Rite Aid is closing 44 more stores. All but two are in Ohio and Michigan

A Rite Aid Pharmacy in Michigan. (Getty Images.)

The number of pharmacies — particularly in Ohio and Michigan — is continuing to drop.

Bankrupt chain Rite Aid last week announced that it was closing 44 additional stores and that all but two are in Ohio and Michigan, Fast Company reported .

The closures come after the Philadelpia-based company in June told U.S. Bankruptcy Court in New Jersey that it was closing more than 300 others in the two states. The numbers are significant, given that each state has about 2,000 retail pharmacies.

They come after years of closures of independent pharmacies. In addition, CVS is finishing up a process in which it closed 900 stores nationally over three years and Walmart last year asked 16,000 pharmacists to help reduce costs by working less. And on top of those, Walgreens is expected to close more than 2,000 of its 8,600 stores in the United States in the coming months.

All the closures create concerns that vulnerable Americans will become sicker because of reduced health care access. For those who lack transportation and often health insurance, the local pharmacist is the only health professional they can regularly talk to about their medications and chronic conditions such as hypertension and diabetes.

Brick-and-mortar pharmacies have been struggling with a difficult environment as they compete with online retailers such as Amazon.

But those aren’t the only headwinds faced by the pharmacies. They’ve been complaining for at least eight years about diminishing reimbursements and clawbacks from middlemen who control access to so many insured patients that pharmacies believe they have no choice but to contract with them.

The businesses, known as pharmacy benefit managers, or PBMs, represent insurers and the biggest three are all part of the same corporation as a major insurer. They decide which drugs are covered, and they decide how much to reimburse pharmacies in a non-transparent system.

The biggest three, CVS Caremark, OptumRx, and Express Scripts, are estimated to control access to 80% of all insured patients in the United States.

The Federal Trade Commission is investigating possible anticompetitive practices by the PBMs. In June, it issued a scathing interim report that said the three massive health conglomerates appeared to be pushing drug costs higher, thereby making Americans sicker .

The middlemen use a non-transparent system to reimburse pharmacies, and there long have been suspicions that they’ve exploited it to reap unfair profits and disadvantage competitors.

Since 2019, each of the big three PBMs created “group purchasing organizations” that added another layer of opacity to drug pricing. This year, two government investigations concluded that those companies appeared to be skimming tens of millions of dollars from drug transactions.

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