducing preventable hospitalizations and boosting productivity. Employers benefit from improved health outcomes and controlled pharmacy benefit costs, meeting the dual goal of managing access while managing spend.
Looking ahead
Pharmacy deserts and access disruptions are not transient. With closures expected to continue through at least 2025, employers must adopt strategies that ensure reliable access to medications for their workforce. By understanding the relationship between pharmacy access, adherence and productivity and by partnering with solutions like Aphora, organizations can protect employee health, improve performance and contain costs. A proactive stance today will help businesses navigate the evolving pharmacy landscape and support the well-being of their teams tomorrow.
