In Clendenin, West Virginia, a small town nestled in the Appalachian hills, the Walgreens that served as the community's primary pharmacy closed its doors last month. For the town's elderly residents, many of whom don't drive, getting life-saving prescriptions now means a 45-minute journey on winding mountain roads.
Clendenin isn't unique. It's one of roughly 1,200 Walgreens locations scheduled to close between 2025 and 2027 as the nation's second-largest pharmacy chain restructures to survive. Combined with Rite Aid's complete wind-down following its May bankruptcy filing, the United States is experiencing an unprecedented contraction in retail pharmacy access.
The Scale of the Crisis
The numbers are sobering: approximately one-third of America's pharmacies have closed since 2010, according to data from the National Association of Boards of Pharmacy. What was once a cornerstone of every Main Street in America—the neighborhood drugstore—is becoming increasingly rare.
In 2025 alone, Rite Aid closed all of its remaining locations as part of its bankruptcy proceedings. CVS shuttered about 270 stores. And Walgreens, facing its own existential challenges, announced plans to close 1,200 "underperforming" locations over three years.
"We're witnessing an unprecedented decline in neighborhood drug stores," said Steven Anderson, president of the National Association of Chain Drug Stores. "The implications for public health access, particularly in vulnerable communities, are significant."
Why Pharmacies Are Disappearing
The retail pharmacy business model that worked for decades has broken down. Several factors are driving the crisis:
Drug Reimbursement Pressures: Pharmacy Benefit Managers (PBMs)—the middlemen who negotiate drug prices between insurers and pharmacies—have squeezed reimbursement rates to the point where many prescriptions are filled at a loss. Pharmacies make pennies, if anything, on generic medications.
Declining Retail Sales: The front-of-store retail business that traditionally subsidized low-margin prescription filling has collapsed. Amazon, grocery stores, and dollar stores have captured much of the convenience retail market that pharmacies once dominated.
Labor Costs: Pharmacist salaries have risen while prescription volumes have flattened. The math no longer works in many locations.
The Sycamore Acquisition Raises Concerns
Adding complexity to Walgreens' situation is its recent acquisition by Sycamore Partners, the private equity firm known for aggressive cost-cutting at retail chains like Staples and Nine West.
According to Walgreens' June proxy statement, Sycamore financed its $18.8 billion leveraged buyout with 70.9% debt—far above the 41% average for private equity acquisitions. The high debt load limits the company's ability to invest in its stores while creating pressure to cut costs wherever possible.
"When private equity loads a company with debt at this level, the playbook is predictable: cut costs, sell assets, and extract value. The question is whether there's anything left for customers and communities when they're done."
— Jim Baker, Director, Private Equity Stakeholder Project
The new CEO, Mike Motz, previously oversaw hundreds of store closures and tens of thousands of layoffs at Staples. His appointment signals that the restructuring at Walgreens may accelerate.
The Human Cost
For the communities losing their pharmacies, the impact extends beyond inconvenience. Pharmacists serve as frontline healthcare providers, administering vaccines, screening for health conditions, and counseling patients on medication management.
In many rural areas, the pharmacist is the most accessible healthcare professional available. Losing that access can have life-or-death consequences for patients managing chronic conditions like diabetes, heart disease, or mental illness.
The phenomenon of "pharmacy deserts"—areas where residents must travel significant distances to fill prescriptions—is expanding rapidly. Research shows that patients in pharmacy deserts are less likely to fill prescriptions, leading to poorer health outcomes and higher healthcare costs down the line.
What's Being Done
Some states are experimenting with solutions. California recently launched a Safe Homes grant program that includes pharmacy access considerations in rural healthcare planning. Several states have loosened regulations to allow mail-order pharmacies to fill more prescription types.
Independent pharmacies, which account for about 35% of all retail pharmacies, are holding on better than chains in some areas. They often have lower overhead costs and stronger community ties that generate customer loyalty.
But independents face the same reimbursement pressures as chains, and many lack the scale to negotiate favorable terms with PBMs.
The Investment Angle
For investors, the pharmacy crisis creates both risks and opportunities. CVS Health, which owns the largest pharmacy chain, has pivoted aggressively toward healthcare services—acquiring Aetna, Signify Health, and Oak Street Health to become an integrated healthcare company. Its pharmacy retail business is increasingly a means to an end rather than a standalone profit center.
Amazon Pharmacy continues to grow market share, offering convenience that traditional pharmacies can't match. For investors bullish on the digitization of healthcare, Amazon's pharmacy expansion represents a significant growth vector.
The PBMs themselves—CVS Caremark, Express Scripts (Cigna), and OptumRx (UnitedHealth)—remain highly profitable, though they face increasing regulatory scrutiny over their role in the pharmacy ecosystem.
The Path Forward
The transformation of American pharmacy is far from over. More store closures are coming, and the communities most affected will be those least equipped to adapt—rural areas, low-income neighborhoods, and regions with aging populations.
For consumers, the message is clear: if you have a relationship with a local pharmacist you trust, don't take it for granted. That relationship may soon become a luxury many Americans can no longer access.
