Nearly half of rural pharmacies are independently owned retail stores and are susceptible to closing due to financial hardship. This policy brief builds on the history of Rural Policy Research Institute projects examining the provision of pharmacy services and updates pharmacy closure in rural areas of the United States. Monthly data on all institutions providing pharmacy services in the 50 states and District of Columbia were obtained from the National Council for Prescription Drug Programs.

Key Findings:

• Between 2003 and 2021, the number of retail pharmacies declined in noncore rural areas by 9.8 percent, and in rural micropolitan areas by 4.4 percent, while the number in metropolitan areas increased by 15.1 percent during the same period.
• Between 2003 and 2021, the number of independently owned retail pharmacies declined in noncore areas by 16.1 percent, and in micropolitan areas by 9.1 percent, while the number in metropolitan areas increased by 28.2 percent during the same period.
• Between 2003 and 2021, the number of chain pharmacies grew in all three geographies, with the largest growth occurring in metropolitan areas (noncore: 4.6 percent, micropolitan: 3.7 percent, metropolitan: 10.5 percent).
• Franchise pharmacies have never represented a large segment of the market (1.1 percent of all retail pharmacies in 2021), but their number declined dramatically in all three geographies from 2003 to 2021.