Research from a Drake University professor has documented what he and others have known to be true, but some denied — Iowa’s network of community pharmacies has been shrinking for more than a decade.

Michael Andreski, associate professor of pharmacy at Drake University, conducted a study tracking open pharmacies in the state between 2008 and 2022. He found that the total number of pharmacies decreased by more than 10%, with the largest losses coming from independent businesses, rather than a chain or franchise.

Closures have been more common in rural than urban areas, but Andreski said every Iowan could feel this impact if actions aren’t taken to help pharmacies handle high costs of operation.

“Patients are not going to be able to have access to the potentially life-altering medication therapy that normally you would expect to have available,” he said. “And people, frankly, in Des Moines or Cedar Rapids just assume that that ability is going to be there, and we’ve even seen that that’s even being affected.”

Andreski’s study used data from the Health Professions Tracking Center at the University of Iowa Carver College of Medicine, which has recorded the number of pharmacists working in the state since the 1990s. He was able to learn how many pharmacies were open at the time, as he said that number isn’t recorded by the Iowa Board of Pharmacy or anyone else.

Biggest losses among independent pharmacies

There were 697 open pharmacies in 2008, with 377 located in rural areas and 320 in urban areas. In 2022, there were 601 pharmacies in Iowa; 305 in rural areas and 296 in urban areas. Chain pharmacies saw the smallest difference: a loss of 11 stores accounting for a 3% decrease, and independent pharmacies saw the largest hit — 87 stores closed, a 38% decrease.

Hospital-sponsored pharmacies were the only subset to see more stores open than close. From 2008 to 2022, the number of hospital-sponsored pharmacies grew by 54% from 35 to 54.

Almost one in 20 pharmacies in Iowa closed between 2018 and 2020.

When a community pharmacy closes, Andreski said Iowans are left without critical medical care. Certain medications can be sent in the mail to households, but often patients are losing out on the chance to speak with a pharmacist about any concerns or other information they should know.

“That’s what community pharmacies do — you go into the pharmacy and you can talk to that pharmacist, and pharmacists in the 2020s are trained on techniques to help patients be successful as much as possible in their medication therapy,” Andreski said. “So that personal touch is gone.”

Also, some people cannot afford to wait days for their prescriptions to be mailed.

A 40-minute drive to the pharmacy might be easy in the summer, but impossible in the winter. This lack of access could cause more problems for those already dealing with health problems.

Researcher plans to map pharmacy deserts

Now that the study is finished, Andreski said he and other Drake University researchers involved in the work will take the findings and use them to create maps of where community pharmacies operated in 2008 and 2022. Like food desert maps created by the U.S. Department of Agriculture, these maps will show where in Iowa people don’t have access to a pharmacy, depending on how far away they are from one.

One of the goals behind this study is to be able to show legislators that there is a crisis in Iowa of its residents slowly but surely losing access to critical health care. Before now, no one was able to point to proof of pharmacies consistently closing, which Andreski said allowed lobbyists for pharmacy benefit managers to claim there weren’t any problems at all.

Pharmacy benefit managers work as a sort of middle-man for insurance companies and pharmacies, managing drug plans on behalf of providers. Gov. Kim Reynolds in 2022 signed into law legislation that requires pharmacy benefit managers to update their reimbursement rate lists on a weekly basis, gives the Iowa Insurance Division oversight authority and prohibits the companies from reimbursing Iowa pharmacies at a lower rate than their own affiliate pharmacies.

Andreski said pharmacy benefit managers make costs higher for community pharmacies, causing more to close and leave people without a pharmacy close by. He said when the Iowa Pharmacy Association contacted 97 independent pharmacies, almost half of them were either breaking even or losing money, and around 40% predicted that they might have to close in the next 12 months.

“They’re in the Fortune 15, and these community pharmacies that provide a needed service are basically on a financial death watch at this point,” Andreski said. “And so we were hoping that the Legislature could at least make some common-sense rules in place to help Iowans have access to these services.”

Now, pharmacy advocates will be able to point at this study when lawmakers ask if there’s an actual problem that needs to be addressed.

From what he’s heard in speaking with pharmacists, Andreski said many are finding it hard to keep their businesses open. He said students he works with in Drake University’s College of Pharmacy & Health Services are unsure of their professional future in Iowa, and don’t know if they’ll be able to fulfill their desire to return to their hometowns and practice.

“People are looking to find a way so that the profession that they’ve invested in, economically and educationally and emotionally, can continue,” Andreski said. “There’s a lot of, almost to the point of despair in many pharmacists that we’re not going to be able to keep things going.”

Iowa has lost more than 10% of pharmacies since 2008, Drake professor finds