In Pennsylvania, many pharmacies have shut down since early 2020. About 1,100 licensed ones have closed, leaving people with fewer places to get vaccines, health tips, and quick checks. This hurts small towns and city areas alike. People now drive farther for meds, overload the ones that stay open, and rural spots suffer most. A few new pharmacies have opened, but not enough to fix the problem.
Local owners blame money troubles they can’t escape as costs keep rising, payments from insurers drop, and big middlemen control the cash flow. Pennsylvania passed a law called Act 77 to help, but closures keep happening. Lawmakers promise better rules soon.
Reasons for the Closures
The problems started big during the COVID-19 pandemic, changing how pharmacies work. From 2020 to 2025, over 800 closed in Pennsylvania. Then a big chain went bankrupt, spiking the number way up. The same thing happens nationwide as drug prices rise but payments don’t match.
Small, independent pharmacies struggle most. Owners say they often lose money on every generic drug prescription after buying it and paying fees. To survive, they cut hours, lay off staff, or close for good. When a town’s only pharmacy vanishes, folks drive far, wait for slow mail deliveries, or lose their trusted pharmacist. This makes health gaps worse in areas already short on doctors.
How Pharmacy Benefit Managers Hurt
Pharmacy benefit managers, or PBMs, are companies in the middle of it all. They deal between drugmakers, insurers, and pharmacies, setting prices, picking approved drugs, and deciding pharmacy payouts. Pharmacists say PBM payments often cost less than what it takes to buy and give out the medicine, so they lose cash on many sales.
Contracts are tricky and secret, so pharmacies can’t easily fight low payments or explain costs to customers. Some rules even stop pharmacists from telling people about cheaper choices. Critics say this funnels money from small shops to big PBMs and their chain stores. It leads to tiny profits, fewer workers, shorter hours, and more shutdowns in needy spots.
Act 77: A Law That’s Not Enough Yet
Pennsylvania passed Act 77 in 2024 to fight PBM power and save pharmacies. It’s a teamwork law from both parties. It lets the state Insurance Department check PBM contracts, watch payments, and stop tricks like pushing people to certain stores. It also demands reports on access and openness.
But by late 2025, hundreds more pharmacies closed net since 2020, even after the law. Key parts don’t start until 2026, like paying pharmacies at least what drugs cost and no fines for using non-favorite spots. Regulators need time for rules amid lawsuits and pushback, but owners say they can’t hold out.
The law only covers about 24% of insurance plans, like personal ones and small groups. That leaves 76% of people, around 9.7 million, in big employer plans, Medicare, or out-of-state deals untouched. For them, issues like steering patients, taking back money, and hidden prices go on.
Rural Problems, National Picture, and Future Steps
Rural Pennsylvania feels it worst. Since 2020, some counties have just one pharmacy left, with people 20-40 miles away. Maps show 540,000 rural folks live at least five miles from one, tough in snow or without a car. This adds to lost hospitals and few doctors.
Seniors, those with ongoing illnesses, and poor people suffer most. They might skip blood pressure pills, insulin, or mental health meds for days. Mail orders delay, transfers mean new doctor visits and extra costs. Some stretch doses or quit, risking hospital stays.
It’s a national issue too. A 2025 University of Pittsburgh and NIH study says 57.1 million Americans, 18% of us, face big travel barriers to pharmacies. These “deserts” hit rural South and Midwest, plus poor city areas, just like Pennsylvania.
In 2026, Act 77 ramps up for marketplace plans and big employers. Reports come in April and July on networks and PBM money flows. Pharmacies try new tricks like shots, med reviews, home drops, and health coaching for extra cash. Will it stop closures? No onr knows, but it affects how millions get vital drugs and care long-term.
Sources:
Spotlight PA – Pharmacy Closures Continue Despite New Law
WPSU – Impact of PA Pharmacy Closures in 3 Maps
ArcGIS StoryMap – Pharmacy Closures & Pharmacies at Risk
RescueMeds – PA Pharmacy Desert Crisis & PBM Reform
Supermarket News – PA’s Pharmacy Problem