The rise of pharmacy deserts and why traditional PBMs are to blame.

Imagine needing a critical medication, but the nearest pharmacy is miles away, and accessing it means missing work or paying for expensive transportation. This is the reality for many Americans living in pharmacy deserts—areas where local pharmacies are scarce or completely absent. In fact, over 45 million Americans now live in a pharmacy desert, with rural and low-income communities bearing the brunt of this growing crisis.

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.

What is a pharmacy desert?

A pharmacy desert is an area where residents have little to no access to a nearby pharmacy. In urban settings, this can mean no pharmacy within a half-mile. In rural areas, the nearest pharmacy might be more than 10 miles away, leaving residents with few, if any, options to get their medications quickly and affordably.

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. 

Pharmacies are vital healthcare hubs for the community.

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. Here’s how the lack of pharmacy access impacts patients in these areas:

• Missed medications. 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. 

• Lost healthcare services. 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.

• Widened health inequities. 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. 

The big 3 PBMs are fueling the growth of pharmacy deserts.

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:

1. Conflicts of Interest. 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.

2. Unfair reimbursement rates. 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.

3. Exclusionary preferred networks. 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.

Bringing life back to pharmacy deserts.

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. Here's how:

• Transparent pricing. 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.

• No conflicts of interest. 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.

• Pharmacy navigation. 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.