As Drugstores Close, Neighbors In Chicago's ‘Pharmacy Deserts’ Struggle To Access Meds (2024)

CHICAGO — Genaro felt like he was suffocating.

The Little Village resident said he started suffering respiratory problems after the 2020 Crawford Coal Plant implosion covered his neighborhood in dust. Genaro relies on a daily medicine to manage his symptoms — but this May, he ran out of pills. Unemployed and uninsured, he didn’t think he could pay for more, so he waited instead of stocking up.

A week after running out of medicine, Genaro was struggling to breathe. At that point, he couldn’t wait to take a bus to his pharmacy, more than a mile from his house. So even though he could barely draw breath, the 63-year-old pushed himself onto his bike and cycled all the way there.

“I felt like my heart lacked oxygen,” Genaro said in Spanish. He asked that his last name not be published. “I felt like I was dying.”

Chicago’s Black and Latino communities have dealt with challenges getting their medications for decades.

People living on the South and West sides are more likely to face poverty, and pharmacies are far sparser in those communities than in the rest of the city. In fact, Chicago has among the worst disparities in pharmacy access in the United States, said Dima Qato, a University of Southern California pharmacy professor.

And as stores continue to close, inequities in access are deepening.

In 2022, the West Roseland Walgreens, the Ashburn CVS, the Little Village Walmart, the Bronzeville Walmart and the Chatham Walmart were all in business. Today, they’re all gone.

“More pharmacies are closing. Fewer pharmacies are opening,” Qato said. “And when they open, they’re opening in neighborhoods that probably don’t need another pharmacy, and they’re avoiding neighborhoods that need a pharmacy.”

What This Story Took

This story relies on conversations with more than 25 Chicago residents, local activists, pharmacists, researchers, legislators and other stakeholders. Reporter Aviva Bechky spoke with many of these people multiple times over the course of several months to ensure their stories were told respectfully. Bechky also analyzed data on Illinois pharmacy locations and Chicago demographics to illustrate pharmacy access — and lack of it — in Chicago.

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To be sure, pharmacies aren’t just closing on Chicago’s South and West sides. Between January 2009 and August 2021, 838 pharmacies closed statewide — an average rate of 70 closures a year, according to research done at Southern Illinois University Edwardsville. In 2021, CVS announced a plan to close 900 stores across the United States over the next three years. In October, Rite Aid filed for bankruptcy. This June, Walgreens CEO Tim Wentworth said he expected the chain to close a “significant” number of its U.S. pharmacies.

However, these closures are often concentrated in low-income communities. In urban areas, pharmacies serving uninsured or publicly insured residents are more likely to close, according to a 2019 study published in JAMA Internal Medicine that Qato led. And because low-income communities often have fewer pharmacies to start with, closures tend to have more significant health impacts there.

“This is an injustice,” said Jahmal Cole, a prominent social justice activist and the founder of My Block, My Hood, My City. “There are people sick out here that need good medicine.”

The Inequity Of Pharmacy Deserts

Pharmacies don’t just dispense medicine. Beyond filling prescriptions, pharmacists often give vaccinations, advise doctors about specific medications and build connections with regular patients.

Van Huynh, St. Anthony Hospital’s pharmacy manager, sees this firsthand. St. Anthony Hospital opened the pharmacy in North Lawndale in July 2023, and Huynh has worked to develop patient relationships and provide accessible bilingual care, she said.

So when people live in “pharmacy deserts,” they lose what should be one of the easiest ways to access health care.

While different researchers define “pharmacy deserts” differently, Qato described urban deserts as places where residents live more than a mile from the nearest pharmacy, or half a mile if the area is low-income and few residents have cars. That may not sound far, but for people who are older, have disabilities or lack cars, even those distances can pose a significant barrier.

In Chicago, one of the most segregated big cities in the country, people in predominantly Black and Latino neighborhoods are significantly more likely to live in pharmacy deserts than those in majority white neighborhoods. A 2021 study Qato worked on found only 1.2 percent of Chicago’s predominantly white census tracts are pharmacy deserts, compared with 32.6 percent of predominantly Black tracts.

Similarly, data on pharmacy licenses from the Illinois Department of Financial and Professional Regulation, updated as of May, show the ZIP codes with the fewest active pharmacy licenses tend to be predominantly non-white.

For example, the 60633 ZIP code has no pharmacies. That area includes Hegewisch and South Deering, which are majority Black and Latino. The 60652 ZIP code, which is mostly made up of the majority Black and Latino Ashburn community, only has one pharmacy.

Eight ZIP codes have just two pharmacies. Three of them are Downtown and cover a much smaller area than most Chicago ZIP codes. Of the other five, four are composed of neighborhoods that are at least 85 percent Black and Latino.

Ald. William Hall (6th), whose ward is on the South Side, said he’s watched pharmacies leave Black neighborhoods for years.

At this point, “there’s a sense of abandonment, anger, frustration,” he said.

Hall said he’s especially frustrated with big pharmacy chains. While CVS’ website lists 57 Chicago locations, fewer than 15 are south of the South Loop. Walgreens similarly has a lower concentration of pharmacies on the South and West sides.

CVS Pharmacy spokesperson Amy Thibault said that about half of Chicago residents live less than a mile from a CVS Pharmacy, and more than 80 percent live within 2 miles. A Walgreens spokesperson said more than 50 percent of the company’s stores nationwide support underserved communities.

Still, Ald. David Moore (17th) sees a discriminatory dynamic at play on the South and West sides.

“Systematic racism. Disinvestment in communities,” he said.

And in areas where pharmacies rarely stay long, residents can get resigned to not having access to medication.

“This has happened so much that sometimes our patients just kind of say, ‘Oh, well,’” said Thomas D. Huggett, a family physician and medical director of mobile health at Lawndale Christian Health Center, where Genaro gets his medicine. “They kind of expect barriers.”

The Impact of Additional Closures

Avalon Park resident Courtney Smith takes medications every day. She’s been using the same pharmacy — a Walgreens in Chatham — to pick them up for almost 25 years. She relies on its 24-hour service, an assurance she would never run out of her meds.

But in February, Smith’s pharmacy shortened its hours. She was taken aback.

“I feel like no one told us, and maybe a memo went out, and I just missed it,” she said.

Instead, Smith found out when she saw that her prescription had accidentally been canceled. In a near panic, she tried to call the Walgreens only to find out it was closed at that time. She couldn’t talk to a pharmacist to figure out what went wrong until the next day.

A Walgreens spokesperson did not specifically comment on policies around changes in hours but said the company works “to provide as much notice as possible via phone calls, signage, posters and in-person informs,” especially when stores close.

Confusion and stress are common when pharmacies cut hours or close. For years, advocates in Chicago have said they’ve asked stores for better communication, with little success. Spokespeople from CVS, Walgreens and Walmart all disputed that claim, saying they provided notice in advance of changes through multiple channels.

In 2019, about 80 residents criticized Walgreens at a forum to discuss the closing of a Calumet Heights location. When the Little Village Walmart closed in April 2023, locals rallied outside, criticizing the company for abandoning the neighborhood. Alderpeople, too, have blasted these closures, such as when the Auburn Gresham CVS shuttered in 2020 and the West Roseland Walgreens followed suit last year.

Those stores all shut down anyway. In statements made at the time and more recently in response to requests for comment, CVS, Walgreens and Walmart explained that they decide to close stores — these examples as well as more broadly — by looking at business performance, costs, consumer purchase patterns, population shifts and proximity to other store locations. Spokespeople for each company said they take the decision to close stores seriously, weighing a broad array of factors.

But to locals like Baltazar Enriquez, the director of the Little Village Community Council, the chains’ priorities are misplaced.

“It should not be about profit margin,” he said. “It’s about becoming part of the community, being with the people in the community, understanding the community and working with the community.”

And community members’ health actively suffers when pharmacies leave. In one 2019 study, Qato and several co-authors found that patients who used those pharmacies became less likely to continue taking life-saving heart medications.

Enriquez has seen this play out firsthand. He said he knows people who started skipping medications and eventually landed in the hospital.

“It becomes a health issue, because you know what? ‘I’ll go tomorrow. I won’t go today,’” he said.

Even when people do switch pharmacies, closures can exacerbate stress. Especially in neighborhoods where most people don’t have cars, people can be forced to travel farther via bus or have to find someone else to pick up their medications for them.

State Rep. La Shawn K. Ford — who represents the 8th District, which covers parts of the West Side and nearby suburbs — said his 85-year-old mother used to live close to multiple pharmacies in Austin. Then they closed down.

“If she has to get her medication, she has to travel,” Ford said. “She has to drive or have someone pick her meds up for her, because there’s not a pharmacy anymore close to her house.”

Independent Pharmacies

Big chains aren’t the only owners of pharmacies in Chicago. Advocates often point to independent stores as examples of success: pharmacies owned by people committed to the communities around them.

Del-Kar Pharmacy has served North Lawndale for 64 years. Owner Edwin Muldrow said seeing nearby communities become pharmacy deserts is just “par for the course” in an area where grocery stores and other forms of health care are also limited.

But Muldrow is determined to stay open. Plus, his connections with people have helped him stay open when he has faced issues like theft.

“I have a good relationship with the people in the community,” Muldrow said. “So therefore, I can engage folks directly and find out what’s going on.”

Muldrow’s longevity is unusual, though. Qato’s 2019 study in JAMA Internal Medicine found that independent pharmacies were two to three times more likely to close than chain stores.

Competition can be hard for small businesses. An example: A CVS opened near the intersection of North Kedzie Avenue and West Madison Street about 12 years ago. The nearby independent pharmacy went out of business — there was too much competition, then-state Rep. Melissa Conyears-Ervin said at the time. Then, in a move that local politicians blasted, the CVS closed in 2017.

Walter Mathis, a Yale University professor who researches health care access, said this is a common pattern. When big-box drugstores open, they often force independent stores out of business, he said. Then those corporate stores may eventually close, too, forcing residents to travel to stores in other neighborhoods.

“They kind of come in, colonized and then retreated,” Mathis said.

When asked for comment, Thibault said CVS never opens stores with the intention of closing them. Walmart and Walgreens spokespeople did not specifically comment on the pattern Mathis described.

Even when independent pharmacies stay open, they aren’t a panacea for Chicago’s pharmacy problems. They can’t always offer as many medications as chain stores due to limited resources, and they can’t operate all over the city like bigger stores.

And competition isn’t the only problem they face.

Muldrow said independent pharmacies are struggling with an obstacle that’s forcing chains to close some of their locations: pharmacy reimbursem*nt.

The Problems with Reimbursem*nt

Under the pharmacy reimbursem*nt system, if a pharmacy sells a drug worth $55, a patient may pay $10 for it, depending on their insurance. Ideally, insurance companies and intermediaries called pharmacy benefit managers would then pay the pharmacy about $50 for the drug, leaving the pharmacy with a net profit.

But that’s not always happening anymore, said Christopher Crank, executive vice president of the Illinois Council of Health-System Pharmacists. Now, insurance companies and pharmacy benefit managers might pay only $44-$46 for a drug like that — leaving pharmacies with barely any profit, and occasionally a loss. Pharmacists have complained about reimbursem*nt shrinkage for decades, but lately, “we’ve really seen reimbursem*nts start to get worse,” Crank said.

That trend is hitting people like Muldrow hard. With declining profits, it’s become a challenge to cover rent, utilities and labor costs, let alone to provide all the medications his community needs, Muldrow said.

“You want us to provide the service,” he said. “We as independent business owners in pharmacy are stepping up to the plate to provide the service, but there’s no compensation.”

These days, Muldrow relies on selling produce and basic retail items to stay in business, he said.

Muldrow’s not the only one struggling: About 10 years ago, the Black-owned 200 Pharmacy Inc. in Calumet Heights pivoted from traditional pharmacy services to compounding — changing pills to liquids, making certain medications into creams and so on — to keep the business alive.

“We transitioned from doing traditional medications because the margins are so slim that we couldn’t afford to stay in business,” said Eryn White, the store’s business operations manager.

Muldrow and Crank, as well as spokespeople for the National Association of Chain Drug Stores, said that changing this dynamic requires statewide or nationwide reforms in how pharmacy benefit managers operate. These managers serve as middlemen between insurers and pharmacies, setting reimbursem*nt prices for pharmacies and deciding on lists of approved medications for insurers and employers.

Pharmacy benefit managers often incentivize patients to go to certain pharmacies over others and refuse to pay pharmacies fair reimbursem*nts, said Crank and Craig Fisher, a pharmacist on the boards of the Chicago Pharmacists Association and the Illinois Pharmacists Association.

A recent New York Times story also highlighted how the industry is driving up the prices of prescription drugs.

The Pharmaceutical Care Management Association, which represents U.S. pharmacy benefit managers, declined to comment on specific allegations.

To many pharmacists, this system is simply unsustainable.

“We need [pharmacy benefit manager] reform,” Muldrow said. “Because if we don’t have reimbursem*nt, then we don’t have business.”

Looking Ahead

Despite documented issues, changing laws around reimbursem*nt at the state level is tricky. For at least five years, Ford worked to expand the pharmacies that Medicaid users could go to, but he’s been met with resistance from managed care organizations, he said. He hasn’t yet found success.

While legislative change stalls, Ford said he’s also hoping to change the system elsewhere. He wants to connect independent pharmacies with more incentives and support, perhaps offering tax breaks or grants to businesses getting started in pharmacy deserts.

“We need to make sure that we partner with community [members] and provide grant opportunities for capital and support for pharmacy deserts,” Ford said. “If there’s a pharmacist that wants to open up a location, then we should do that. We should provide some resources.”

Meanwhile, Melvin Thompson, a community engagement consultant in Chicago, wants to see some kind of penalty imposed on big-box pharmacies that leave. With the South and West sides suffering from decades of disinvestment, he said stores should be actively disincentivized from opening only to quickly close. Pharmacies need to come to the South and West sides, but they also need to stay.

For now, though, these solutions remain tentative or theoretical. In the meantime, Chicagoans in Black and Latino communities continue to face a landscape of closed pharmacies.

These days, when Jeffery Manor resident Camille Long drives through the South Side, she passes closed pharmacy after closed pharmacy — including the store she once frequented. She’s stopped picking up medications near home and switched to getting them in the Loop, where she works, because she finds it easier to get to a pharmacy Downtown.

But for many of Long’s neighbors who don’t have cars, responding to pharmacy closures is much harder. And for them, Long said the empty storefronts leave a distinct message:

“You have to be in a certain place to deserve health care.”