As pharmacy closures create 'pharmacy deserts' across the nation, Blue Cross NC provides multiple solutions to ensure members can continue accessing their prescriptions—from Amazon Pharmacy mail-order delivery to enhanced services at independent pharmacies.
The pharmacy landscape in the United States is experiencing unprecedented change. Major chains are closing stores at an alarming rate, leaving communities with limited access to essential prescription services. This trend, driven by declining profitability in prescription filling due to complex reimbursement structures, is creating "pharmacy deserts" in both urban and rural areas.
As independent pharmacies work to fill the gaps left by these closures, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is taking proactive steps to ensure its members maintain access to medications. This article examines the challenges posed by pharmacy closures and explores Blue Cross NC's initiatives to support its members.
The closure of pharmacy storefronts across the nation has reached critical levels. In 2025 alone, nearly 770 CVS and Walgreens stores are closing their doors—and that doesn't count the complete collapse of Rite Aid, America's third-largest pharmacy chain.
Major Pharmacy Chain Closures (2021-2027)
Chain | Closures | Timeline |
Rite Aid | ~2,088 (ALL stores) | 2023-2025 (closed Oct 2025) |
CVS | ~1,171 | 2021-2025 |
Walgreens | ~1,200 | 2025-2027 |
Rite Aid's Complete Closure: After 63 years in business, Rite Aid filed for bankruptcy twice (October 2023 and May 2025) and closed its final 89 stores in early October 2025. The company sold its prescription files to CVS, Walgreens, Albertsons, Kroger, and Giant Eagle. Bankrupt Rite Aid is no longer operating any brick-and-mortar stores, and all customer prescriptions have been transferred to other pharmacies.
CVS Closures: CVS closed 900 stores between 2022 and 2024 and is closing approximately 270 additional locations in 2025. The company notes that even after realignment, 85% of Americans will still live within 10 miles of a CVS Pharmacy.
Walgreens Closures: Walgreens announced plans to close 1,200 stores over three years, with 500 closures in fiscal year 2025. CEO Tim Wentworth noted that approximately 25% of Walgreens stores are unprofitable. The company is exiting 225 counties while maintaining presence in about 80% of U.S. counties.
These closures are creating "pharmacy deserts"—areas where residents have limited or no reasonable access to pharmacies. According to 2025 research from GoodRx:
48.4 million Americans (1 in 7) now live in pharmacy deserts
45% of U.S. counties are classified as pharmacy deserts
Nearly 90% of those living in pharmacy deserts are in rural areas
56.8% of all rural residents live in a pharmacy desert
North Carolina has seen almost 1 million additional residents affected by pharmacy closures between 2021 and 2024
In pharmacy desert counties, residents face significantly longer travel times. Those in nonmetropolitan areas must drive an average of 85 minutes (round trip) and cover 36 miles, while metropolitan residents travel 53 minutes and 18 miles.
The core issue lies in declining profitability from prescription filling:
Reimbursement rates: Pharmacy Benefit Managers (PBMs), which control about 80% of the market, have significant pricing power over pharmacies. Approximately 15% of prescriptions filled by independent pharmacies are reimbursed at rates below their acquisition costs.
Shifting consumer habits: More consumers are filling prescriptions via mail order, reducing foot traffic and high-margin front-of-store sales.
Competition: Big-box retailers like Walmart, online giants like Amazon, and Dollar General are capturing market share in rural areas.
Overexpansion: Chains aggressively expanded in the 1990s and 2000s to drive out competitors, resulting in overlapping locations that are now unprofitable.
Legal settlements: Opioid litigation has added significant costs for major pharmacy chains.
Blue Cross NC is actively addressing the challenges posed by pharmacy closures to ensure its members can continue accessing necessary medications. The insurer has implemented a comprehensive approach that includes enhanced mail-order services, support for independent pharmacies, and optimized pharmacy networks.
Starting January 1, 2026, Amazon Pharmacy will be Blue Cross NC's only preferred mail-order pharmacy for Medicare members. For individual and family plan members, Blue Cross NC offers mail-order through Amazon Pharmacy (MedsYourWay®) and Express Scripts® Pharmacy.
Key benefits of mail-order pharmacy:
Up to a 90-day supply of medications delivered with free standard shipping
Amazon Prime members get free two-day delivery; non-Prime members receive five-day delivery
MedsYourWay® discount card built into the Amazon Pharmacy experience, offering up to 80% savings on brand and generic medications
Eligible covered purchases count toward your deductible and out-of-pocket maximum
Automated features like auto-refill, shipping updates, and refill notifications
24/7 customer care and pharmacist support in multiple languages
How to get started with Amazon Pharmacy:
Register online at amazon.com/bluecrossnc or call 833-566-7111 (TTY 711)
Request a prescription transfer from your current pharmacy, or have your doctor send a new prescription
Continue getting short-term prescriptions (like antibiotics) from your local pharmacy
Note: Amazon Pharmacy does not dispense Schedule 2 controlled substance drugs.
Blue Cross NC launched the "More Than a Script" program to strengthen independent pharmacies and enhance member care, particularly in rural areas of North Carolina. This innovative program, developed in partnership with the UNC Eshelman School of Pharmacy, reimburses independent pharmacists for providing personalized services beyond filling prescriptions.
Services provided through More Than a Script:
One-on-one medication education
Meal planning and nutrition guidance
Blood sugar testing and monitoring
Recommendations for screenings and vaccinations
Collaboration with members' primary care teams
The program currently focuses on diabetes and hypertension—two chronic conditions that significantly impact North Carolinians. People with diabetes incur medical expenses approximately 2.3 times higher than those without diabetes, and hypertension contributed to 27% of all deaths in North Carolina in 2018.
"Independent pharmacists have a unique position in their communities, and we want our members to feel comfortable asking them to be a partner in improving their health," said Dr. Stephen Friedhoff, senior vice president of health care services at Blue Cross NC.
Program expansion: More Than a Script plans to implement a second phase in 2025-2026, expanding services to focus on maternal health, including oral contraceptive and prenatal vitamin prescribing.
For members requiring specialty medications—which can cost between $6,000 and $350,000 per patient annually—Blue Cross NC has developed the Advocate+ Pharmacy Match program, effective October 1, 2025.
This program, operated in partnership with Free Market Health (FMH), matches members with highly qualified pharmacies to fill their specialty medications. Key features include:
Expanded pharmacy network access for specialty medications
Streamlined referral process to decrease time to receive medications
Monitoring of first fills and reduced medication abandonment
Transparent and fair access to authorized referrals
Dynamic market rates ensuring specialty drugs remain affordable
Blue Cross NC actively monitors drug shortages and adjusts coverage policies as needed. The insurer's team of clinical pharmacists reviews reported shortages and considers temporary alternative options to ensure members can access necessary medications.
Members can use Blue Cross NC's drug search tools to find covered drugs and prior authorization forms, streamlining prescription access when local pharmacies are unavailable. Blue Cross NC's pharmacy benefits are managed by Prime Therapeutics (for most individual and family plans) and Optum Rx (for some group plans).
While mail-order and telehealth solutions help bridge gaps, local pharmacies provide irreplaceable community health services:
Vaccination access: More than 60% of adult flu shots and nearly 90% of COVID-19 vaccines were given at pharmacies during the 2024-2025 flu season
Preventing ER visits: Pharmacists successfully manage most minor health concerns, with only about 15% of patients needing referral to other providers.
Chronic condition management: Pharmacist-led interventions significantly improve medication adherence for diabetes, hypertension, and asthma
Accessibility: Americans visit their pharmacist twice as often as other healthcare providers, and no appointment is needed
Extended hours: Many pharmacies stay open later than primary care clinics, with some open 24 hours
If your local pharmacy is closing or has closed:
Check prescription transfers: Most closing pharmacies automatically transfer prescriptions to nearby pharmacies. Verify your prescriptions were transferred correctly.
Consider mail-order: For maintenance medications (those you take regularly), Blue Cross NC's mail-order programs offer convenience and often cost savings.
Find participating pharmacies: Use Blue Cross NC's Find Care tool or call the number on your member ID card to locate in-network pharmacies near you.
Explore independent pharmacies: Many independent pharmacies offer personalized service and may participate in programs like More Than a Script.
Request records: If your pharmacy closed suddenly, request prescription and immunization records for your files.
Despite Blue Cross NC's efforts, the pharmacy-closure crisis continues to pose challenges. The dominance of PBMs in setting reimbursement rates continues to strain both chain and independent pharmacies, and the lack of transparency in pricing remains a significant hurdle.
While mail-order services and programs like More Than a Script are promising, they may not fully address the needs of members in remote areas with limited internet access or those who prefer in-person interactions with their pharmacists.
Independent pharmacies are increasingly positioned to fill the void left by chain closures. They already serve more than 15 million patients across the U.S., with two-thirds serving areas with populations under 50,000. Their relationship-driven approach offers a scalable solution for care delivery, particularly in communities at higher risk of experiencing healthcare gaps.
Blue Cross NC's continued investment in community health programs, including partnerships like More Than a Script and the Health Through Food initiative, demonstrates an ongoing commitment to making healthcare accessible and affordable across North Carolina.
The closure of major pharmacy chains is reshaping the healthcare landscape, creating significant challenges for communities nationwide. With Rite Aid completely gone and CVS and Walgreens continuing to reduce their footprints, millions of Americans face longer drives to pick up prescriptions and reduced access to pharmacy services.
Blue Cross NC is responding with a comprehensive strategy that includes transitioning to Amazon Pharmacy for mail-order services, supporting independent pharmacies through innovative programs like More Than a Script, and optimizing specialty pharmacy networks through Advocate+ Pharmacy Match.
While these efforts provide important solutions for members navigating pharmacy closures, the broader issues of reimbursement rates and PBM influence require systemic change to prevent further pharmacy deserts. For now, Blue Cross NC's proactive measures offer a lifeline to members during this turbulent period in healthcare access.