Pharmacy deserts, and what the closure data show

From 2022 through 2024, 7,240 community pharmacies in the United States closed and 4,178 opened, a net loss of 3,062 stores in three years. Chains accounted for most of that loss. They closed 3,401 locations and opened 721, according to a study published online Oct. 17, 2026¹ in the Journal of the American Pharmacists Association.

Independent and franchise pharmacies churned faster but nearly broke even, with 3,839 closures against 3,457 openings. The pharmacies that closed had been open an average of 18 years and nearly nine months. The authors tied the closures to shrinking payment for dispensing prescriptions, a squeeze our explainer on how pharmacies get paid walks through.

A pharmacy is the last stop in the drug supply chain, and for many people it is the most accessible health care site they have. When one closes in a neighborhood with few others, residents can end up in what researchers call a pharmacy desert. This piece pulls together what peer-reviewed studies and federal rules say about where those deserts are, who lives in them, how closures have changed the map and what happens to patients when their pharmacy shuts.

How researchers define a pharmacy desert

Researchers coined the term in 2014, when a team at the University of Illinois at Chicago mapped pharmacy access across the city. They found "disproportionately more pharmacy deserts"⁶ in segregated Black communities, low-income communities and federally designated Medically Underserved Areas in 2012. Their definition has two parts, and later national work kept both. A census tract counts as a desert only if it is both low income and low access.

A 2024 national mapping study in Health Affairs Scholar spelled out the thresholds. Low income² means at least 20 percent of residents live below the federal poverty level, or the tract's median household income is under 80 percent of the surrounding metro area's. Low access depends on how built-up the area is, as the table shows. Medicare's network rule for Part D drug plans, set out in 42 CFR 423.120¹⁰, uses a different yardstick and is shown alongside for comparison. Our piece on how Part D pays for generics covers how those plans work.

Each measure answers a different question. The Part D rule tests whether a drug plan's network is wide enough, averaged across a whole service area. The desert definition asks whether a particular low-income neighborhood has a pharmacy within reach, and a plan can meet the Medicare standard while specific tracts fall short.

How many people live in one

Using pharmacy locations as of April 2022 and Census data, the national study² found that "15.82 million (4.7%) of all people in the United States live in pharmacy desert communities," spread across all 50 states. Of 84,414 census tracts, 4,679 (5.5 percent) qualified. Most of those desert tracts, 94.5 percent, had no pharmacy at all, and only 294 of the country's 60,475 community pharmacies (0.5 percent) served desert communities. Urban tracts made up 57.5 percent of deserts and rural tracts 38.1 percent, so the problem is not mainly a rural one.

Desert tracts are poorer, less insured and more often home to people with a disability that makes walking or climbing stairs hard. They also skew slightly younger. The authors reported every difference in the table as statistically significant.

How closures have changed the map

Several national studies, most built from the same industry pharmacy registry, have tracked closures over a longer span. A Health Affairs study published in December 2024 found that of 88,930 retail pharmacies operating at some point from 2010 through 2020, "29.4 percent had closed by 2021," according to its abstract³. Pharmacies in predominantly Black and Latinx neighborhoods faced a higher risk of closure than those in White neighborhoods, and independents were at greater risk than chains "across all neighborhood and market characteristics."

A 2025 study in JAMA Health Forum looked at the same years from a business angle. It counted 61,054 retail pharmacies in 2010⁴ and 60,354 at the end of 2023, with chains falling from 39,158 to 36,622 and independents and franchises rising from 21,896 to 23,732. Turnover, openings plus closings, averaged 6.2 percent a year, or 10.9 percent for independents and 3.6 percent for chains. Chains posted net openings each year from 2010 to 2015 and net closings from 2016 to 2023. Our piece on independent and chain pharmacies has more on the two business models.

Rural and state-level studies fill in detail. The RUPRI Center for Rural Health Policy Analysis counted 1,231 independently owned rural pharmacies, 16.1 percent of the total⁷, that closed from 2003 to 2018, and 630 rural communities that had a retail pharmacy in March 2003 and none in March 2018. In Ohio, pharmacy desert tracts rose from 106 in 2021 to 139 in 2024 as the number of pharmacies in the state's license data⁹ fell from 2,206 to 1,854. Minnesota lost a net 156 community pharmacies (15 percent) from October 2009 to August 2025, and the population living in deserts there grew from 142,659 to 189,222, a 2026 study found⁸.

What a closure does to patients

The clearest evidence on consequences comes from prescription claims. A 2019 study in JAMA Network Open followed more than 3 million adults 50 and older who filled statins from 2011 through 2016. People whose pharmacy closed saw an "immediate and significant decline" in adherence, measured as the share of days they had medication on hand, of 5.90 percentage points⁵ in the first three months compared with similar patients whose pharmacy stayed open. The gap persisted through 12 months. Users of beta-blockers and oral anticoagulants showed similar drops, and the decline was larger, about 8 points, for people who had used an independent pharmacy or lived in a neighborhood with fewer pharmacies.

Mail delivery and 90-day fills can cover some of that distance for maintenance drugs, as our explainers on mail-order pharmacy and 90-day supplies describe. Whether either fits a given prescription is a question for the prescriber, the pharmacist or the drug plan.

Counting pharmacies with federal data

Most of the studies above rely on a commercial pharmacy registry. The free federal alternative is the National Plan and Provider Enumeration System (NPPES), which issues the 10-digit National Provider Identifier (NPI) that pharmacies use to identify themselves when they bill insurers electronically. Each NPI record carries a provider taxonomy code, and community pharmacies generally use "Pharmacy, Community/Retail Pharmacy." The public NPI Registry API¹¹ lets anyone search those records by location and type. GxRadar's pharmacy finder is built on it. A query on Nov. 3, 2026, for example, returned 173 organization records in Wyoming with that taxonomy.

NPPES has limits as a census. A record shows that a provider enumerated. It does not show whether a store is open today or what hours it keeps. Accuracy depends on providers reporting changes, which 45 CFR 162.410¹² requires "within 30 days of the change." One location can also hold more than one NPI. Most of the studies cited here used the industry registry or state license records instead, and the Minnesota and Ohio studies relied on their state boards of pharmacy.

The Minnesota team also identified "keystone" pharmacies, defined as the only pharmacy serving a census tract within the distance threshold. Of the state's 867 remaining community pharmacies, 129 (15 percent) fit that description. If one of them closes, its tract is left without a pharmacy inside the distance threshold.