PHARMAGEDDON: What’s Behind the Death of America’s Pharmacies?

The pharmacy used to be a key fixture is almost every town and neighborhood in America. The mortar and pestle was a symbol that everyone recognized and trusted. For more than a century the “mom and pop” pharmacy was often a hub of social life. There was frequently a soda fountain where customers could get milkshakes or ice cream and share local gossip. But America’s pharmacies are dying. The Rite Aid pharmacy chain has just filed for bankruptcy a second time and hundreds of its stores will close in coming weeks (USA Today, May 30, 2025). According to this account, CVS “…closed 900 stores between 2022 and 2024 and aims to close an additional 270 stores in 2025…” Will warehouses and mail-order pharmacies replace the local drugstore?

The Good Old Days of America’s Pharmacies:

What will happen to America’s pharmacies? This question is personal for me. My grandfather Joseph (who I am named after) was a pharmacist around the turn of the 20^th century. He died before I was born, but I still prize his old scale and the specialized glass beaker he used to measure liquid medicines.

Grandpa Joe used a mortar and pestle to make “compounded” herbal products. My mother lived in horror of the live leeches that clung to the large jar on his pharmacy counter. My grandpa was almost assuredly an anchor in his little New York City neighborhood. Like most pharmacists of that day, he offered free health advice and sold specialized medicines to a wide range of customers.

I grew up on the outskirts of a small town called New Hope, Pennsylvania, population about 1000. There was a neighborhood pharmacy on the corner of Main and Bridge Street. Bridge street led to a beautiful old bridge two blocks away that crossed the Delaware river. It was just up the river from Washington’s Crossing. And yes, that was where George Washington crossed the river to defeat the Hessians in Trenton, NJ, in 1776.

Benjamin Sidon was the pharmacist and Sarah (Benny’s wife) was the assistant who kept things organized and maintained the cash register. Sidon’s Pharmacy was a gathering place. Sarah made milkshakes and could tell you what was going on in the community because she knew almost everyone in town.

Why Are America’s Pharmacies Disappearing?

The days of mom and pop pharmacies are disappearing fast. Many independent pharmacies have been bought out by chain drugstores. The soda fountain has disappeared and in its stead are aisles of candy, soft drinks, canned soup, hardware, beauty products and pet supplies, to name just a few of the items on sale.

Now, though, even chain pharmacies are closing at an alarming rate. A study published in the journal Health Affairs (Dec. 3, 2024) found that nearly one-third of America’s pharmacies that were operating between 2010-2021 had closed.  Independent pharmacists, especially those serving as the only access for healthcare in a neighborhood, were most vulnerable.

Ohio’s Drugstores: A Grim Picture of the Future of America’s Pharmacies:

The Ohio Board of Pharmacy recently reported that 215 drugstores had closed in 2024. That means the number of pharmacies in the state had dropped to the lowest number in memory. It wasn’t just independents that shuttered their doors. Over 180 large chain pharmacies closed, along with 19 independent stores and 14 small chain pharmacies.

The trend continues. Already in 2025, 35 pharmacies have closed in Ohio. Such closings are creating pharmacy “deserts” across the United States. Even large chain drug stores like Walgreens, CVS and Rite Aid are closing many locations.

The Poorest Folks Suffer the Most:

The researchers writing in Health Affairs point out:

“Although the number of US pharmacies increased from 2010 to 2017, our findings indicate unprecedented declines starting in 2018. These recent declines were primarily due to closures of chain pharmacies and are consistent with reported increases in planned chain pharmacy closures, mergers and acquisitions, and the integration of PBMs with large pharmacy chains.

“Independent pharmacies, which were much more likely than chain pharmacies to be located in Black, Latinx, low-income, and disproportionately publicly insured neighborhoods during the study period, were at a higher risk for closure than chain pharmacies. Therefore, the increased risk for closure among independent pharmacies may have worsened racial and ethnic disparities in access to pharmacies and medications, especially as Black and Latinx neighborhoods are more likely to be pharmacy deserts and have lower adherence rates for some medications than White neighborhoods.”

What’s Happening at Walgreens?

Walgreens was planning on closing up to a fourth of its store fronts before it sold itself to a private equity firm (Sycamore Partners) for around $10 billion. Such organizations are renowned for scooping up distressed businesses and wringing out profits.

According to NPR (March 7, 2025):

“Walgreens, founded in 1901, has been dealing with thin prescription reimbursement, rising costs, persistent theft and inflation-sensitive shoppers who are looking for bargains elsewhere. Walgreens is in the early stages of a plan to close 1,200 of its roughly 8,500 U.S. locations.

“The Deerfield, Illinois, company had already shed about a thousand U.S. stores since it grew to nearly 9,500 after buying some Rite Aid locations in 2018.”

The Wall Street Journal (March 21, 2018) characterized Sycamore Partners this way:

“With Sycamore’s strategy, it isn’t necessary to spruce up a purchased company. The firm often buys struggling retailers and sells off their most valuable pieces. It cuts costs at whatever remains, sometimes using the savings to extract dividends.

“Employees sometimes lose their jobs as Sycamore closes stores and cuts costs, while remaining workers are often left to pick up the slack. ‘The employees, communities and neighboring tenants are the ones that feel the negative consequences,’ said Thomas Paulson, principal at Inflection Capital Management, an investment firm that focuses on consumer companies.”

Why Are America’s Pharmacies in Such Trouble?

When Grandpa Joe was a pharmacist, people paid out of pocket for medications. Ditto when Benny was running Sidon’s Pharmacy in New Hope, PA. The cost of medicines was not outrageous.

When the very first edition of The People’s Pharmacy was published by St. Martin’s Press in 1976, here were some prices of commonly prescribed medications. These prices were “supplied by OSCO DRUG, INC, and were based on 1976 costs to the consumer. These prices are representative of many national chain store drug retail values.”

• Achromycin-V (tetracycline) 500 mg = $2.88 for 24 pills
• Coumadin (warfarin) 5 mg = $5 for 100 pills
• Elavil (amitriptyline) 25 mg = $9.65 for 100 pills
• Hydrodiuril (hydrochlorothiazide) 50 mg = $5.70 for 100 pills
• Librium (chlordiapoxide) 10 mg = $6.86 for 100 pills
• Premarin (conjugated estrogens) 1.25 mg = $6.90 for 100 pills
• Ritalin (methylphenidate) 10 mg = $9.20 for 100 pills
• Synthroid (levothyroxine) 0.1 mg = $3.20 for 100 pills

As a source of comparison, here is what some of those medications might cost today based on data from GoodRx.com:

• Coumadin (100 tablets) = $290
• Premarin (100 tablets) = $330
• Ritalin (100 tablets) = $135-$160
• Synthroid (100 tablets) = $236-$309

I recognize that there has been major inflation since I wrote the first edition of The People’s Pharmacy. But many people experience sticker shock if they have to pay out of pocket at America’s pharmacies. Remember, we pay substantially more for our medicines than just about any other country in the world. Life-saving medicines for hard-to-treat cancers can cost over $500,000. Even for people with good insurance, the co-pay can be devastating.

America’s Pharmacies and PBMs:

Part of the problem, experts say, are the middlemen called pharmacy benefit managers or PBMs. These organizations sit between the insurance companies and the drugstores, controlling reimbursement rates for roughly four-fifths of the prescriptions filled in this country.

If they reduce what they pay the pharmacies, they can put more money in their own pocketbooks. Many analysts believe that this squeeze has made it much harder for pharmacies to survive.

Another explanation is that mail-order pharmacy services have seen rapid growth over the last decade or so. Just as people now buy their pet supplies and electronic devices online, so too they are increasingly turning to mail-order or direct delivery for prescriptions. And let’s not forget that many employers and/or insurance companies may require people to buy their medications from mail-order pharmacies.

Why You Should Worry If Your Drugstore Disappears!

Why should we care about the decline in local pharmacies? For one thing, it makes it much harder to pick up an urgent prescription or over-the-counter medication at a moment’s notice. If you need an antibiotic like doxycycline because you are diagnosed with Rocky Mountain Spotted Fever or Lyme disease, you want that medicine immediately!

We also worry about mail-order deliveries. When vulnerable medications are allowed to sit in the back of hot delivery vehicles, in hot mailboxes or on doorsteps for hours, they may deteriorate. The FDA has strict guidelines for storage and shipping, but delivery vehicles rarely meet these criteria. You can listen to an amazing guest, Loretta Boesing, on this podcast:

Show 1351: Are You Risking Your Life Trusting Mail Order Medicines?

This article is also an eye-opener:

Insiders Blow Whistle on Mail Order Med Deliveries

Are America’s Pharmacies and Pharmacists Hard to Find?

As much as I am concerned about mail-order medicines and the closing of America’s pharmacies, I am even more alarmed about the loss of personal contact. Neighborhood pharmacists like my grandpa Joe and Benjamin Sidon had personal relationships with their customers. They were able to discuss health concerns and provide counseling as well as monitor for side effects and drug interactions.

When I visit most chain pharmacies these days, the pharmacist is tucked away behind barriers. A clerk or pharmacy tech gets my information, scurries around trying to find my bag of medication, and then rings me up.

If I want to talk to a pharmacist, I have to make an effort. And if the pharmacist is busy giving shots or filling prescriptions or on the phone, there can be quite a wait. Many people are impatient and leave the pharmacy without discussing side effects or drug interactions with the pharmacist. Trying to make sense of the leaflet that is included in the bag can be an exercise in futility.

If local pharmacies continue to close, many people will have a harder time getting access to critical health care information.

Final Words:

What is your experience with America’s pharmacies? Have you seen drug prices soar? When you look at the prices for brand name medicines from 1976 and compare them to today’s costs, what is your take-away?

Do you know the name of the pharmacist at your local drug store? Have you received great service? Please share your story in the comment section below. Are you at all concerned if independent and chain store pharmacies start to disappear? We’d like your thoughts on that question.

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