The importance of pharmacies in rural areas

When discussing access to healthcare in rural communities, the focus often centers on hospitals and physicians’ offices—rarely on pharmacies. Yet pharmacies are critical healthcare access points: they provide not only prescription and over-the-counter medications, but also direct access to highly trained healthcare professionals. Pharmacists counsel patients on medications, diagnoses, and general health concerns while serving as trusted, familiar faces in their communities. They answer questions about immunizations, referrals to medical services, common colds, heart attack symptoms, and even pet medications. Pharmacists have a uniquely valuable position in their community-- they possess specialized medical and pharmacological knowledge while maintaining close personal relationships with their patients. 

At the same time, rural hospitals are increasingly at risk of closure due to systemic challenges such as funding reductions, high operational costs, and insurance provider reimbursement inadequacies. An article from Boston University School of Public Health stated that over 100 rural hospitals have closed in the United States over the past decade. The article also found that currently 700 rural hospitals are at risk of closing with 300 of them being at immediate risk of closing. Rural healthcare systems are already strained, and hospital closures further restrict access to care and shift additional pressure onto remaining providers, including pharmacies, critical access hospitals and small clinics, all of which are already few and far between. 

As hospitals close and medical services shrink, rural pharmacies absorb much of the strain. They face growing patient volumes, inadequate reimbursement from insurers—sometimes resulting in financial losses on certain prescriptions—and increasing pressure to expand services such as compounding and immunizations. An analysis by the Rural Policy Research Institute found that 80% of rural independent pharmacies recieved reimbursement less than the cost of acquiring and dispensing medications. Some states, like New York, provide additional reimbursement rates for state medical programs in rural areas to bolster healthcare assess. Additionally, unlike chain pharmacies, independent pharmacies often have the flexibility to adapt. Many provide delivery services for patients without reliable transportation and expand clinical offerings to fill gaps left by other providers.

Despite funding challenges and cuts, there are still signs of support for rural healthcare infrastructure. On December 30, 2025, the New York State Department of Health announced that New York will receive $212 million in 2026 under the federal Rural Health Transformation Program to improve health care access and delivery in New York communities. Programs like this are essential to sustaining healthcare infrastructure and providers in rural areas.

Access to prescriptions has increasingly shifted to mail-order pharmacy services. While mail delivery can be convenient, particularly for maintenance medications, it presents its own set of challenges. Delays, incorrect dosages, stolen packages, or temperature-sensitive drugs compromised during transit can place patients at serious risk. Additionally, mail-order services do not offer the same in-person consultation and real-time problem-solving that community pharmacists provide. Although mail services play a role in rural healthcare delivery, policy efforts should prioritize sustaining brick-and mortar pharmacies that provide direct support. 

Recent retail pharmacy closures have further intensified the strain. The closure of all Rite Aid stores and numerous CVS locations has increased patient volume at independent pharmacies. With a large proportion of rural patients relying on government-funded insurance programs, reimbursement pressures can make profitability difficult. Independent pharmacists must balance delivering high-quality healthcare with managing the financial realities of running a small business. The dual responsibility of being a pharmacist and a business owner adds stress but many remain committed because of the meaningful and tangible impact they make in their communities.

With healthcare in rural areas experiencing increased strain, policymakers should consider how to strengthen pharmacies’ roles. Should independent pharmacies have the ability to prescribe some prescriptions in rural areas? Should federal and state governments allocate greater support to rural healthcare infrastructure compared to urban ones? Rural pharmacies are pillars of community healthcare—the question is whether policy will evolve to recognize, and adequately support, that reality.