Walgreens is closing 1,200 stores, Rite Aid has ceased operations entirely, and 48 million Americans now live in pharmacy deserts more than 10 miles from any pharmacy

In 2024 alone, 2,800 pharmacies in the United States closed. Walgreens announced plans to close 500 locations in 2025 and another 700 over the following two years. Rite Aid, after a second bankruptcy filing, has ceased operations entirely. The result: 48.4 million people -- one in seven Americans -- now live in a pharmacy desert, defined as an area more than 10 miles from the nearest pharmacy. Another 9% of Americans have access to only a single pharmacy, meaning one more closure eliminates their access completely. In Mendocino County, California, when Genoa Healthcare closed its Gualala location in November 2025, it was the sole pharmacy along a 60-mile stretch of coast. Residents now drive over 90 minutes round-trip to fill prescriptions. For elderly patients who no longer drive, for patients without reliable transportation, for patients on daily medications like insulin or blood thinners that cannot wait for a mail-order delivery delay, this is not an inconvenience -- it is a medical emergency in slow motion. Pharmacy deserts are not randomly distributed. They concentrate in rural areas, low-income urban neighborhoods, and communities of color -- the same populations with the highest chronic disease burden and the greatest need for medication access. The closures are driven by a business model that has become structurally unprofitable. PBM reimbursement rates for generic drugs are often below the pharmacy's acquisition cost. DIR fees and GER clawbacks eat remaining margins retroactively. Front-end retail sales that once subsidized pharmacy operations have shifted to Amazon and dollar stores. Meanwhile, pharmacies cannot raise prices because PBMs set the reimbursement rates unilaterally. The Consolidated Appropriations Act of 2026 included funding for investigations of pharmacy reimbursement complaints, and the Rural Health Transformation program allocated $50 billion over five years for rural healthcare, but neither addresses the fundamental economics: as long as PBMs can reimburse pharmacies below cost, closures will continue, and the distance between patients and their medications will keep growing.