In the past decade, dozens of pharmacies have closed in rural and vulnerable areas of Missouri, creating “pharmacy deserts." Residents often struggle to fill prescriptions, receive important vaccines and get medication advice.
The Walgreens at 1400 N. Grand Blvd. shut down in April, causing people in the Jeff-Vander-Lou neighborhood to travel to the nearest pharmacies in downtown and the Central West End.
But in November, Bronx-based BOCA pharmacy, a smaller drugstore, opened on the campus of Doorways, a nonprofit that serves people with HIV.
“I want to be in an area that’s accessible to the community,” said pharmacist Brennae Thomas, who left her job at a larger chain pharmacy to work at BOCA. “If somebody wants to come in and talk, I don't have to worry about getting back to doing a whole bunch of work. I can actually help you.
“I feel like people should know that they're not forgotten,” she added. “We are here to help you, to hear you, and we see you.”
The St. Louis BOCA location is the first to operate outside its headquarters in New York state. CEO Jacob Jamron said he thinks community-based stores can succeed where larger, less nimble drugstores have failed.
“I think we use a different approach. You’ve got to have the same pharmacists there every day. Because if you're not warm and welcoming, it's the only way to have that type of relationship.”
A community-based business
The gleaming new pharmacy in the Jeff-Vander-Lou neighborhood doesn’t resemble a CVS or Rite-Aid as much as a small bank branch. There are a few toiletries and other sundries available for purchase, but there are no aisles, just a large counter in the front and a workspace in the back.
BOCA's pharmacy on Doorways' newly built campus is near the intersection of Jefferson and Martin Luther King Jr. Drive. The campus cost $40 million and provides services and housing units for more than 80 residents.
Doorways President Opal Jones said it was important that the organization placed a business in the new complex that benefited the public as well as the people who lived in the new apartments.
“We knew we wanted to bring retail on the campus,” she said. “If we want to address the stigma around HIV, one way to do that is to bring the community into our surroundings.
“The idea quickly surfaced that a pharmacy was the answer because we were located in a pharmacy desert,” she said.
The impact of pharmacy deserts
More closures are on the horizon as CVS, Walgreens and other retail chains have announced they’re shutting down stores across the country.
In statements, corporations blame increased competition, staffing shortages and the consideration of how many physical stores make sense financially and where they should be located.
The National Institutes of Health reports that the decreased access disproportionately affects largely Black and Latino neighborhoods.
The Walgreens on North Grand Boulevard was the only drugstore in the neighborhood. When it closed last April, the residents were distressed, said Ernestine Stewart, a member of the neighborhood planning committee.
“People had to rush to try to get their medicine sent to a different [location] and then try to either get delivered or figure out how to get it,” she said.
Research in the journal Health Affairs Scholar found that other populations affected include the elderly and people with high school educations or lower. There's also higher proportions of people with no health insurance or who don’t speak English affected.
Some older residents had difficulty transferring medications, Stewart said. “Some people don't have an understanding or that technology knowledge. … In their mind, it's only here, right there on Grand. ‘That’s where I get my medicine. I can't get it anymore.’”
Even if they did know how to transfer medications, it was not always easy to pick them up.
Residents in ZIP codes that include the Jeff-Vander-Lou neighborhood have lower-than-average rates of car ownership for the city and higher-than-average rates of poverty, according to the data reported by the St. Louis Department of Health.
“Especially when you have low-income residents and seniors that are on fixed incomes and on Medicaid and things like that, their resources to travel to get to other stores outside the neighborhood are very limited,” said Bobby Bonner, a real estate developer who works in Jeff-Vander-Lou.
If you build it, will they come?
Even though BOCA has opened, there still aren’t a lot of customers coming in, said Jamron. He figured the location has roughly two dozen customers.
Some in the neighborhood didn’t even know a new pharmacy had opened, according to members of the Jeff-Vander-Lou neighborhood association.
Stewart isn’t convinced those behind the pharmacy have the neighborhood’s needs in mind.
“I’m not saying they are doing it to help. I'm saying they're doing it to help themselves, not to help us,” she said.
Stewart mentioned there has been a history of people proposing developments in north St. Louis without considering residents’ opinions. She and other members of the planning committee are opponents of the proposed $1 billion Green Line MetroLink extension into the neighborhood, which she calls “a train to nowhere.”
Stewart wants the people behind BOCA to help residents — particularly elderly ones — understand they can use the location to ensure neighbors can get their medicines and have them covered by their insurance.
“How difficult is it going to be? How much is it going to cost them? Is it going to be cost-friendly?” she said. “None of that is considered, we’re not hearing any of that.”
Companies will need to build trust among neighbors, Bonner said. Previous development has used eminent domain to displace people from their homes. Other developers have bought up properties on the north side and then abandoned them, critics say.
“I think it comes to that point of making the community aware, [bringing] knowledge to the community, you have to get out and talk to the people,” Bonner said. “But because Doorways is within the community, they're going to be there for the long haul … they have to become a community partner as well.”
It doesn’t happen overnight
Jamron said a new pharmacy takes a while to get off the ground. For example, he’s waiting for credentialing approval from pharmacy benefits providers. Until that happens, the business can begin to fill prescriptions using certain insurance companies. (Jamron said Missouri has approved credentials to fill prescriptions for patients with Medicaid and Medicare insurance coverage.)
Until then, he’s holding off on trying to publicize the new location much. He doesn’t want to have people come to the pharmacy and have to pay a dizzying amount if their insurance isn’t yet accepted, he said.
Once that happens, he’s confident word of mouth will carry the business forward.
“Once we get going and we start taking care of each person as they come in and we find out who the providers are in the area, I think we'll be just fine,” Jamron said.
