Rite Aid closures will create pharmacy deserts. And without pharmacies, public health unravels.

I’ve been thinking of a patient I saw in the emergency department years ago. She came in for evaluation of a headache and high blood pressure. An insurance company or a hospital administrator might look at her case and call it unwarranted emergency care and use it to illustrate unnecessary healthcare expenses. In truth, she tried to do everything she could to avoid the ED. The system pushed her to our doors.

The root of the issue for my patient was her medication. She ran out. Her insurance company mandated that she get her prescriptions through mail order, but her delivery never arrived. After failed attempts to get her medicine, she finally saw her primary care doctor, only to be sent to the ED with a blood pressure of 220/114 — a hypertensive crisis that put her at risk of organ damage or a stroke. After I improved her blood pressure, treated her headache, and the social worker helped with her meds, she smiled weakly. “You seem to be the only ones who can help me.”

With the news of Rite Aid filing for its second bankruptcy in as many years and preparing to close hundreds of pharmacies across the country, my patient is the perfect illustration of how easily health can unravel without some pills.

Rite Aid is a Pennsylvania company with a 60-year-history, headquartered in Philadelphia, and the greatest number of its pharmacies are here. Philadelphia’s communities are particularly vulnerable to the impact and consequences of its financial ruin. Large swaths and neighborhoods across the city run the risk of becoming a pharmacy desert.

Pharmacy deserts were first described in 2014 when the prevailing understanding of disparities in access to medications was only affordability. Since then, it’s become abundantly clear that geographic proximity is a significant factor in availability of medications, as seen in the nation’s four largest cities and across every rural county.

Even more concerning, pharmacy deserts disproportionately impact communities that are Black and brown (Black, Latino, Native American/ Alaskan), less likely to receive a higher education, under- or uninsured, and are either urban or rural. In rural areas, there is a higher proportion of pharmacy deserts impacting people over 65.

In short, pharmacy deserts are yet another determinant of health burdening individuals and communities who are at risk or vulnerable, through no fault of their own.

As one of the largest cities by land mass and a “majority-minority” city by population, Philadelphia carries an outsize risk of not having enough neighborhood embedded pharmacies to serve its community. Counties with a high Social Vulnerability Index (SVI) are 30-40% more likely to be sites of pharmacy closures or pharmacy deserts.

For those with chronic disease, such as diabetes, heart disease, high blood pressure, or heart failure, missed medication could land them in the hospital — or worse, cause a life-threatening situation. Medications prevent emergency visits, hospitalizations, and worsened disease — all of which cost individuals and the system far more over time.

But chronic disease management is only one of the many ways pharmacies support community health. From vaccine administration across the life span (children to elderly), to reproductive health, overdose prevention, management of acute illness, even access to bottled water and food, to name a few, pharmacies touch every major public health issue Philadelphians face daily.

Even in the city of eds and meds, pharmacists are often the most accessible healthcare providers, embedded within the communities they serve. I have seen the Herculean efforts they go through to ensure people get medications and supplies through the fires in Maui and California, the floods in North Carolina, and every other disaster that has faced their communities.

I’ve watched them jump through hoops, unimaginable to me, to get permission to give their patients what the doctor ordered. In 2022, nearly 90% of the U.S. population lived within five miles of a community pharmacy, a reach unmatched by any other healthcare provider or system.

It makes the growing outlier communities even more notable.

The pressures on pharmacies — all of healthcare really — are overwhelming and come from all directions. The profit margins are razor-thin; the responsibilities monstrous. I do not doubt that the leaders at Rite Aid and other pharmacies had no intention of getting into this mess and that they share my concern for their patients and their employees. There is definitely blame to go around.

But finger-pointing does nothing for my patient and the many like her across Philadelphia and the country. It doesn’t help the pharmacists, techs, and store employees who face uncertain employment. It all comes down to leadership and execution.

It will fall to the doctors and other healthcare providers in Philadelphia to try to absorb the fallout and bridge the gaps — for the sake of the community.

I’ve spent two decades on the front lines of healthcare in the emergency department, and even longer doing public health work within communities. As a doctor, I think about patients and their well-being; as a public health expert, I think about the bigger picture. I cannot shed all that I’ve seen, the experiences I’ve had or the people I’ve worked with to help others. They are always on my mind — even, and especially, when working on an executive level. They shape my missions and goals and drive how I lead and execute.

When will healthcare CEOs and other executives — most of whom have never themselves provided care to others — understand? Health is not a commodity, easily bought and sold as other retail products may be. Failing in healthcare is not a zero sum game.

As we’ve seen the impacts with hospital closures like Hahnemann, Jennersville, and now Crozer, the ripples may be far-reaching and long lasting. It will fall to the doctors and other healthcare providers in Philadelphia to try to absorb the fallout and bridge the gaps — for the sake of the community.

Unfortunately, people with much at risk and little power, are the ones to bear the consequences. They deserve better.

Priya E. Mammen is an emergency physician, executive, and public health specialist who helps the nation’s most impactful companies integrate clinical integrity at scale.