The Most Accessible Healthcare Professional—But Accessible to Whom?

Pharmacists have long been recognized as some of the most accessible healthcare professionals in the United States. A nationwide geographic analysis found that approximately 89% of Americans live within 5 miles of a community pharmacy.¹ This statistic is frequently cited when discussing the importance of pharmacists in expanding health care access, particularly in communities where traditional healthcare services may be limited.

However, an important question remains: Does living near a pharmacy necessarily mean having access to pharmaceutical care?

Geographic proximity is an important component of health care accessibility, but it does not account for the economic, structural, and social barriers that may prevent patients from receiving necessary services. A pharmacy may be located within walking distance of a patient's home, yet that same patient may be unable to afford their medications, obtain adequate counseling, or navigate insurance requirements necessary to receive treatment. If the pharmacy profession is going to continue describing itself as one of the most accessible components of the healthcare system, we must examine what accessibility actually means and, more importantly, who benefits from it.

Meaningful pharmacy accessibility should be evaluated through at least 3 interconnected dimensions: physical access to a pharmacy, financial access to medications, and access to pharmacist-provided clinical services. Although these dimensions overlap, having access in one area does not guarantee access in the others.

Physical Access: Proximity Does Not Guarantee Equitable Care

The geographic distribution of community pharmacies across the United States is far from equitable. Although national statistics suggest that most Americans live relatively close to a pharmacy, these figures can obscure substantial differences between communities.

In a study published in Health Affairs, Guadamuz and colleagues examined pharmacy closures through 2021 among pharmacies operating at some point during 2010–2020. Among 88,930 retail pharmacies, 29.4% had closed by 2021. Closure rates were higher in predominantly Black neighborhoods (37.5%) and Latino neighborhoods (35.6%) compared with predominantly White neighborhoods (27.7%).² These disparities are particularly concerning because communities experiencing pharmacy closures may also face other barriers to health care, including limited transportation, fewer primary care providers, and greater socioeconomic disadvantage.

A 2024 study published in JAMA Network Open identified associations between pharmacy deserts, higher levels of social vulnerability, and reduced primary care practitioner availability.³ These findings suggest that individuals facing difficulty accessing pharmacies may simultaneously experience barriers to other essential healthcare services.

Importantly, pharmacy closures are not simply a matter of convenience. In a retrospective cohort study examining adults aged 50 years and older prescribed cardiovascular medications, Qato and colleagues found that pharmacy closures were associated with an immediate decline of approximately 5.9 percentage points in statin adherence compared with patients whose pharmacies remained open. Similar declines were observed among patients prescribed beta-blockers and oral anticoagulants.⁴ These findings demonstrate that disruptions in geographic access are associated with measurable changes in medication use.

Consider 2 patients whose nearest pharmacy closes, requiring them to travel an additional five miles. For an individual with reliable transportation, flexible employment, and adequate financial resources, this change may represent a relatively minor inconvenience. For an older adult with limited mobility or someone who relies on public transportation, the same closure may create a substantial barrier to obtaining medications. Both patients may technically live within a reasonable distance of another pharmacy. However, their ability to access that pharmacy may differ considerably. Physical accessibility should therefore be measured not only by the location of pharmacies but also by patients' realistic ability to reach and utilize them.

Financial Access: When Medications Are Available but Unaffordable

Even when patients can physically access a pharmacy, obtaining necessary medications is not always financially feasible.

In a nationally representative survey of 2,005 adults aged 65 years and older, Dusetzina and colleagues found that 20.2% reported cost-related medication nonadherence. Additionally, 8.5% reported foregoing basic needs, and 4.8% reported going into debt to afford medications.⁵

These findings raise a larger question: What does it mean to call a service accessible when patients cannot afford to use it? Financial barriers may be particularly consequential for individuals managing chronic conditions. A 2025 analysis of National Health Interview Survey data found that 14.3% of adults with diabetes experienced cost-related medication nonadherence, compared with 9.6% of the overall adult population represented in the analysis.⁶

Consider a patient with hypertension who lives less than 1 mile from a community pharmacy. The patient may have a valid prescription, access to a knowledgeable pharmacist, and a pharmacy that operates 7 days a week. However, if the medication is unaffordable, the patient may delay filling the prescription, reduce the prescribed dose, or discontinue treatment altogether. From a geographic perspective, that patient has access to a pharmacy. From a clinical perspective, the patient may still lack meaningful access to treatment.

These circumstances also challenge how health care professionals interpret medication nonadherence. When a patient does not consistently take a prescribed medication, the immediate focus may be placed on individual behavior. Yet this characterization may overlook financial hardship, insurance restrictions, competing household expenses, or difficulties navigating the healthcare system. Rather than asking only why a patient is not taking a medication, healthcare professionals should also consider whether the patient can realistically obtain and sustain the prescribed treatment. Pharmacists can play an important role by identifying affordability concerns, discussing lower cost therapeutic alternatives with prescribers when appropriate, and connecting patients with available assistance resources. However, individual interventions cannot fully compensate for broader medication pricing and reimbursement challenges.

A medication that is clinically appropriate but financially unattainable offers limited benefit to the patient who cannot obtain it.

Clinical Access: Being Able to Enter a Pharmacy Is Not the Same as Receiving Care

The third dimension of accessibility is perhaps the least frequently considered: whether patients can meaningfully engage with a pharmacist and receive appropriate clinical services.

Although community pharmacies are central to discussions of geographic accessibility, the pharmacy profession extends well beyond retail settings. Pharmacists working in hospitals, ambulatory care clinics, specialty pharmacies, long-term care facilities, and other health care environments contribute to medication optimization, chronic disease management, transitions of care, and interdisciplinary treatment decisions.

Across these settings, meaningful access should include more than the availability of medications. It should also encompass patients' ability to receive understandable information, appropriate clinical guidance, and opportunities to participate in decisions affecting their treatment. However, the availability of a pharmacist does not automatically guarantee access to these services.

In a 2025 study examining community pharmacist work activities, Schenkelberg and colleagues analyzed responses from 1,971 pharmacists. More than 75% reported increased time spent administering vaccinations, while at least 35% reported increased time devoted to advisory services, including assistance with insurance-related concerns. Pharmacists working in larger chains and other high-volume retail settings also reported lower satisfaction with time spent on work activities compared with those working in independent or smaller chain pharmacies.⁷ These findings raise important questions about whether pharmacy staffing models and operational expectations consistently support the expanding clinical responsibilities of pharmacists.

Patient level research provides another perspective. In an observational study involving simulated patients at community pharmacies across 41 states and Washington, DC, Kimberlin and colleagues found that some form of medication-related oral communication occurred in 68% of encounters, while information about medication risks was provided in only 22%. The strongest predictor of oral counseling was whether the pharmacist personally handed the medication to the patient.⁸ Although these observations were collected in 2008 and should not be interpreted as a reflection of current national counseling rates, they illustrate an important distinction between dispensing medications and providing meaningful medication related information.

Communication barriers further complicate this issue. In a survey of pharmacies in Milwaukee County, Wisconsin, Bradshaw and colleagues found that 64% of responding pharmacies reported that they could never or only sometimes communicate verbally in languages other than English.⁹ Although the study was conducted in a single geographic area and reflects practices at that time, it highlights how language accessibility can influence the delivery of pharmaceutical care.

Consider a patient who successfully obtains a prescription but leaves the pharmacy without understanding its potential adverse effects, appropriate administration, or available alternatives. The prescription has been dispensed, but has the patient received meaningful pharmaceutical care?

Importantly, these concerns should not be interpreted as a failure of individual pharmacists. Many pharmacists are already navigating substantial workloads, staffing constraints, administrative responsibilities, and competing clinical demands. Expecting them to continually expand patient care services without providing the necessary resources is neither realistic nor sustainable. Instead, these challenges highlight the importance of organizational support, appropriate staffing, and care delivery models that allow pharmacists to practice to the full extent of their training.

If a patient can walk into a pharmacy but cannot meaningfully engage with a pharmacist, how accessible is the care being provided?

Rethinking Accessibility: From Availability to Meaningful Care

Pharmacists have an important role in addressing barriers to health care access. However, improving accessibility requires more than recognizing the profession's contributions. It requires examining whether patients can actually benefit from the services being offered. Pharmacists occupy a unique position within the health care system, often interacting with patients at the point where prescribed treatment must become an actionable part of daily life. This creates opportunities to identify barriers that may not be apparent during traditional healthcare encounters.

At the individual level, pharmacists can identify affordability concerns, assess patient understanding, facilitate access to appropriate resources, and collaborate with other healthcare professionals when treatment barriers arise. Many pharmacists already incorporate these activities into their daily practice. The challenge is not necessarily convincing pharmacists to recognize these barriers, but ensuring they have the resources, authority, and organizational support to address them effectively. However, improving accessibility also requires reconsidering how the profession defines and measures it.

Geographic proximity remains an important indicator of access, but it should not be treated as a complete measure of the patient experience. Rather than focusing primarily on how many Americans live within a certain distance of a pharmacy, the profession should also consider whether patients can reliably obtain their medications, afford prescribed treatments, and receive the clinical services necessary to use those medications safely and effectively.

This raises an important question: What would pharmacy accessibility look like if we measured it from the patient's perspective rather than primarily from the location of the pharmacy?

A more comprehensive assessment could incorporate 3 interconnected dimensions:

• Physical access: Can patients reliably reach a pharmacy and obtain necessary medications without unreasonable transportation, mobility, or geographic barriers?
• Financial access: Can patients afford to initiate and maintain prescribed treatment without sacrificing other essential needs?
• Clinical access: Can patients obtain meaningful pharmacist-provided services, including appropriate counseling, medication management, and follow-up when needed?

These dimensions are not entirely new concepts, nor would evaluating them require developing an entirely new understanding of health care access. However, considering them together could provide a more meaningful assessment of pharmacy accessibility than relying primarily on geographic proximity.

For example, a community may have several pharmacies within a 5 mile radius, yet patients may continue to experience high rates of cost related medication nonadherence or difficulty accessing pharmacist provided clinical services. Under a geographically focused assessment, that community may appear adequately served. A broader assessment, however, could reveal substantial gaps between the availability of pharmacies and patients' ability to benefit from them.

Importantly, this approach would not place the responsibility for improving accessibility solely on individual pharmacists. Pharmacy organizations could examine whether staffing and workflow models support meaningful patient interactions. Health care systems could evaluate whether patients successfully transition between prescribed treatment and medication access. Policymakers could consider whether reimbursement structures and medication affordability policies facilitate or undermine access to essential care.

The objective would not be to diminish the value of geographic accessibility, but to recognize that being near a pharmacy and being able to benefit from its services are not necessarily the same thing. A pharmacy can be open, a medication can be available, and a pharmacist can be present, yet a patient may still lack meaningful access to care.

If our definition of accessibility begins and ends with how close a patient lives to a pharmacy, we may be measuring the convenience of our health care infrastructure rather than the accessibility of the care it provides.

Perhaps the question is no longer whether pharmacists are among the most accessible healthcare professionals.

Perhaps the more important question is: Accessible to whom?

References

1. Berenbrok LA, Tang S, Gabriel N, et al. Access to community pharmacies: a nationwide geographic information systems cross-sectional analysis. J Am Pharm Assoc (2003). 2022;62(6):1816-1822.e2. doi:10.1016/j.japh.2022.07.003

2. Guadamuz JS, Alexander GC, Kanter GP, Qato DM. More US pharmacies closed than opened in 2018-21; independent pharmacies, those in Black, Latinx communities most at risk. Health Aff (Millwood). 2024;43(12):1703-1711. doi:10.1377/hlthaff.2024.00192

3. Catalano G, Khan MMM, Chatzipanagiotou OP, Pawlik TM. Pharmacy accessibility and social vulnerability. JAMA Netw Open. 2024;7(8):e2429755.doi:10.1001/jamanetworkopen.2024.29755

4. Qato DM, Alexander GC, Chakraborty A, Guadamuz JS, Jackson JW. Association between pharmacy closures and adherence to cardiovascular medications among older US adults. JAMA Netw Open. 2019;2(4):e192606. doi:10.1001/jamanetworkopen.2019.2606

5. Dusetzina SB, Besaw RJ, Whitmore CC, et al. Cost-related medication nonadherence and desire for medication cost information among adults aged 65 years and older in the US in 2022. JAMA Netw Open. 2023;6(5):e2314211. doi:10.1001/jamanetworkopen.2023.14211

6. Kim D, Danpanichkul P, Wijarnpreecha K, Ahmed A. Healthcare and prescription medication affordability in adults with diabetes in the United States, 2020-2023. Diabetes Res Clin Pract. 2025;226:112340. doi:10.1016/j.diabres.2025.112340

7. Schenkelberg CV, Bakken BK, Arya V, et al. Evaluation of work activities for pharmacists in community pharmacy settings. J Am Pharm Assoc (2003). 2025;65(5):102423. doi:10.1016/j.japh.2025.102423

8. Kimberlin CL, Jamison AN, Linden S, Winterstein AG. Patient counseling practices in U.S. pharmacies: effects of having pharmacists hand the medication to the patient and state regulations on pharmacist counseling. J Am Pharm Assoc (2003). 2011;51(4):527-534. doi:10.1331/JAPhA.2011.10012

9. Bradshaw M, Tomany-Korman S, Flores G. Language barriers to prescriptions for patients with limited English proficiency: a survey of pharmacies. Pediatrics. 2007;120(2):e225-e235. doi:10.1542/peds.2006-3151