The availability of pharmacies in the United States: 2007-2015

Abstract

Importance: Despite their increasingly important role in health care delivery, little is known about the availability, and characteristics, of community pharmacies in the United States.

Objectives: (1) To examine trends in the availability of community pharmacies and pharmacy characteristics (24-hour, drive-up, home delivery, e-prescribing, and multilingual staffing) associated with access to prescription medications in the U.S. between 2007 and 2015; and (2) to determine whether and how these patterns varied by pharmacy type (retail chains, independents, mass retailers, food stores, government and clinic-based) and across counties.

Methods: Retrospective analysis using annual data from the National Council for Prescription Drug Programs. Pharmacy locations were mapped and linked to the several publically-available data to derive information on county-level population demographics, including annual estimates of total population, percent of population that is non-English speaking, percent with an ambulatory disability and percent aged ≥65 years. The key outcomes were availability of pharmacies (total number and per-capita) and pharmacy characteristics overall, by pharmacy type, and across counties.

Results: The number of community pharmacies increased by 6.3% from 63,752 (2007) to 67,753 (2015). Retail chain and independent pharmacies persistently accounted for 40% and 35% of all pharmacies, respectively, while the remainder were comprised of mass retailer (12%), food store, (10%), clinic-based (3%) or government (<1%) pharmacies. With the exception of e-prescribing, there was no substantial change in pharmacy characteristics over time. While the number of pharmacies per 10,000 people (2.11) did not change between 2007 and 2015 at the national-level, it varied substantially across counties ranging from 0 to 13.6 per-capita in 2015. We also found that the majority of pharmacies do not offer accommodations that facilitate access to prescription medications, including home-delivery, with considerable variation by pharmacy type and across counties. For example, the provision of home-delivery services ranged from less than <1% of mass retailers to 67% of independent stores and was not associated with county demographics, including ambulatory disability population and percent of the population aged ≥65 years.

Conclusions: Despite modest growth of pharmacies in the U.S., the availability of pharmacies, and pharmacy characteristics associated with access to prescription medications, vary substantially across local areas. Policy efforts aimed at improving access to prescription medications should ensure the availability of pharmacies and their accommodations align with local population needs.

Fig 1. Trends in the availability of community pharmacies by pharmacy type in the US, 2007–2015.

Data source: Authors’ analyses of data from the National Council for Prescription Drug Programs on licensed community pharmacies in the U.S. (February 2007-February 2015).

Fig 2. Pharmacies per 10,000 People by County in the U.S., 2015.

Data source: Authors’ analyses of data from the National Council for Prescription Drug Programs on licensed community pharmacies in the U.S. for February 2015, and the US Census Bureau’s Population Estimates Program to derive information on annual total population for all counties (N = 3,141) for each year between 2007 and 2015.

Fig 3. Retail Chain and Independent Pharmacies by County in the U.S., 2015.

Fig 4. The availability of pharmacies and accommodations by quintiles of county population demographics, 2015.

Data sources: Authors’ analyses of data from the National Council for Prescription Drug Programs on licensed community pharmacies in the U.S. for February 2015; the US Census Bureau’s Population Estimates Program to derive information on annual total population at the county-level for 2015; 2010 US decennial Census to derive information in the % of the population aged 65 years or older; 5-year estimates (2010–2014) from the American Community Survey to derive information on the percent of the population that is non-English speaking defined as those who “speak a language other than English” and percent of the adult population that has an ambulatory disability; and the Health Resources and Services Administration to identify counties that are designated as completely or partially Medically Underserved Areas/Populations (MUA/P) or primary care Health Professional Shortage Areas (HPSA). Quintiles (range) are reported from lowest to highest percent (Quintiles 1 to 5) of county population demographics. For example, 0 to 2.5% of the total population is non-English speaking for counties in Quintile 1. Reported means are population-weighted to account for differences in the size of county total populations; Error-Bars are 95% Confidence Intervals.