BOTETOURT CO., Va. – More than half of Virginia’s zip codes lack a single physical pharmacy location, highlighting a growing healthcare crisis as rural and underserved communities struggle with diminishing access to prescription medications and pharmaceutical care.
The Virginia Board of Health has declared pharmacy deserts a public health threat after the commonwealth lost 62 pharmacies between 2022 and 2025, with 32 closures in 2025 alone.
“We actually in the Roanoke Valley alone have had multiple pharmacies closed recently,” said Tim Lucas, owner of Downhome Pharmacy in Botetourt. “Pharmacy deserts are traditionally just basically large areas where people don’t have quite an adequate supply of pharmacies to be able to get the prescriptions that they need.”
For families in affected areas, obtaining necessary medications can require significant travel. “It’s this one or Walmart is the closest one to me. And Bedford is like 45 minutes away. I’m not doing that,” said Alecia Carwile, a Downhome Pharmacy customer who drives 15 minutes to reach the nearest pharmacy.
The situation becomes particularly challenging for families managing chronic conditions or emergencies. “It can be rough on any family, especially after an ER visit, having to find a 24-hour pharmacy that will take a prescription,” Carwile said. “It’s stressful, especially if it’s for your sick child or special needs child.”
ECONOMIC PRESSURES
Independent pharmacies face mounting financial pressures, often operating at a loss to serve their communities. “I will fill prescriptions on a daily basis that I’m giving to patients because I got paid less than it cost me to buy it,” Lucas revealed.
The crisis extends beyond rural areas. Lucas noted that in Roanoke alone, five or six pharmacies have recently closed. The problem stems partly from challenges with pharmacy benefit managers (PBMs), which act as middlemen between insurance companies and pharmacies.
“Independent pharmacies actually bind together in a lot of cooperative types of purchases. So we purchase things very similar to what the big chains do,” Lucas explained. “But the difference is independent pharmacies rely on taking care of their patients. And 90% of a lot of their business is the prescription market.”
LEGISLATIVE RESPONSE
Virginia lawmakers have responded with the “Save Local Pharmacies Act,” which requires the state to contract with one transparent pharmacy benefit manager by July 2026. The legislation aims to provide greater oversight of pharmacy reimbursements and maintain access to local pharmaceutical care.
“What we struggled for and got passed was transparency,” Lucas said. “We want to be able to see what the pharmacy benefit manager is paying pharmacies, what they are collecting from manufacturers as far as rebates go.”
The impact of pharmacy closures extends beyond healthcare access, affecting local economies through lost jobs and tax revenue. “Pharmacy is an integral part of the entire community,” Lucas emphasized. “Whether you’re needing something on the medical side, whether it be respiratory, whether it be physical therapy, all of those things traditionally connect back to the pharmacy.”
As communities await the implementation of the new legislation, residents like Carwile continue to face limited options.
“They need to bring a couple more or they need to build a couple more down this way,” she said, highlighting the ongoing challenges in accessing essential pharmacy services.