Pharmacies across Iowa closing at alarming rates, how it can impact patients and communities

MINDEN, Iowa — According to the Iowa Pharmacy Association, pharmacies across the state are closing at alarming rates and pharmacists are voicing concerns for the effects.

"In the last ten years, we've seen 143 closures, but the rate of closures is accelerating," said the CEO of the Iowa Pharmacy Association, Kate Gainer.

So far in 2024, 20 pharmacies across the state have closed and more are expressing to the IPA that they're expecting to close soon. The closures are impacting both rural and urban communities, and chain companies and independent pharmacies alike.

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According to Dr. Michael Andreski, a Drake University Professor of Pharmacy and pharmacy researcher, these are all of the Iowa pharmacies that have closed so far:

Andreski previously told WHO 13 News that he foresaw several pharmacy closures in 2024 from his previous research.

The IPA said the leading cause for pharmacy closure is corruption within Pharmacy Benefit Managers (PBMs), or the so-called middlemen between pharmacies and insurance companies. PBMs determine the total drug costs for insurers, shape patients' access to medications, and determine how much pharmacies are paid.

According to Gainer, the number one complaint the IPA receives from its members about PBM practices is that pharmacies are dispensing prescriptions at a loss. Meaning, it's common for a PBM to pay a pharmacy less money than the pharmacy had to pay to purchase a drug. An independent pharmacy in Oskaloosa previously told WHO13 News that they are foreseeing their closure because of this same reason.

Another concern Gainer hears from her members is that PBMs make it harder for patients to support local or independent pharmacies. PBMs determine which pharmacies and mail-order pharmacies a patient can use. According to the IPA, it's common for PBMs to force patients to use a mail-order pharmacy owned by the same PBM instead of using a local pharmacy.

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The last concern Gainer listed is that PBMs can interfere with the patient-doctor and patient-pharmacist relationships by dictating what prescriptions a patient is allowed to fill or dictating which prescriptions are affordable according to standards set by PBMs.

"[The Iowa Pharmacy Association is hearing] a lot of concern from pharmacies across the state. It's reached a tipping point worse than I've ever heard in my 12 years as CEO," said Gainer.

Aside from pharmacy owners losing their businesses and pharmacists losing their jobs, patients are also impacted by pharmacy closures because they lose access to healthcare.

Gainer said a growing trend across Iowa is that communities are becoming pharmacy deserts or areas without access to pharmacies. The IPA says pharmacy deserts can exist in both rural and urban areas and require patients to travel farther to access prescription or pharmacy services.

Minden is a city in western Iowa with a population of around 600 people. It is one of the latest pharmacy deserts in the state after the community's only pharmacy had to close in mid-September.

Rick and Tina Dotzler are the former owners of Lehan's Pharmacy, which was once rooted in the Minden Business District. Residents in surrounding communities were also patients at this pharmacy.

An EF-3 tornado went through Minden in late April, and the Dotzlers said that was the last straw.

"The tornado did damage the building, and in doing that, it made it that we had to relocate the pharmacy, and the business just wasn't strong enough to survive a relocation, we didn't think," said Rick.

However, they have anticipated this closure for years since they filled a lot of prescriptions at a loss because of corrupt PBM practices. The closest pharmacies to Minden residents are now at least 25 miles away, and that's if their insurance is accepted by that pharmacy.

Pexton Pharmacy in Harlan is also owned by the Dotzlers, and some Minden residents now travel there for service. However, other residents are traveling to Council Bluffs for their prescriptions.

Gainer said, "Whether it's transportation, whether it's cost or affordability, anything that reduces a patient's access to their pharmacy, pharmacist services, or prescription drugs can ultimately impact their health outcomes."

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However, pharmacy closures can also impact other small businesses.

"Minden being a small community, the pharmacy was a financial benefit to the area. It drew people into town for some of the other businesses there, like the grocery store and the cafe, so that was a real loss for the community which had already suffered quite a bit with a tornado that hit it in the Spring," said Rick.

The IPA said there are other ways patients can see the impact of alleged corrupt PBM practices.

"Even in communities where a pharmacy doesn't close, pharmacies across the state have had to reduce their hours. So, having fewer hours on evenings or weekends. Most communities no longer have a 24/7 pharmacy," said Gainer.

The Iowa Pharmacy Association says change is needed now.

On a federal level, the Federal Trade Commission filed a lawsuit against the three largest PBMs, Caremark Rx, Express Scripts, and OptumRx, for allegedly engaging in anticompetitive and unfair rebating practices resulting in the inflated price of insulin drugs.

On a state level, the IPA said they would support any PBM reform legislation proposed during the upcoming legislative session.

Caremark Rx and OptumRx have not immediately responded to our request for comment.