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The number of pharmacies in the U.S. is on the rise, but they’re moving out of low-income, urban neighbourhoods, according to a recently-published report in JAMA Internal Medicine.

Between 2009 and 2015, one in eight pharmacies — 9,654 in total — closed across the U.S. despite an overall, nationwide increase. Independent pharmacies were three times more likely to shutter than chain locations.

Approximately 25 per cent of the pharmacies located in urban, low-income neighbourhoods closed during the study, compared with a 14 per cent closure rate in rural, low-income neighbourhoods.

“Independent pharmacies are often excluded from preferred pharmacy networks and 340B contracts, which are both increasingly important aspects of the pharmacy market, so it is not surprising that independent stores are at greater risk for closure,” Dima Mazen Qato, senior author of the study and associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy, said in a statement.

“Efforts to improve access to prescription drugs have focused almost exclusively on reducing drug costs, but affordable medications aren’t easily accessible when a local pharmacy closes. We need policies that specifically address pharmacy closures because such closures negatively impact access and adherence to prescription drugs.”

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In urban communities, pharmacies serving predominantly uninsured or publicly-insured residents using Medicare or Medicaid were two times more likely to close — a factor that did not appear to force closures in rural areas.

“Pharmacies located in rural areas may have financial incentives, including tiered pharmacy reimbursement rates for Medicaid prescriptions and critical access pharmacy payments, that are lacking 

in urban areas,” Qato hypothesized.

The study’s authors are calling on policymakers to introduce payment reforms and strengthen regulations around pharmacy access.

“Such policies may also protect pharmacies in predominately black and Latino communities and reduce disparities in access to prescription medications in urban areas,” Jenny Guadamuz, first author of the study and UIC graduate student, said.

Read the full study here.