Over the last 16 years, 1,231 independently owned rural pharmacies (16.1%) in the United States have closed. The most drastic decline occurred in the immediate period following the implementation of Medicare Part D - between 2007 and 2009. This decline has continued through 2018, although at a slower rate. Six hundred and thirty rural communities that had at least one retail (independent, chain, or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018.