Loading...
Discover how traditional PBMs fuel pharmacy deserts, and how Rightway’s transparent, conflict-free model is restoring access across communities.
What is a pharmacy desert? A pharmacy desert is an area where people have limited or no access to nearby pharmacies. This means residents may struggle to get essential medications without traveling long distances, often at the cost of time, money, or both. For many Americans—especially those in rural or low-income communities—this lack of access creates serious barriers to managing their health. Today, more than 45 million people in the U.S. live in pharmacy deserts, highlighting a growing healthcare gap that demands urgent attention.
Nearly half of U.S. counties have at least one pharmacy desert, and as access to pharmacies dwindles, patients miss out on essential medications and services, putting their health and well-being at serious risk. A major contributor to this problem is the role of traditional pharmacy benefit managers (PBMs), whose profit-driven practices are pushing small, independent pharmacies out of business.
A pharmacy desert is an area where residents have little to no access to a nearby pharmacy. These can show up differently based on the type of area:
Defined as areas with no pharmacy within a half-mile.
Common in low-income or underserved neighborhoods.
Residents often face long waits, limited transportation, or high delivery costs.
Defined as areas where the nearest pharmacy is 10 miles or more away.
Long travel times and lack of public transportation make access difficult.
In some rural counties, people drive over an hour to get prescriptions.
In some areas, residents must drive over an hour to fill prescriptions. In Navajo County, Arizona, more than 100,000 residents drive an average of 77 minutes to the nearest pharmacy. In nearby Apache County, over 66,000 residents have to drive an hour and a half.
From 2021 to 2024, the number of community retail pharmacies decreased by nearly 15%, worsening pharmacy access across the country. In communities affected by pharmacy deserts, the absence of local pharmacies creates significant barriers to healthcare access. Without a nearby pharmacy, the simple act of filling a prescription can turn into a daunting task. For many, the consequences extend far beyond inconvenience, often resulting in worse health outcomes and increased healthcare costs.
When patients lack easy access to a nearby pharmacy, they are more likely to skip or delay taking their medications. Managing chronic conditions like diabetes, hypertension, and asthma requires medication adherence, but if getting to the pharmacy becomes a time-consuming, costly, or difficult task, many patients won’t make the trip.
Pharmacies aren't just places to pick up prescriptions. They also provide vaccinations, offer health screenings, and give personalized advice that can make all the difference in a patient’s care. When pharmacies disappear, these services disappear along with them, forcing patients to travel further for basic healthcare—or go without.
Pharmacy deserts disproportionately affect low-income and minority communities, exacerbating existing health disparities. These are the same communities that often face other barriers to care, like fewer doctors or hospitals nearby.
More than 45 million people in the U.S. live in pharmacy deserts.
Nearly half of all U.S. counties have at least one pharmacy desert.
From 2021 to 2024, the number of community retail pharmacies decreased by nearly 15%.
The three largest pharmacy benefit managers—CVS Caremark, Express Scripts, and Optum Rx—dominate the prescription drug market, and their profit-driven practices are directly contributing to the rise of pharmacy deserts. These PBMs are squeezing independent pharmacies out of business. Here’s a closer look at the three ways their actions are creating and expanding pharmacy deserts:
Traditional PBMs often own their own pharmacies. For example, CVS Caremark is linked to CVS Pharmacy, giving them a clear financial incentive to steer patients toward their own stores. They achieve this by creating restrictive networks or imposing higher copays for patients who use non-affiliated pharmacies. As a result, patients are funneled into using PBM-owned pharmacies, even if they’re far from home or offer less competitive pricing.
PBMs also control how much pharmacies are reimbursed for dispensing medications. For many independent pharmacies, fair reimbursement is essential to staying in business. However, 99% of pharmacies report that PBMs have slashed their reimbursement rates, leaving many struggling to cover their costs. While independent pharmacies face these cuts, PBM-owned pharmacies often receive higher reimbursements for the exact same medications, giving them an unfair competitive edge and forcing small, local pharmacies out of the market.
The big 3 PBMs also create preferred pharmacy networks, which are essentially a list of pharmacies where patients are encouraged—or even required—to fill their prescriptions. Smaller, independent pharmacies are frequently excluded from these networks, which drives patients to large chain pharmacies (often owned by the PBMs themselves). This practice further erodes the ability of local pharmacies to compete, particularly in areas where access to healthcare is already limited.
Not every PBM is contributing to the pharmacy desert crisis. Aligned PBM models like Rightway are taking a different approach, with a clear focus on improving patient access and supporting local pharmacies.
Rightway uses a transparent PBM pricing model with no hidden costs, spread pricing, or retained rebates and passes savings directly to our members and employers. We partner with a network of independent specialty pharmacies that provide high-quality drugs at the lowest costs, and these pharmacies receive fair compensation for the services they provide, which helps them stay open and continue serving their communities.
Unlike the big PBMs, Rightway doesn’t own any pharmacies, which means we have no financial stake in directing patients to any specific location. Our only focus is on helping patients find the most cost-effective and convenient pharmacy options, whether that's a local independent pharmacy or a larger chain. This ensures that patients can choose the pharmacy that works best for them without hidden agendas.
Rightway goes beyond simply managing pharmacy benefits—we actively guide members through the process of finding the right pharmacy for their needs. Rightway is the only PBM to use pharmacy navigation delivered by licensed clinicians to guide patients toward low-cost, high-quality drugs. Pharmacy guides help patients locate nearby, cost-effective pharmacies. Whether it's finding the closest independent pharmacy or utilizing a mail-order service when appropriate, Rightway ensures that patients receive the medications they need in the most convenient and affordable way possible.
The rise of pharmacy deserts is more than just a healthcare policy issue; it’s a crisis affecting millions of Americans every day. For patients living in these areas, it means fewer options, higher costs, and worse health outcomes. The role of traditional PBMs cannot be overlooked, but there is a way forward.
At Rightway, our goal is to drive access to the highest-quality, lowest-cost medications for members and preserve small pharmacy businesses. We intentionally do not, nor ever will we own pharmacies that create a conflict of interest. By rethinking the way PBMs operate, we can turn the tide on pharmacy deserts and bring healthcare back to the communities that need it most. Get in touch to learn more.
Rightway makes switching PBMs easy.
Watch the video to see how a smooth implementation and ongoing support makes a difference.
In response to the recent FTC interim staff report on PBMs, Rightway is proud to show the proactive measures and industry-leading practices we have implemented to ensure transparency, fair pricing, and better healthcare outcomes for our clients and members.
Read more
Explore the role of pharmacy benefit managers as middlemen in drug pricing. Learn how they impact costs and healthcare decisions for patients and employers.
Read more
Watch our webinar to hear from innovative benefit leaders who cut ties with traditional PBMs for greater flexibility, a better member experience, and outsized cost savings.
Read more