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Pharmacies in rural areas struggle to remain open as costs rise

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Posted at 12:37 PM, Oct 18, 2022

Much has been made of the struggles of rural hospitals through the years, and one of the trickle-down effects of that is the closure of rural pharmacies. Millions of Americans either live or are at risk of living in a “pharmacy desert."

Nearly half a century ago, Walter Holland set up a pharmacy in the small town of Columbia, Tennessee.  And for almost half a century, Walter Holland has been the living embodiment of a small-town pharmacist.

“We are with them and happy for them when major events occur in their lives. We weep with them when they lose their loved ones. You get involved with people; you get to know them. You get to love them,” Holland said.

Holland’s town isn’t so small anymore. Forty-thousand people now reside in Columbia. That growth has shielded Holland from what faces many of his peers in much smaller towns.

Keith Mueller runs the Rural Policy Research Institute at the University of Iowa. His team just released a report that found rural areas have lost 10 percent of their pharmacies in roughly the last two decades. 

Mueller points to population and changes to reimbursement rates from insurance providers, Medicare and Medicaid. Major chains such as Walgreens or CVS can lean on income from other areas. Pharmacies that stand alone often can’t. 

“The loss of population base is going to affect everyone. The Walgreens I go to, they’ve had to close on certain days because they simply don’t have enough people to stay open every single day,” Mueller said.

We’ve reported in the past on the uncertain future of rural hospitals. Nearly 200 have closed since 2005. But most rural areas have the fewest resources throughout health care: fewer medical centers, primary care physicians and pharmacies. 

“Whether it’s John Doe’s Pharmacy or it is an outlet that’s part of a chain, maybe it’s a pharmacy within the grocery store, it’s still part of the fabric of that community,” Mueller said.

Holland doesn’t need to worry about that, anyway. His town has a hospital. Its population has been rising for a century. Even with bigger-name options, Holland’s pharmacy continues to thrive. It’s why he believes he will continue to chart his course as a small-town pharmacist in a not-so-small town, unlike many in his field. 

“I told my wife back when we were dating, back in the dark ages, that it was my intent to work as long as the Lord gave me enough strength and enough mind to work. And so far, I’m still at it. I still enjoy it. And I love my customers,” Holland said.