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.
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.