The growth of "pharmacy deserts"

Neighborhoods in cities like Chicago are rapidly becoming places where people can't fill medical prescriptions locally because their drugstores have shuttered or don't accept Medicaid.

Why it matters: The pandemic has accelerated the growth of "pharmacy deserts" as unprofitable and less-profitable stores have closed. It's a worrisome trend for the urban poor, who are less likely to try online pharmacies and more likely to let their drug regimens lapse when they can't get medication locally.

Driving the news: Effective Dec. 1, Medicaid patients in Illinois — of which there are 400,000, per the Chicago Tribune — could no longer get their prescriptions filled at Walgreens, a prevalent chain headquartered in a Chicago suburb.

• The change came because Aetna, which provides contracts with the state of Illinois to serve Medicaid recipients, dropped Walgreens as a provider. CVS — a top Walgreens rival — owns Aetna as well as the pharmacy benefits manager CVS Caremark.
• CVS "has no pharmacies in five key West Side neighborhoods," per the Tribune.
• Illinois state Rep. La Shawn Ford called Aetna's decision "pathetic" and told the Tribune, "It's an attack not just on Black people, but on those that are struggling during the pandemic."

The backstory: Researcher Dima Qato coined the term "pharmacy desert" in a 2014 article that found there were far fewer pharmacies in Chicago's Black neighborhoods than in white and mixed neighborhoods.

• Medicaid policies like the one in Illinois "are all over the country, where Medicaid dictates where and where you can go fill your medication," Qato tells Axios. "And that leads to certain pharmacies having less patients in them, which leads to less profits, which leads to closures."
• Qato — who recently took a post as a professor at the University of Southern California, and is in the process of moving from Chicago — said that the new Medicaid policy in Illinois is generating "a lot of outrage in the community right now."
• Per Qato's definition, people live in a "pharmacy desert" if they can't fill a prescription within a half-a-mile of their homes (for low-income people without cars), and a mile for others.
• "We’ve estimated it for Chicago at a third of the city’s population, with substantial difference by racial composition," Qato says.

Between the lines: Because pharmacies get the lowest reimbursements for filling Medicaid prescriptions, they're more likely to close stores in low-income neighborhoods and open them in wealthy ones, notes Antonio Ciaccia, chief strategy officer of 3 Axis Advisors, a consultancy focused on the drug supply chain.

• "We're seeing a general retreat from impoverished areas," said Ciaccia, who serves as an adviser to the American Pharmacy Association.

Of note: Studies draw a direct line between pharmacy closures and people stopping their vital medications — with terrible health outcomes.

• Adults over 50 were more likely to drop their cardiovascular pills after their local drug store closed, according to a study published in the Journal of the American Medical Association in 2019 (of which Qato is the lead author). 
• Benjy Renton, the Middlebury College senior who has been closely tracking the COVID-19 outbreak, noted on Twitter that pharmacy deserts could hold back the administration of vaccines.

What's next: While "food deserts," where inner-city residents lack access to fresh and healthy groceries, are a bigger problem in places like New York City, pharmacy access is a growing concern. The number of drugstores has declined 20% in NYC since 2016, according to Jonathan Bowles, executive director of the Center for an Urban Future.

• "I for one will miss the 70 Duane Reades that closed this year," was the headline of an an article that New York Magazine's "Curbed" ran on Dec. 30. (Duane Reade is owned by Walgreens.)