The news that Rite Aid is likely to close its New York stores if it can’t sell them by June is going to be a problem for those who live in rural areas.

Closing the Brooklyn Square and West Ellicott stores isn’t a huge inconvenience given that there are pharmacies very close to both locations. The same is true of locations in Dunkirk and Fredonia; there are options for customers don’t mean a lengthy drive to another pharmacy.

But for those who use Rite Aid pharmacies in Mayville, Silver Creek, Salamanca and Gowanda, the loss of their pharmacy will make life more difficult.

Welcome to the age of growing pharmacy deserts, brought to you by decades of inaction that have made it difficult for non-chain pharmacies to remain open and now, apparently, making it increasingly difficult for even the big chain pharmacies to keep their doors open. A report published in late April by The Ohio State University School of Pharmacy reports between 2010 and 2021, more than 29% of pharmacies across the country closed. Declining reimbursement rates and complex payment systems are making it increasingly difficult for pharmacies to remain financially viable, the report states, leading first small pharmacies to close and, now, bigger chains to close.

Pharmacy Benefit Manager (PBM) reform at the federal level remains needed. PBMs are often blamed for driving up prescription costs for users while at the same time decreasing reimbursement rates or pharmacies. And while PBM reform would likely help some local and chain pharmacies remain open, the Ohio State report outlines other avenues that seem worth examining, including incentive programs for pharmacies in pharmacy deserts, investment in remote dispensing pharmacies and expansion of mail delivery prescriptions. All of those ideas have pros and cons – and all should be on the table for consideration.

It’s quite possible Walgreens will be the next domino to fall after the Walgreens Boots Alliance agreed to be acquired by private equity firm Sycamore Partners as the struggling retailer looks to turn itself around after years of losing money. In March Walgreens was in the early stages of a plan to close 1,200 of its roughly 8,500 U.S. locations.

We’ve heard warnings about the state of pharmacies for years. Those warnings are starting to come true. There is no single silver bullet to get prescription drugs in the hands of those who need them – but we must take action as the pharmaceutical dominos continue to fall.