Iowa's Community Pharmacies Grapple with Decade-Long Decline, Reveals Drake University Study


A recent study conducted by Michael Andreski, Associate Professor of Pharmacy at Drake University, has confirmed a long-held concern: Iowa's network of community pharmacies has been steadily dwindling for over a decade.

Andreski's research tracked the operational status of pharmacies in the state from 2008 to 2022. The findings revealed a significant decline of more than 10% in the total number of pharmacies. Notably, the most substantial losses were observed among independent businesses, as opposed to chain or franchise establishments.

While closures have been more pronounced in rural areas compared to urban centers, Andreski warned that all Iowans could be impacted if measures aren't implemented to alleviate the high operational costs facing pharmacies.

"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 emphasized.

Andreski's study relied on data from the Health Professions Tracking Center at the University of Iowa Carver College of Medicine, as this information is not recorded by the Iowa Board of Pharmacy or any other entity.

The study's key findings include:

- In 2008, there were 697 operational pharmacies in Iowa, with 377 in rural areas and 320 in urban areas. By 2022, this number had reduced to 601, with 305 in rural areas and 296 in urban areas.


- Chain pharmacies experienced a marginal decline, accounting for a 3% decrease, whereas independent pharmacies faced a substantial hit with 87 closures, constituting a 38% decrease.


- Hospital-sponsored pharmacies saw an increase of 54% from 35 to 54 between 2008 and 2022.

Andreski stressed the critical role community pharmacies play in providing personalized care, a facet often absent in online transactions. "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,” he noted.

In addition to the loss of personalized care, some individuals may face logistical challenges in waiting for prescriptions to be delivered, especially in emergencies or during inclement weather.

The research team plans to use the findings to create maps showcasing the distribution of community pharmacies in 2008 and 2022, akin to food desert maps created by the U.S. Department of Agriculture. This visual representation aims to highlight areas in Iowa lacking access to a nearby pharmacy.

The study also seeks to provide concrete evidence to legislators of an ongoing crisis in Iowa's access to critical healthcare. Previously, the closure of pharmacies lacked definitive data, allowing lobbyists for pharmacy benefit managers to downplay the issue.

Pharmacy benefit managers, who act as intermediaries between insurance companies and pharmacies, have been identified by Andreski as a contributing factor to higher costs for community pharmacies, resulting in closures and decreased accessibility. Recent legislation in Iowa aims to address this by requiring pharmacy benefit managers to update their reimbursement rates weekly, among other measures.

Andreski's study now provides advocates with solid evidence when presenting the issue to lawmakers. Many pharmacists in Iowa, according to Andreski, are struggling to keep their businesses afloat, leading to concerns about the future of the profession and its practitioners in the state.