This data brief continues the RUPRI Center's series of reports exploring the availability of retail pharmacy services in rural areas of the U.S. It provides information on rural communities that have kept, lost, or gained a retail pharmacy between 2018 and 2023. Retail pharmacies were identified using data from the National Council for Prescription Drug Programs. This analysis examines changes in rural pharmacies and uses Census-defined “places” as the geographic unit of analysis. Places are geographies defined by the U.S. Census Bureau and include incorporated places and Census Designated Places.

Key Findings:

• Between 2018 and 2023, the number of retail pharmacies in the U.S. declined by 3.9 percent. During that same period, the number of retail pharmacies located in rural communities declined by 5.9 percent and the number of retail pharmacies located in urban communities declined by 3.4 percent.
• While the number of retail pharmacies in rural communities declined during that period (11,489 in 2018 to 10,808 in 2023), the number of rural communities with retail pharmacies remained relatively constant (44.7 percent of rural communities had at least one retail pharmacy in 2018 versus 47.6 percent in 2023).
• During this five-year period, 184 rural communities lost all local retail pharmacy service but 195 other rural communities gained retail pharmacy service.
• There was little variation in the characteristics of the populations in places that kept, lost, or gained pharmacy service. Where there was any variation, the results were often counterintuitive. For example, places that gained pharmacy service had a lower proportion of population that was non-White but a higher proportion that was Hispanic, and a higher proportion with no health insurance.