I live in a county bigger than Connecticut with zero pharmacies. The clinic has a big medicine pantry, but if they don't have it your next best bet is to drive to the next state over, about two hours from the clinic. The clinic was staffed by a nurse practitioner only on my last visit. Rural America is not a convenient place to be sick.
Isn't this like 1/2 the appeal of living in rural America though?
Way out there, on your own. Fewer creature comforts, more getting stuff done on your own. No paying the connivence fee associated with cities, having everything nearby but paying double the rent.
Yes this sounds like an obscene edge case but it's part of the deal
You're really stretching by assuming rural Americans have the option of living somewhere else.
I live in a relatively small town (~3000, though it's much bigger than other towns nearby). Most people here have never gone more than 100 miles from town. They have shit jobs (when they get them), live below the poverty line, have poor education. There is no transportation but rotted-out 20-year-old trucks or whatever $500 used car you could find in a nearby town. Their families have lived here their whole lives. They have no savings, no retirement, usually no health insurance.
This isn't "an appeal" or "a deal" they took, like they decided it would be cute to live a libertarian dream in the sticks. They have no other choice. This is what being poor is: a lack of options and no recourse.
Rural people who aren't poor still live there because... it's their home. You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy. Expecting people to just put up with pharmacy deserts or move, is a pretty hostile and careless position. It would be like expecting city people to get mugged every so often because that's the price you pay for wanting to have a pharmacy nearby.
These things shouldn't be expectations, they are problems to be solved, as in most other developed nations they largely are solved. We're the freaks for putting up with ridiculous amounts of crime, death, inconvenience, and needless expense.
> Rural people who aren't poor still live there because... it's their home. You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy.
It absolutely is all of that. It's also the money. $10k in flames is the low end of an interstate move. Supporting yourself and arranging all the pieces (ex:training) into a job that pays the bills - maybe quadruple that. Maybe more.
Can't tell if this is a weak troll, or you literally have a very tenuous grip on reality. The land was not covered with pharmacies and people migrating to find new pharmacies.
Let me explain how the current residents ended up here:
- Indian tribes used this land as hunting grounds.
- English surveyors came and mapped out the area.
- The land was granted to a wealthy business owner by the King of England.
- A few wealthy families buy more land, form homesteads, moving away from NYC after the Revolutionary War.
- Over time those families develop more of the land and invest in property and business, and more families move in over time as the town grows.
- Factories and farms nearby provide a steady source of income and the town flourishes. The outer village is connected to the town after the county is officially formed.
- Eventually due to economic pressure from overseas, the factories and farms dwindle. Those who have enough money move away to find work; those who have lots of money, or none at all, stay.
- Most of the small businesses disappear as franchises move in. The small yet sizeable population is enough to keep a few big-name, low-cost stores in profit.
The story of America is rich people taking advantage of cheap land, and poor people struggling to survive.
> Expecting people to just put up with pharmacy deserts or move, is a pretty hostile and careless position.
What other option is there? They won’t vote for a government solution. Can’t have socialism forcing a pharmacy to exist where the market says it can’t.
The idea that moving into town, or the next town over, is going to mean giving up your family and friends seems overstated. Everyone I know in the sticks has some family that’s an hour away because they married or got a job.
Is everyone supposed to move a town over? Two towns, three? Is there housing for that? Services? Jobs? Or are we also expecting some kind of magic pixie dust to pick all these people up and move them all and everything be okay?
And how does voting solve the problem? Who's putting what propositions forward? How does voting magically solve tax shortfalls, a lack of capital, deficits, state-wide or nation-wide political bullshit? How does voting create pharmacies, much less bring in people to staff them?
The point isn't that there's an easy solution. The point is, saying "just move" is as ridiculous and unrealistic as "just change our economic structure". There is no easy solution. But that also doesn't mean we should abandon our people because we don't want to deal with hard problems.
No, only the people who want to. The people who want rugged individualism stay rugged.
> And how does voting solve the problem?
They vote in representatives who will enact change through federal, state, and local governments.
There probably aren’t many candidates like that currently because the electorate demands candidates far to the right of that, but that could change.
> But that also doesn't mean we should abandon our people because we don't want to deal with hard problems.
Who’s abandoning them? They asked for small government and unchecked corporate power. Everyone on the left wants to deal with these hard problems, but you can’t force it on them.
> Can’t have socialism forcing a pharmacy to exist where the market says it can’t.
Strange that small towns (500-5000) in Brazil are able to have a pharmacy, same in many countries in Europe, just found this one in Portugal in a town of 600 people: https://maps.app.goo.gl/fnFZMFtU3ZqbBAVk8
Perhaps the over-reliance on massive corporations like Walmart, CVS, Walgrens, etc. instead of small shops owned by private individuals is not really very good for society to fill in basic needs like groceries, medicine, etc. where "the market says it can't".
I grew up in a fairly rural community. Every common service has basically collapsed.
The town I lived in had a grocery store, full service station, restaurant, hardware store, and even a bowling alley. Those are all completely gone. This was in a town with about 300 people.
How the collapse happened is actually pretty simple. As suppliers slowly consolidated they started raising prices for smaller business as somewhat of a "go away, you're annoying to deal with" policy. It's simply far easier to sell 1000 items to walmart than it is to sell 10 items to 100 different stores. That in turn collapsed businesses in the town as you could literally go to the walmart a 45 minute drive away and get things for half the price.
Medicine is mostly due to privatization of education and consolidation of medical offices. There are simply limits to how many students medical schools can take and as a result they've simply continued to raise tuition prices to try and limit demand. That has put huge debt burdens on new doctors which makes working in rural locations particularly unappealing (they can't afford the salary a doctor needs to afford the debt they've taken on).
15 minutes from my hometown, there's a medical center that used to employ about 10 doctors when I was a kid. Now it's mostly staffed by 1 or 2 nurses with a doctor that comes in 3 times a week. Where they used to have to tools and equipment to handle most medical needs, now they are effectively just a stabilization location while patients wait for life flight to take them to one of the more major medical locations.
I personally blame weak anti-trust enforcement and mass privatization and deregulation for the current state of things in rural America. These communities are dying because they have no capital power. That causes them to be steam rolled by basically everyone. Big business has wrecked that part of america.
Oh, and one more thing I'll add. I can't move to my hometown anymore because housing prices have gotten insane. I could probably build for cheaper than it costs to buy an existing home.
Why is this? Because a bunch of "get rich quick" scammers have purchased all the vacant homes and turned them into air-bnbs while they wait and hope to flip the properties to someone else.
My hometown is not some sort of "vacation destination". I highly doubt anyone is ever renting a single one of those homes. Yet here we are, with people sitting on property that used to be the homes of my childhood friends leaving them vacant or with a sale price that's double or triple what it should be for the location.
My rural (then) hometown was rearranged out of existence. They even changed the name.
I visited 5 years back and it was weirder than I imagined. Most of the roads don't go in the same direction any more. A massive 100year old prison complex was erased.
The woods were cleared for roads, parks and housing. Meanwhile, the prison fields had grown into woods. Taken together, it was right out of my 7yo Kafka-dreams.
The point is that being far away from critical services is part of the rural-urban tradeoff. It's like being upset that there isn't a level 1 trauma center within a 30 minute drive, because you live in the middle of nowhere. Nobody is going to deny the importance of living near a level 1 trauma center, but you kinda signed up for it when you decided to live in the middle of nowhere.
Easy there. Just because you can afford a computer, internet, car and rent doesn’t mean everyone can. A common theme of rural America is getting out if you can.
It costs money to move, and if you don’t have the money I wonder how kind the GP commenter would be to someone fleeing a rural area and living out of their car or a tent in their community.
I think the "you signed up for it" rubs me the wrong way. Particularly when it doesn't have to be that way, wasn't always that way, and there are specific policy choices causing a change.
Sure, most places never had a level 1 trauma center, but they did have hospitals, clinics, and pharmacies. Many of these medical institutions are leaving despite increasing population due to changing healthcare economics and policy choices.
You signed up for it by deciding to be born in one of the families living there, with no money nor possibilities to move away. Now what? Receive the irony of the well-situated IT workers for it?
I remember a documentary on China and apparently they let people study medicine for free if they play Medicine Woman Quinn in the boonies for a few years in exchange.
If you study medicine in Turkey, at a public or private university, you have to do up to 3 years of mandatory but paid service in a place government assigns you in order to obtain your diploma. This is how you can get rather good healtchcare coverage accross the country.
You need to do this once more if you do a specialization.
There were three doctors here before Obamacare, now zero, same population. So it's very common out here to blame that. Healthcare access in the nearest big city has also cratered. Two week appointments have become six months ... to see a nurse.
I'm extremely hopeful that congress will do something crazy like repeal that or otherwise screw things up SO BADLY we, as a country, backlash far enough to socialize the basic human rights.
EVERYONE should have healthcare. Just provide and tax to fund. It'd be cheaper than their medical bills, and WAY less headache if they don't have to deal with medical billing <<< THAT is the selling point.
Everyone should have retirement... wait that's what social security was supposed to be right? What's the problem *(other than funding it)... Medicine has developed 'old people jails' to turn the elderly into medicine consuming vegetables like some dystopian videogame or movie? Well... socialize that and have the experts figure something out. That's clearly a problem of improperly aligned incentives wound around a bunch of stuff I'd like people of various correct fields to address.
Why there aren't people in big cities: Costs too damned much to DO anything here; the rent is WAY too high. (we need to build a LOT, a WHOLE LOT more to catch up to years of not enough housing and slightly less not enough of the other stuff).
Why there aren't people in the rural areas: I suspect that though the rent is nicely low, the population density no longer supports the service. PART of that could be addressed by getting everyone on the same service (single payer healthcare), 3000 people sounds like enough for a basic family practice doctor to me. That's seeing ~10 people a day for 300 days out of 365 days a year. However that's about it.
I have a nephew currently going to medical school in Idaho (So by no means prestigious). By the time he's finished the expected tuition costs are $500,000.
A big reason you don't see family doctors in the sticks isn't because there aren't people that would love to be a small practice in the middle of nowhere. It's that nobody but a major medical institution can give them enough of a salary that they don't go broke under student debt.
> There were three doctors here before Obamacare, now zero, same population. So it's very common out here to blame that.
Medical news during the decade after ACA passage was positively maddening. The ACA helped a lot of people. It didn't help a lot more people and those people did not exist - except for 5 min to bash their politicians.
And no one, anywhere poked around the ACA to scout out problems. For example: I did income comparisons and learned that coverage cost went down as income went up. Someone making 22k/yr paid 4x what someone making 32k/yr did.
ACA made that info a huge pain to find because you had to simulate enrollment over and over. But it wasn't particle physics.
Not just likes to mail things, they basically try to force you to use the mail pharmacy service that they own.
My Aetna policy will deny all prescriptions for anything greater than 30 days supply or multiple refills unless you go through their mail pharmacy - it's the only way to get a 90 day supply.
And yup. Their online service often is "unable to determine status" of a prescription that they are filling, which means I can't even order a refill through them.
So let’s vote for the party who isn’t for healthcare for everyone. Obviously business will sort this out and put pharmacies in these places. I cannot help but remain cynical of the world that we’ve inherited.
Putting pharmacies in all those places when door to door delivery exists would be insanely wasteful. Just make it easier for pharmacists to mail you your medicines.
Or relax the requirements so you don't need a 6-8 years of postsecondary education and a 250k degree to be a glorified cashier. And that is before even getting into the consolidation of the pharmacy/PBM industry.
I've spent a lot of time in tiny poor Mexican towns that manage to have a pharmacy, sometimes several. Not only that, but you can get hundreds of prescriptions over the counter that would cost thousand dollar doctors visits in the US.
I can only imagine every small town in the US would also have an economically viable pharmacy if the regulatory environment here was the same.
There's also problems with the concept of these deserts. I live in a small town in a pretty rural county, the town is big enough to have a couple of superstores, so we have those pharmacies, a Walgreen's, and a regional one.
People that don't live in the small town are definitely going to be driving 10 and 20 minutes to get to a pharmacy, but the majority of that population is living outside of town by choice, because they want the lifestyle. Much of the cheaper housing in the county is in the town, and it's not like it's crime ridden or anything.
When I was a kid, it seemed every town had two or three pharmacies (~1980s). Now, unless you have a CVS, Walgreens, or are lucky enough to have a pharmacy in a grocery store, its not as common.
Did something change in the regulation or cost model to make pharmacy deliver unprofitable? Medicare/Medicaid too expensive? Less demand for Pharma services? Not sure of the driver -- there are a lot of points one could evaluate.
Vertical integration among healthcare providers, insurers, and pharmacy benefit managers (PBMs) due to PBMs being extremely costly middlemen. So the big insurers and providers started buying the PBMs and using them to abuse pharmacies out of the market to continue their vertical integration and complete rent-capture of American health.
No, what happened is the same thing that's been happening to smaller retail shops, grocery stores and so forth. Smaller pharmacies are either obliterated by larger stores using economy of scale to undercut and kill competition, or they're bought out by larger corporations, hollowed out and then consolidated.
You can look at the history of Bartell Drugs in WA. They were sold to Rite Aid, Rite Aid went under because of them being a shitty business and so most Bartells have closed down or are practically dead. And without replacement, that means there's now fewer pharmacies and the ones remaining are understaffed and overworked.
In the 80s the local pharmacy was your primary source of sundries, towns and cities alike. Everything from hardware to toys to medicine. If the local pharmacy didn't have it, you didn't buy it.
Now with hoards of Chinese shit available at your fingertips to order with same-day delivery, pharmacies couldn't survive on selling medicine alone, of which there are very small margins.
San Francisco and other cities making widespread theft and shoplifting de facto legal didn't help either. Local mom & pop pharmacies can't afford to put the entire store behind glass.
Rural resentment of cities is as old as the hills. I don’t know what the solution is. Price supports to keep small pharmacies alive? Heavy regulation of e-commerce? I’m no free-market zealot, but it’s hard to see how you blunt this impact in a non-heavy-handed way.
Wait for them to actually care about it. Where I live, rural areas are supposedly desperately short of doctors but the rural people can’t stop whining about them always wanting more money and to not be berated for being brown or gay.
Why is a solution needed if the people it supposedly impacts hardly care?
Yes, pricing regulations forced brick and mortar pharmacies to sell drugs below cost. Several closed in my area in the last few years and this was one of their cited reasons why.
I have two pharmacies in my town, but they're both owned by RiteAid which can't keep inventory on the shelves. If you need a prescription filled they can do that, but if you need something over the counter they won't have it. I walked into a Walgreens the other day in the next town over and was amazed at fully stocked shelves. Hadn't seen that in a drug store for quite some time.
Yes, keyword hopefully...over some indeterminate time horizon...but surely not a mere 6 months after emergence from a legal proceeding that took a year to resolve.
Commodified OTCs are hardly raking in compelling margins relative to filling scripts, so it's unsurprising that some Rite Aids are operating as the parent reports.
Sounds like Bartell's in the Seattle area. Plenty of friendly staff but nothing on the shelves. Walgreens meanwhile has fully stocked shelves but 1 barely conscious person at the register and a 30 minute wait at the pharmacy.
We had Rite Aid and Walgreens, then Rite Aid went bankrupt or whatever all they aren't here anymore (they would always be across the street from each other).
Now you have a 45 minute wait when you go, they never have stuff in stock, their phone support people are terrible...
Walgreens was great (and 24 hours) but now it's a shit show. At least we still have the pharmacy at grocery stores, Walmart, and a couple mom-n-pop pharmacies but their hours stink.
There are a couple other places without a storefront that are delivery-only but I haven't tried any of them yet.
I'm trying to understand what their actual definition of a Pharmacy Desert is, as they don't seem to define it. A search suggests it might be having no pharmacy within 1 mile in a city or 10 miles in a rural area.
I'm guessing I've lived most of my life in a pharmacy desert without realising it.
Looks like I'm 18 km (23 km by road) from a pharmacy to the north and 22 km (28 km by road) to the south, but the one I actually go to because it has longer hours (7 days until 9 PM) is 32 km drive.
On the other hand, when I lived in Russia every street had a pharmacy seemingly about every 300m, and people ran to them for the slightest sniffle. That's probably why they have such a good life expectancy.
The paper describes it as communities >=10 miles from the nearest pharmacy. This is a pretty garbage definition in my opinion, if you are somewhere like the Midwest or the basin and range.
The thing that always shocks me is the number of Americans on prescription drugs. We eat this stuff like candy. 66 percent of all adults in the United States use prescription drugs[1]. 50 percent of people used at least one prescription drug in the past 30 days[2]. I get asked as part of a routine doctor's visit what prescription drugs I'm on, and I sometimes get weird looks when I say "none."
I'm not a doctor, but these numbers seem totally out of whack and out of control. It's not just the elderly, either, although the percentages from 80+ aged folks do skew the overall numbers.
I was given my first prescription drug (to suppress stomach acid) around my 61st birthday. It's a PITA. Though the drug itself is "free" (or was ... my last pickup in December they charged me $5) they will only give you three months of it at a time and the freaking GPs office charges $20 each time to receive a "please can I have some more" request on their web site / app and forward the order to the pharmacy.
> they will only give you three months of it at a time and the freaking GPs office charges $20 each time to receive a "please can I have some more" request on their web site / app and forward the order to the pharmacy.
I take it you are outside of the US? For all the criticism of the American health system, this has never been a problem.
For most maintenance medications, which this sounds like it is, the doctor will authorize one year's supply, for which you pick them up every 30 or 90 days at a time. When you run out of refills the pharmacy will usually contact your doctor for re-authorization, typically at no charge.
Often the doctor wants to see you anyway to check your progress before you run out.
During your yearly visit there is usually a short conversation about getting medication refilled.
The exception to this are when the doctor wants to order tests to see how you are reacting to the medication, or periodic tests for long term medications (in case they need to adjust the dosage).
Things like pain medications or for urgent issues are dispensed as a one-time thing.
It’s only 12% of women of childbearing age on the pill - under 10 million. Another smaller chunk uses depo or norplant, but the CDC figures lump those in with IUDs so it’s hard to tell exactly.
Either way a small number compared to e.g. statins.
Why do you think that’s negative?
The most common prescriptions are for blood pressure and cholesterol, which has brought down the deaths from cardiovascular disease dramatically.
There’s an ignorant, trolling comment on this thread I’m not going to dignify with a response that suggests rural Americans somehow deserve a lack of proper medical care because they “chose” to live in a rural area.
Many of these people have no choice to live where they do because of high home prices in Bluer cities. The reason why home prices are high is because zoning restricts the supply of new homes. This often prevents poorer Americans from moving to cities with better jobs.
Instead of inflaming Red vs Blue state politics (which is really Red rural America vs Blue urban America), we should think about how our housing policies act like Medieval walls of centuries past, keeping the poor and disfavored outside the city gates.
Health discussions commonly assume that medical services are within reach. But for much (often most) of the US that isn't the case. Most counties do not have sufficient mental health services, few have medical specialists and an ER can be several counties away.
People who live in underserved areas matter. Overwhelmingly, they are people who are trapped there by poverty. And while poor urban Americans get occasional lip service (if little else), poor rural Americans (inc brown, white, indigenous) don't even get that. No one is more invisible than the rural poor.
> The rural parts consistently prefer a tax cut over anything else.
No. They do not prefer tax cuts over eating, for example.
> Rural people elected the current federal government.
When the entire country acts as if you and your problems don't exist (for several generations), burning it all down doesn't feel like much of a catastrophe.
I've heard from Indigenous Americans who aren't overly bothered by our massive ongoing crises. Their position is something like 'you might experience a tiny sliver of what we've had for centuries'. And they have a point.
> They turned out in droves to cut food stamps to fund large tax cuts.
They can't get SNAP so, again, burning down SNAP doesn't feel like a catastrophe.
When calls to aid the poor and vulnerable
consistently omit most counties,
we ought to be not stupid;
we ought to expect those counties to become estranged.
Estranged, vulnerable people are more likely to be susceptible to manipulation because that's how people work.
If this -> We Need To Help The Rural Poor In A Consistent And Meaningful Way <- will never be on the table, that's a decision. Own it.
It’s not even legal for them to try to compete. Even if someone preferred to pay more for the convenience the brick and mortar shops aren’t allowed to charge a premium over the online pharmacies.
According to one of my local pharmacies (that closed in the last year), there are laws in some states preventing brick and mortar stores from imposing additional fees over online pharmacies. Reference in a sibling comment.
There is no law against a pharmacy owner from charging whatever they want.
However, most pharmacies enter into contracts with various groups, such as the government, insurance companies, etc so that they effectively give away their right to charge what they want.
> There is no law against a pharmacy owner from charging whatever they want.
On closing, one of my local pharmacies claimed otherwise and referenced the following:
> states have enacted legislation prohibiting certain PBM clients from imposing additional co-payments, deductibles, limitation on benefits, or other conditions (“Conditions”) on covered individuals utilizing a retail pharmacy when the same Conditions are not otherwise imposed on covered individuals utilizing home delivery pharmacies. However, the legislation requires the retail pharmacy to agree to the same reimbursement amounts and terms and conditions as are imposed on the home delivery pharmacies.
Interesting. I guess that sort of qualifies, even though a pharmacy owner can technically choose to not enter into any agreements.
The government is at the root cause of wanting to squeeze all players in the healthcare business, since public rancor reached a tipping point in the late 2000s and ACA was passed. Pharmacists just got shafted first because they were the easiest to squeeze due to supply and demand. Doctors were next with the insertion of physician assistances and nurse practitioners.
Pharmacists could be replaced by vending machines and a phone consult. They're the proof that even if GPT-n can replace humans, humans will still have jobs. The only thing they're good for in my experience is to fail to read the script properly, necessitating you to perform some social engineering so that they can read it again and get it right. Bottom tier intelligence.
"Oh but they can tell you drug interacti-" give me a break. They've never done that and besides, so can a computer.
> Why do we need a pharmacy when it can be delivered by postal mail.
Answer: We need them for prescriptions that aren't routine refills. We need them where mail is less predictable and for addresses that are at risk of non-delivery. We need them for new medical events. We need them when the last med didn't work and the next 2 might not either.
We need them when our local pharmacist is literally the only one who cares enough to keep our meds stocked (me+now).
One big thing pharmacies do is answer questions about drugs to educate the users in ways the doctors prescribing them often don't and also check for drug interactions to protect patients. Sometimes you wind up getting prescriptions for two things from different doctors and one doesn't notice or ask to find out that your prescription from doctor A has a bad interaction with drug B they're prescribing.
Also the US mail is also being actively degraded so the ability to reliably get mail delivered to the entire US guaranteed may just disappear soon.
>One big thing pharmacies do is answer questions about drugs to educate the users in ways the doctors prescribing them often don't and also check for drug interactions to protect patients.
It /could/ be but we also all know how great remote call centers do actually caring about the people they're supposed to serve. The real outcome will be fewer people servicing more customers for less money.
I've had many prescriptions and the pharmacist was pretty useless about side effects. It would be after I researched the new side effects I'd have that I trace it back...to the drug I was prescribed.
Your second point is probably more salient. But we do have UPS & FedEx.
They're not required to deliver your package where USPS is and can be done for flat rates. It's the problem with spinning out government services and trying to run them like a business, they're not there to make money they provide a service.
This to me is like a classical junior software engineering design fallacy. Why do we need to do things this old way when we can just do things this new way.
If you ever find yourself thinking like this: you should always step back and figure out why something is actually done a certain way.
> Why not state why something is done a certain way instead .
Because everyone else did that for me in responding to you. And if people are telling you you're wrong, you should be able to step back and analyze why people are telling you that and determine why it might be the case, even if it's for validating your own argument.
> Mail order is cheap and efficient.
Mail is cheap and efficient in areas that are not part of the Last Mile problem. The people without pharmacies are in the the areas most expensive and most inefficient for mail. This should be obvious. And for medications that are critical or same-day, you cannot rely on mail order in these areas which is a deadly problem. This is also without going into things like reliability and/or theft in lower income areas.
> My junior developers analyze why things are done a certain way and don't blindly advocate or prefer "new" methods.
Aren’t compounding pharmacies meant to solve this? I’m not familiar with how they work but I remember small family compounding pharmacies used to be everywhere. Now you never see them and I’ve heard some states like California are trying to get rid of them.
Are you thinking of the correct term? Compounding pharmacies provide simple drug manufacturing tasks, like pressing pills from raw ingredients or splitting and mixing liquid drugs.
Some regulators dont like them because the medicine and dosages they produce do not need FDA review for safety or efficacy.
I was working in a college job for a pharmaceutical distributor when the New England Compounding Center outbreak happened. I think that dropped a nuke on the whole industry. We stopped dealing with compounding pharmacies after that because that whole thing was more like a matter of when not if.
I'm most familiar with them for off label ocular injections. Avastin is a common medication for colorectal cancer, but has an extremely similar biologic to Lucentis, used of ocular injections. Compounding pharmacies will breakdown Avastin because it is cheaper than Lucentis, and pre-fill disposable syringes.
I think I am. But maybe I’m wrong. What I remember is these pharmacies could basically make prescription drugs locally and do custom drugs and things like that because they worked differently from big pharmacies. That was what kept them surviving as small businesses. But over time they’ve just disappeared. At least in places I’ve lived and traveled to.
I live in a county bigger than Connecticut with zero pharmacies. The clinic has a big medicine pantry, but if they don't have it your next best bet is to drive to the next state over, about two hours from the clinic. The clinic was staffed by a nurse practitioner only on my last visit. Rural America is not a convenient place to be sick.
Isn't this like 1/2 the appeal of living in rural America though?
Way out there, on your own. Fewer creature comforts, more getting stuff done on your own. No paying the connivence fee associated with cities, having everything nearby but paying double the rent.
Yes this sounds like an obscene edge case but it's part of the deal
You're really stretching by assuming rural Americans have the option of living somewhere else.
I live in a relatively small town (~3000, though it's much bigger than other towns nearby). Most people here have never gone more than 100 miles from town. They have shit jobs (when they get them), live below the poverty line, have poor education. There is no transportation but rotted-out 20-year-old trucks or whatever $500 used car you could find in a nearby town. Their families have lived here their whole lives. They have no savings, no retirement, usually no health insurance.
This isn't "an appeal" or "a deal" they took, like they decided it would be cute to live a libertarian dream in the sticks. They have no other choice. This is what being poor is: a lack of options and no recourse.
Rural people who aren't poor still live there because... it's their home. You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy. Expecting people to just put up with pharmacy deserts or move, is a pretty hostile and careless position. It would be like expecting city people to get mugged every so often because that's the price you pay for wanting to have a pharmacy nearby.
These things shouldn't be expectations, they are problems to be solved, as in most other developed nations they largely are solved. We're the freaks for putting up with ridiculous amounts of crime, death, inconvenience, and needless expense.
> Rural people who aren't poor still live there because... it's their home. You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy.
It absolutely is all of that. It's also the money. $10k in flames is the low end of an interstate move. Supporting yourself and arranging all the pieces (ex:training) into a job that pays the bills - maybe quadruple that. Maybe more.
And all of that assumes luck.
Who said anything about an interstate move?
I did because the term interstate move strongly reflects the resources required to get to a job-rich area.
Most counties are that kind of distance from job-rich areas.
> You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy.
That’s how those people got there a few generations ago in the first place.
Can't tell if this is a weak troll, or you literally have a very tenuous grip on reality. The land was not covered with pharmacies and people migrating to find new pharmacies.
Let me explain how the current residents ended up here:
- Indian tribes used this land as hunting grounds.
- English surveyors came and mapped out the area.
- The land was granted to a wealthy business owner by the King of England.
- A few wealthy families buy more land, form homesteads, moving away from NYC after the Revolutionary War.
- Over time those families develop more of the land and invest in property and business, and more families move in over time as the town grows.
- Factories and farms nearby provide a steady source of income and the town flourishes. The outer village is connected to the town after the county is officially formed.
- Eventually due to economic pressure from overseas, the factories and farms dwindle. Those who have enough money move away to find work; those who have lots of money, or none at all, stay.
- Most of the small businesses disappear as franchises move in. The small yet sizeable population is enough to keep a few big-name, low-cost stores in profit.
The story of America is rich people taking advantage of cheap land, and poor people struggling to survive.
Funny they all vote Republican. Turkeys and Christmas.
> Expecting people to just put up with pharmacy deserts or move, is a pretty hostile and careless position.
What other option is there? They won’t vote for a government solution. Can’t have socialism forcing a pharmacy to exist where the market says it can’t.
The idea that moving into town, or the next town over, is going to mean giving up your family and friends seems overstated. Everyone I know in the sticks has some family that’s an hour away because they married or got a job.
Is everyone supposed to move a town over? Two towns, three? Is there housing for that? Services? Jobs? Or are we also expecting some kind of magic pixie dust to pick all these people up and move them all and everything be okay?
And how does voting solve the problem? Who's putting what propositions forward? How does voting magically solve tax shortfalls, a lack of capital, deficits, state-wide or nation-wide political bullshit? How does voting create pharmacies, much less bring in people to staff them?
The point isn't that there's an easy solution. The point is, saying "just move" is as ridiculous and unrealistic as "just change our economic structure". There is no easy solution. But that also doesn't mean we should abandon our people because we don't want to deal with hard problems.
> Is everyone supposed to move a town over?
No, only the people who want to. The people who want rugged individualism stay rugged.
> And how does voting solve the problem?
They vote in representatives who will enact change through federal, state, and local governments.
There probably aren’t many candidates like that currently because the electorate demands candidates far to the right of that, but that could change.
> But that also doesn't mean we should abandon our people because we don't want to deal with hard problems.
Who’s abandoning them? They asked for small government and unchecked corporate power. Everyone on the left wants to deal with these hard problems, but you can’t force it on them.
> Can’t have socialism forcing a pharmacy to exist where the market says it can’t.
Strange that small towns (500-5000) in Brazil are able to have a pharmacy, same in many countries in Europe, just found this one in Portugal in a town of 600 people: https://maps.app.goo.gl/fnFZMFtU3ZqbBAVk8
Perhaps the over-reliance on massive corporations like Walmart, CVS, Walgrens, etc. instead of small shops owned by private individuals is not really very good for society to fill in basic needs like groceries, medicine, etc. where "the market says it can't".
I grew up in a fairly rural community. Every common service has basically collapsed.
The town I lived in had a grocery store, full service station, restaurant, hardware store, and even a bowling alley. Those are all completely gone. This was in a town with about 300 people.
How the collapse happened is actually pretty simple. As suppliers slowly consolidated they started raising prices for smaller business as somewhat of a "go away, you're annoying to deal with" policy. It's simply far easier to sell 1000 items to walmart than it is to sell 10 items to 100 different stores. That in turn collapsed businesses in the town as you could literally go to the walmart a 45 minute drive away and get things for half the price.
Medicine is mostly due to privatization of education and consolidation of medical offices. There are simply limits to how many students medical schools can take and as a result they've simply continued to raise tuition prices to try and limit demand. That has put huge debt burdens on new doctors which makes working in rural locations particularly unappealing (they can't afford the salary a doctor needs to afford the debt they've taken on).
15 minutes from my hometown, there's a medical center that used to employ about 10 doctors when I was a kid. Now it's mostly staffed by 1 or 2 nurses with a doctor that comes in 3 times a week. Where they used to have to tools and equipment to handle most medical needs, now they are effectively just a stabilization location while patients wait for life flight to take them to one of the more major medical locations.
I personally blame weak anti-trust enforcement and mass privatization and deregulation for the current state of things in rural America. These communities are dying because they have no capital power. That causes them to be steam rolled by basically everyone. Big business has wrecked that part of america.
Oh, and one more thing I'll add. I can't move to my hometown anymore because housing prices have gotten insane. I could probably build for cheaper than it costs to buy an existing home.
Why is this? Because a bunch of "get rich quick" scammers have purchased all the vacant homes and turned them into air-bnbs while they wait and hope to flip the properties to someone else.
My hometown is not some sort of "vacation destination". I highly doubt anyone is ever renting a single one of those homes. Yet here we are, with people sitting on property that used to be the homes of my childhood friends leaving them vacant or with a sale price that's double or triple what it should be for the location.
My rural (then) hometown was rearranged out of existence. They even changed the name.
I visited 5 years back and it was weirder than I imagined. Most of the roads don't go in the same direction any more. A massive 100year old prison complex was erased.
The woods were cleared for roads, parks and housing. Meanwhile, the prison fields had grown into woods. Taken together, it was right out of my 7yo Kafka-dreams.
Very few completely eschew the option to get medical services when they decide they need them.
The point is that being far away from critical services is part of the rural-urban tradeoff. It's like being upset that there isn't a level 1 trauma center within a 30 minute drive, because you live in the middle of nowhere. Nobody is going to deny the importance of living near a level 1 trauma center, but you kinda signed up for it when you decided to live in the middle of nowhere.
Easy there. Just because you can afford a computer, internet, car and rent doesn’t mean everyone can. A common theme of rural America is getting out if you can.
It costs money to move, and if you don’t have the money I wonder how kind the GP commenter would be to someone fleeing a rural area and living out of their car or a tent in their community.
I think the "you signed up for it" rubs me the wrong way. Particularly when it doesn't have to be that way, wasn't always that way, and there are specific policy choices causing a change.
Sure, most places never had a level 1 trauma center, but they did have hospitals, clinics, and pharmacies. Many of these medical institutions are leaving despite increasing population due to changing healthcare economics and policy choices.
You signed up for it by deciding to be born in one of the families living there, with no money nor possibilities to move away. Now what? Receive the irony of the well-situated IT workers for it?
Some people do not decide.
I remember a documentary on China and apparently they let people study medicine for free if they play Medicine Woman Quinn in the boonies for a few years in exchange.
If you study medicine in Turkey, at a public or private university, you have to do up to 3 years of mandatory but paid service in a place government assigns you in order to obtain your diploma. This is how you can get rather good healtchcare coverage accross the country.
You need to do this once more if you do a specialization.
Rural America certainly votes that way. I’d be curious if the people in these counties view this report as more than bashing.
There were three doctors here before Obamacare, now zero, same population. So it's very common out here to blame that. Healthcare access in the nearest big city has also cratered. Two week appointments have become six months ... to see a nurse.
I'm extremely hopeful that congress will do something crazy like repeal that or otherwise screw things up SO BADLY we, as a country, backlash far enough to socialize the basic human rights.
EVERYONE should have healthcare. Just provide and tax to fund. It'd be cheaper than their medical bills, and WAY less headache if they don't have to deal with medical billing <<< THAT is the selling point.
Everyone should have retirement... wait that's what social security was supposed to be right? What's the problem *(other than funding it)... Medicine has developed 'old people jails' to turn the elderly into medicine consuming vegetables like some dystopian videogame or movie? Well... socialize that and have the experts figure something out. That's clearly a problem of improperly aligned incentives wound around a bunch of stuff I'd like people of various correct fields to address.
Why there aren't people in big cities: Costs too damned much to DO anything here; the rent is WAY too high. (we need to build a LOT, a WHOLE LOT more to catch up to years of not enough housing and slightly less not enough of the other stuff).
Why there aren't people in the rural areas: I suspect that though the rent is nicely low, the population density no longer supports the service. PART of that could be addressed by getting everyone on the same service (single payer healthcare), 3000 people sounds like enough for a basic family practice doctor to me. That's seeing ~10 people a day for 300 days out of 365 days a year. However that's about it.
I have a nephew currently going to medical school in Idaho (So by no means prestigious). By the time he's finished the expected tuition costs are $500,000.
A big reason you don't see family doctors in the sticks isn't because there aren't people that would love to be a small practice in the middle of nowhere. It's that nobody but a major medical institution can give them enough of a salary that they don't go broke under student debt.
> There were three doctors here before Obamacare, now zero, same population. So it's very common out here to blame that.
Medical news during the decade after ACA passage was positively maddening. The ACA helped a lot of people. It didn't help a lot more people and those people did not exist - except for 5 min to bash their politicians.
And no one, anywhere poked around the ACA to scout out problems. For example: I did income comparisons and learned that coverage cost went down as income went up. Someone making 22k/yr paid 4x what someone making 32k/yr did.
ACA made that info a huge pain to find because you had to simulate enrollment over and over. But it wasn't particle physics.
Is telehealth an option?
Not really, it doesn't have to be a binary, and wasn't always that way, and doesnt have to be this way.
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Similar story here. Our insurance likes to mail things, but gets the prescription wrong or it doesn’t show up 60% of the time.
We spend a lot of time arguing on the phone.
Not just likes to mail things, they basically try to force you to use the mail pharmacy service that they own.
My Aetna policy will deny all prescriptions for anything greater than 30 days supply or multiple refills unless you go through their mail pharmacy - it's the only way to get a 90 day supply.
And yup. Their online service often is "unable to determine status" of a prescription that they are filling, which means I can't even order a refill through them.
I use a mail order pharmacy for most of my needs, and I live in a major metro.
So let’s vote for the party who isn’t for healthcare for everyone. Obviously business will sort this out and put pharmacies in these places. I cannot help but remain cynical of the world that we’ve inherited.
Putting pharmacies in all those places when door to door delivery exists would be insanely wasteful. Just make it easier for pharmacists to mail you your medicines.
Let’s see how that works out with privatized USPS. Last mile isn’t free.
You know what really isn’t free—putting highly educated, well-paid medical professionals in a building serving an extremely low density area.
Or relax the requirements so you don't need a 6-8 years of postsecondary education and a 250k degree to be a glorified cashier. And that is before even getting into the consolidation of the pharmacy/PBM industry.
I've spent a lot of time in tiny poor Mexican towns that manage to have a pharmacy, sometimes several. Not only that, but you can get hundreds of prescriptions over the counter that would cost thousand dollar doctors visits in the US.
I can only imagine every small town in the US would also have an economically viable pharmacy if the regulatory environment here was the same.
I heard that the drugs for sale in Mexican pharmacies are often counterfeit or defective in other ways, so I'm not sure how relevant that example is.
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'No Way to Prevent This,' Says Only Nation Where This Regularly Happens.
Those might be the only educated people for people to talk to in that entire extremely low density area
And who is going to pay for or subsidize the delivery costs? Especially when the government is talking about axing USPS?
Who was going to pay to build those pharmacies in the middle of nowhere?
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Which party is that? Both of them?
At the very least one of them tried with the ACA.
ACA is also just Romneycare from MA.
To me, the headline is a little misleading. From the first paragraph of the article:
> ... 46 percent of all counties studied had at least one pharmacy desert, and that 15.8 million people in the U.S. live in pharmacy deserts.
So while 46% of all counties have at least one pharmacy desert, less than 5% of people actually live in a pharmacy desert (USA population of ~340.1M).
There's also problems with the concept of these deserts. I live in a small town in a pretty rural county, the town is big enough to have a couple of superstores, so we have those pharmacies, a Walgreen's, and a regional one.
People that don't live in the small town are definitely going to be driving 10 and 20 minutes to get to a pharmacy, but the majority of that population is living outside of town by choice, because they want the lifestyle. Much of the cheaper housing in the county is in the town, and it's not like it's crime ridden or anything.
Walgreens is being taken private in a $10B deal, and is planning on closing 1200 locations in the near future.
When I was a kid, it seemed every town had two or three pharmacies (~1980s). Now, unless you have a CVS, Walgreens, or are lucky enough to have a pharmacy in a grocery store, its not as common.
Did something change in the regulation or cost model to make pharmacy deliver unprofitable? Medicare/Medicaid too expensive? Less demand for Pharma services? Not sure of the driver -- there are a lot of points one could evaluate.
Vertical integration among healthcare providers, insurers, and pharmacy benefit managers (PBMs) due to PBMs being extremely costly middlemen. So the big insurers and providers started buying the PBMs and using them to abuse pharmacies out of the market to continue their vertical integration and complete rent-capture of American health.
No, what happened is the same thing that's been happening to smaller retail shops, grocery stores and so forth. Smaller pharmacies are either obliterated by larger stores using economy of scale to undercut and kill competition, or they're bought out by larger corporations, hollowed out and then consolidated.
You can look at the history of Bartell Drugs in WA. They were sold to Rite Aid, Rite Aid went under because of them being a shitty business and so most Bartells have closed down or are practically dead. And without replacement, that means there's now fewer pharmacies and the ones remaining are understaffed and overworked.
{ Amazon, Target, Walmart } happened.
In the 80s the local pharmacy was your primary source of sundries, towns and cities alike. Everything from hardware to toys to medicine. If the local pharmacy didn't have it, you didn't buy it.
Now with hoards of Chinese shit available at your fingertips to order with same-day delivery, pharmacies couldn't survive on selling medicine alone, of which there are very small margins.
San Francisco and other cities making widespread theft and shoplifting de facto legal didn't help either. Local mom & pop pharmacies can't afford to put the entire store behind glass.
Rural resentment of cities is as old as the hills. I don’t know what the solution is. Price supports to keep small pharmacies alive? Heavy regulation of e-commerce? I’m no free-market zealot, but it’s hard to see how you blunt this impact in a non-heavy-handed way.
Wait for them to actually care about it. Where I live, rural areas are supposedly desperately short of doctors but the rural people can’t stop whining about them always wanting more money and to not be berated for being brown or gay.
Why is a solution needed if the people it supposedly impacts hardly care?
Yes, pricing regulations forced brick and mortar pharmacies to sell drugs below cost. Several closed in my area in the last few years and this was one of their cited reasons why.
What regulations specifically?
There's a lot of competition with mail order pharmacies, I think.
I have two pharmacies in my town, but they're both owned by RiteAid which can't keep inventory on the shelves. If you need a prescription filled they can do that, but if you need something over the counter they won't have it. I walked into a Walgreens the other day in the next town over and was amazed at fully stocked shelves. Hadn't seen that in a drug store for quite some time.
> I have two pharmacies in my town, but they're both owned by RiteAid which can't keep inventory on the shelves.
Rite Aid filed chapter 11 bankruptcy almost 2 years ago.
Sure, but the point of Chapter 11 is to restructure so you can hopefully get back to operating profitably.
Yes, keyword hopefully...over some indeterminate time horizon...but surely not a mere 6 months after emergence from a legal proceeding that took a year to resolve.
Commodified OTCs are hardly raking in compelling margins relative to filling scripts, so it's unsurprising that some Rite Aids are operating as the parent reports.
Sounds like Bartell's in the Seattle area. Plenty of friendly staff but nothing on the shelves. Walgreens meanwhile has fully stocked shelves but 1 barely conscious person at the register and a 30 minute wait at the pharmacy.
> Sounds like Bartell's in the Seattle area.
To be sure, Bartell's is a subsidiary of Rite Aid.
We had Rite Aid and Walgreens, then Rite Aid went bankrupt or whatever all they aren't here anymore (they would always be across the street from each other).
Now you have a 45 minute wait when you go, they never have stuff in stock, their phone support people are terrible...
Walgreens was great (and 24 hours) but now it's a shit show. At least we still have the pharmacy at grocery stores, Walmart, and a couple mom-n-pop pharmacies but their hours stink.
There are a couple other places without a storefront that are delivery-only but I haven't tried any of them yet.
Yea, where I live there is sometimes a 2+ hr wait at the Rite Aid.
I'm trying to understand what their actual definition of a Pharmacy Desert is, as they don't seem to define it. A search suggests it might be having no pharmacy within 1 mile in a city or 10 miles in a rural area.
I'm guessing I've lived most of my life in a pharmacy desert without realising it.
Looks like I'm 18 km (23 km by road) from a pharmacy to the north and 22 km (28 km by road) to the south, but the one I actually go to because it has longer hours (7 days until 9 PM) is 32 km drive.
On the other hand, when I lived in Russia every street had a pharmacy seemingly about every 300m, and people ran to them for the slightest sniffle. That's probably why they have such a good life expectancy.
The paper describes it as communities >=10 miles from the nearest pharmacy. This is a pretty garbage definition in my opinion, if you are somewhere like the Midwest or the basin and range.
The thing that always shocks me is the number of Americans on prescription drugs. We eat this stuff like candy. 66 percent of all adults in the United States use prescription drugs[1]. 50 percent of people used at least one prescription drug in the past 30 days[2]. I get asked as part of a routine doctor's visit what prescription drugs I'm on, and I sometimes get weird looks when I say "none."
I'm not a doctor, but these numbers seem totally out of whack and out of control. It's not just the elderly, either, although the percentages from 80+ aged folks do skew the overall numbers.
1: https://hpi.georgetown.edu/rxdrugs/
2: https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm
I was given my first prescription drug (to suppress stomach acid) around my 61st birthday. It's a PITA. Though the drug itself is "free" (or was ... my last pickup in December they charged me $5) they will only give you three months of it at a time and the freaking GPs office charges $20 each time to receive a "please can I have some more" request on their web site / app and forward the order to the pharmacy.
> they will only give you three months of it at a time and the freaking GPs office charges $20 each time to receive a "please can I have some more" request on their web site / app and forward the order to the pharmacy.
I take it you are outside of the US? For all the criticism of the American health system, this has never been a problem.
For most maintenance medications, which this sounds like it is, the doctor will authorize one year's supply, for which you pick them up every 30 or 90 days at a time. When you run out of refills the pharmacy will usually contact your doctor for re-authorization, typically at no charge.
Often the doctor wants to see you anyway to check your progress before you run out.
During your yearly visit there is usually a short conversation about getting medication refilled.
The exception to this are when the doctor wants to order tests to see how you are reacting to the medication, or periodic tests for long term medications (in case they need to adjust the dosage).
Things like pain medications or for urgent issues are dispensed as a one-time thing.
Does that include birth control? If so I think that would account for a pretty large portion of the 50% that used one in the last 30 days.
It’s only 12% of women of childbearing age on the pill - under 10 million. Another smaller chunk uses depo or norplant, but the CDC figures lump those in with IUDs so it’s hard to tell exactly.
Either way a small number compared to e.g. statins.
Why do you think that’s negative? The most common prescriptions are for blood pressure and cholesterol, which has brought down the deaths from cardiovascular disease dramatically.
There’s an ignorant, trolling comment on this thread I’m not going to dignify with a response that suggests rural Americans somehow deserve a lack of proper medical care because they “chose” to live in a rural area.
Many of these people have no choice to live where they do because of high home prices in Bluer cities. The reason why home prices are high is because zoning restricts the supply of new homes. This often prevents poorer Americans from moving to cities with better jobs.
Instead of inflaming Red vs Blue state politics (which is really Red rural America vs Blue urban America), we should think about how our housing policies act like Medieval walls of centuries past, keeping the poor and disfavored outside the city gates.
I'm grateful for the focus on counties here.
Health discussions commonly assume that medical services are within reach. But for much (often most) of the US that isn't the case. Most counties do not have sufficient mental health services, few have medical specialists and an ER can be several counties away.
People who live in underserved areas matter. Overwhelmingly, they are people who are trapped there by poverty. And while poor urban Americans get occasional lip service (if little else), poor rural Americans (inc brown, white, indigenous) don't even get that. No one is more invisible than the rural poor.
The rural parts consistently prefer a tax cut over anything else. Rural people elected the current federal government.
> The rural parts consistently prefer a tax cut over anything else.
No. They do not prefer tax cuts over eating, for example.
> Rural people elected the current federal government.
When the entire country acts as if you and your problems don't exist (for several generations), burning it all down doesn't feel like much of a catastrophe.
I've heard from Indigenous Americans who aren't overly bothered by our massive ongoing crises. Their position is something like 'you might experience a tiny sliver of what we've had for centuries'. And they have a point.
> No. They do not prefer tax cuts over eating, for example.
They turned out in droves to cut food stamps to fund large tax cuts. So yes, they do.
> They turned out in droves to cut food stamps to fund large tax cuts.
They can't get SNAP so, again, burning down SNAP doesn't feel like a catastrophe.
Estranged, vulnerable people are more likely to be susceptible to manipulation because that's how people work.If this -> We Need To Help The Rural Poor In A Consistent And Meaningful Way <- will never be on the table, that's a decision. Own it.
"X desert" is a catchy phrase that often covers up weak analysis. Commonly the availability of delivery grocery, medicines, etc. is ignored.
It’s only going to get worse with brick and mortar pharmacies not being able to compete with online pharmacies.
It’s not even legal for them to try to compete. Even if someone preferred to pay more for the convenience the brick and mortar shops aren’t allowed to charge a premium over the online pharmacies.
>brick and mortar shops aren’t allowed to charge a premium over the online pharmacies.
What is this referring to? Is there some law that prevents pharmacies from setting their own sales prices?
According to one of my local pharmacies (that closed in the last year), there are laws in some states preventing brick and mortar stores from imposing additional fees over online pharmacies. Reference in a sibling comment.
There is no law against a pharmacy owner from charging whatever they want.
However, most pharmacies enter into contracts with various groups, such as the government, insurance companies, etc so that they effectively give away their right to charge what they want.
> There is no law against a pharmacy owner from charging whatever they want.
On closing, one of my local pharmacies claimed otherwise and referenced the following:
> states have enacted legislation prohibiting certain PBM clients from imposing additional co-payments, deductibles, limitation on benefits, or other conditions (“Conditions”) on covered individuals utilizing a retail pharmacy when the same Conditions are not otherwise imposed on covered individuals utilizing home delivery pharmacies. However, the legislation requires the retail pharmacy to agree to the same reimbursement amounts and terms and conditions as are imposed on the home delivery pharmacies.
https://www.sec.gov/Archives/edgar/data/1532063/000153206318...
Interesting. I guess that sort of qualifies, even though a pharmacy owner can technically choose to not enter into any agreements.
The government is at the root cause of wanting to squeeze all players in the healthcare business, since public rancor reached a tipping point in the late 2000s and ACA was passed. Pharmacists just got shafted first because they were the easiest to squeeze due to supply and demand. Doctors were next with the insertion of physician assistances and nurse practitioners.
Pharmacists could be replaced by vending machines and a phone consult. They're the proof that even if GPT-n can replace humans, humans will still have jobs. The only thing they're good for in my experience is to fail to read the script properly, necessitating you to perform some social engineering so that they can read it again and get it right. Bottom tier intelligence.
"Oh but they can tell you drug interacti-" give me a break. They've never done that and besides, so can a computer.
The computer could do it better, with little errors from fatigue or focus degradation--provided you tell them the drugs/supplements to worry about ...
what is the population of these 46% of U.S. counties? 15% of the total US population?
4.7% of population, as the says so in summary of the study[1] , 3rd sentence. (1st sentence of second paragraph)
[1] https://www.drugtopics.com/view/pharmacy-deserts-prominent-i...
Why do we need a pharmacy when it can be delivered by postal mail.
I for one welcome our postal overlords.
Is it not self serving for the JAMA to fund a study on a lack of pharmacies but not on, say,medical incompetence, fraud, or corruption?
Luigi wasn't applauded because he seemed to decry a lack of pharmacies afaict.
> Why do we need a pharmacy when it can be delivered by postal mail.
Answer: We need them for prescriptions that aren't routine refills. We need them where mail is less predictable and for addresses that are at risk of non-delivery. We need them for new medical events. We need them when the last med didn't work and the next 2 might not either.
We need them when our local pharmacist is literally the only one who cares enough to keep our meds stocked (me+now).
Have you never been sick enough to go to the doctor/urgent care...and get prescribed medicine to take the same day?
The urgent care gave me the meds or shot.
One big thing pharmacies do is answer questions about drugs to educate the users in ways the doctors prescribing them often don't and also check for drug interactions to protect patients. Sometimes you wind up getting prescriptions for two things from different doctors and one doesn't notice or ask to find out that your prescription from doctor A has a bad interaction with drug B they're prescribing.
Also the US mail is also being actively degraded so the ability to reliably get mail delivered to the entire US guaranteed may just disappear soon.
>One big thing pharmacies do is answer questions about drugs to educate the users in ways the doctors prescribing them often don't and also check for drug interactions to protect patients.
That can easily be done over the phone.
It /could/ be but we also all know how great remote call centers do actually caring about the people they're supposed to serve. The real outcome will be fewer people servicing more customers for less money.
I've had uncaring in person pharmacists
Ok. It doesn't counteract the high likelihood that trying to go to a centralized call center style is doing to degrade that experience even further.
Poorly managed and trained people are the same in person or on the phone
I've had many prescriptions and the pharmacist was pretty useless about side effects. It would be after I researched the new side effects I'd have that I trace it back...to the drug I was prescribed.
Your second point is probably more salient. But we do have UPS & FedEx.
They're not required to deliver your package where USPS is and can be done for flat rates. It's the problem with spinning out government services and trying to run them like a business, they're not there to make money they provide a service.
One issue is that for controlled substances mail order often isn't an option.
Given we have an epidemic of controlled substance abuse (driving its postal theft) I'm not sure this is such a bad thing
This to me is like a classical junior software engineering design fallacy. Why do we need to do things this old way when we can just do things this new way.
If you ever find yourself thinking like this: you should always step back and figure out why something is actually done a certain way.
Uhm. What?
Why not state why something is done a certain way instead .
Mail order is cheap and efficient. Building a pharmacy in Sparks, Nevada or Tokio, Texas just to fix a "pharma desert" is expensive and inefficient.
My junior developers analyze why things are done a certain way and don't blindly advocate or prefer "new" methods.
> Why not state why something is done a certain way instead .
Because everyone else did that for me in responding to you. And if people are telling you you're wrong, you should be able to step back and analyze why people are telling you that and determine why it might be the case, even if it's for validating your own argument.
> Mail order is cheap and efficient.
Mail is cheap and efficient in areas that are not part of the Last Mile problem. The people without pharmacies are in the the areas most expensive and most inefficient for mail. This should be obvious. And for medications that are critical or same-day, you cannot rely on mail order in these areas which is a deadly problem. This is also without going into things like reliability and/or theft in lower income areas.
> My junior developers analyze why things are done a certain way and don't blindly advocate or prefer "new" methods.
And where is that analysis here?
Putting a pharmacy in Tokio, Texas to solve a last mile problem is stupid.
You live in a small remote town you use mail & phone or you drive to civilization.
Ever try to get a scheduled medication (ie, some sleep and or anti-psychotics) through mail-order? You can't.
I don't doubt you're right but the irony is illegal drugs go through the postal mail by the metric fuck tonne.
Many pharmacies also do minor medical procedures like vaccinations. You can not get vaccinated by mail.
Try getting Medicaid to pay for a vaccination at a pharmacy
Aren’t compounding pharmacies meant to solve this? I’m not familiar with how they work but I remember small family compounding pharmacies used to be everywhere. Now you never see them and I’ve heard some states like California are trying to get rid of them.
Are you thinking of the correct term? Compounding pharmacies provide simple drug manufacturing tasks, like pressing pills from raw ingredients or splitting and mixing liquid drugs.
Some regulators dont like them because the medicine and dosages they produce do not need FDA review for safety or efficacy.
I was working in a college job for a pharmaceutical distributor when the New England Compounding Center outbreak happened. I think that dropped a nuke on the whole industry. We stopped dealing with compounding pharmacies after that because that whole thing was more like a matter of when not if.
I'm most familiar with them for off label ocular injections. Avastin is a common medication for colorectal cancer, but has an extremely similar biologic to Lucentis, used of ocular injections. Compounding pharmacies will breakdown Avastin because it is cheaper than Lucentis, and pre-fill disposable syringes.
I think I am. But maybe I’m wrong. What I remember is these pharmacies could basically make prescription drugs locally and do custom drugs and things like that because they worked differently from big pharmacies. That was what kept them surviving as small businesses. But over time they’ve just disappeared. At least in places I’ve lived and traveled to.
Does it really matter that much when you can get same day delivery?
I think same day delivery only applies to urban and some suburban areas, definitely not the majority of rural America.
probably not as much as it would without mail delivery, but in person pharmacies have an important role.
Examples would be if you are discharged and need your medication that night, or for serving the disabled and handicapped.
That is not a thing in rural areas, Prime 1 day is more like Prime 3 day