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Americans have been going to their local pharmacy for more than just prescriptions during the pandemic. They've been going there for masks, COVID-19 tests and vaccines. But even with that increased business, retail pharmacies, big and small, are closing their doors. Oregon Public Broadcasting's April Ehrlich reports that these closures are straining small towns where options were already limited.
APRIL EHRLICH, BYLINE: Lisa Raffety has rheumatoid arthritis and needs to take an anti-inflammatory medicine every day. If she can't get it on time, the consequences are severe.
LISA RAFFETY: I'll go two to three days at the most, and then I'm pretty much - I can't walk.
EHRLICH: She lives in Baker City, a small town in eastern Oregon that had one of its four pharmacies closed last year. Fifty-five-year-old Raffety says, since then, lines at the remaining pharmacies started going out the door.
RAFFETY: And it hurts to stand for any length of time, to be on my feet. It's a hard, cement floor.
EHRLICH: Raffety says some people bring their dinners and eat them in line. Store clerks have to bring out wheelchairs for people who can't stand that long. Last year, the Pacific Northwest retailer Bi-Mart announced it was getting out of the pharmacy business, closing nearly 60 pharmacy counters in three states. Many of them were in rural areas.
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EHRLICH: And now the pharmacies that remain are picking up the slack.
RICK CHESTER: It happened immediately - like, overnight.
EHRLICH: Rick Chester owns Medicap Pharmacy in Talent, a small town in southern Oregon. He says business has been hectic since the Bi-Mart closed its pharmacy nearby. Then chain stores like Rite Aid started severely limiting their pharmacy hours, sometimes closing it for weeks straight.
CHESTER: And so everything is just more of a pressure cooker for everybody here. And you don't really know when it's going to end.
EHRLICH: Another pressure - insurance companies pushing people toward mail-order prescriptions, even though that doesn't always work for people in rural areas. Bi-Mart's spokesman Don Leber says there are several factors that went into the decision to close its pharmacies.
DON LEBER: We were really forced to make a decision we never wanted to make.
EHRLICH: He says one big issue is affecting pharmacies across the country - increasing fees, specifically from the middlemen that bridge pharmacies and insurance companies, called pharmaceutical benefit managers, or PBMs. Oregon Senator Ron Wyden has had his eye on these companies recently, which he says are charging excessive fees that are pushing smaller pharmacies out of business.
RON WYDEN: For rural communities in Oregon, this is a five-alarm emergency.
EHRLICH: Basically, when someone gets a prescription through an insurance or Medicare plan, the PBM is supposed to reimburse the pharmacy for the drug cost and some overhead. But in recent years, PBMs started decreasing the amount they reimburse when pharmacies don't meet certain sales markers. Wyden has called on Congress to increase its oversight of pharmaceutical benefit managers. And some states like New York have started regulating PBMs at the state level.
WYDEN: The rules are so vague and so inconsistent. They can kind of decide, gee, we really weren't making enough money, but we'll say the pharmacy's inefficient and just throw some more costs at them.
EHRLICH: According to a report by the U.S. Centers for Medicare and Medicaid Services, PBMs have increased their fees for Medicare plans by more than 91,000% in the last two years. PBM reimbursements have gotten so low that sometimes pharmacies say they actually lose money when they fill prescriptions from certain insurers. And some pharmacies, like the ones at Bi-Mart, just can't make it work financially. The PBM Trade Association disputes that PBMs are the reason for rural pharmacy closures. Regardless, when pharmacies close, people like Lisa Raffety have an even harder time getting the medicines they need.
RAFFETY: I haven't figured out when the best time to come and stand in line would be. I don't want to know 'cause I don't want to do this anymore.
EHRLICH: But standing in line is something she and many rural residents will have to get used to as more and more pharmacies close.
For NPR News, I'm April Ehrlich in Portland, Ore.
(SOUNDBITE OF MF DOOM'S "PENNYROYAL") Transcript provided by NPR, Copyright NPR.
