Rite Aid Closure in Honesdale Raises Concerns Over Growth of Pharmacy Deserts

Narrowsburg resident Catherine Montesi had been going to the Rite Aid in Honesdale, PA for her 30-day prescription of Lexapro since she moved to the town a year ago. That is until she was confronted with news of the pharmacy closing on June 4 and a subsequent text from Rite Aid detailing that her prescriptions had been transferred to the Weis Pharmacy across the street after Weis Markets bought the former out.

Momentarily relieved that she didn’t have to go and search for a new pharmacy herself, Montesi has since been facing new barriers to accessing her prescription. From calling the pharmacy repeatedly with no response to learning in-person that her Lexapro prescription did not transfer during her first visit in late June, she said it’s proven challenging to try and navigate the precarious aftermath of Rite Aid’s closure.

“I call the Weis Pharmacy because I just want to make sure that my prescription is indeed there before I go pick it up,” Montesi said.” I call, and I don’t get anybody. I call again, and I don’t get anybody…So the next day I call when they first open, no answer. A few more times throughout the day, nothing. The next day I call and finally I’m like, ‘it’s clear that no one’s answering the phone, so I’m just gonna go over there and pick it up.’ And so I get to the Weis. It’s maybe an hour and a half before lunch, but there’s a line at the window and I realized just by listening to the people in line in front of me, that what has happened is that every single person who had their prescriptions at the Rite Aid had their prescriptions transferred to the Weis, but those prescriptions that are on automatic refill were not automatically re-upped.”

And she’s not the only one.

“In some ways I feel lucky because the prescription that I’m picking up is for Lexapro, right?” Montesi said. “Like if I don’t take my antidepressant, um, like life can be a real struggle. I don’t feel very good, but my heart’s not gonna stop beating. My cancer treatment isn’t gonna get interrupted. But there was a guy behind me in line who was telling me…’my brother has cancer and he didn’t get his medication and was just on the floor in pain, just like waiting for his prescriptions to be re-upped.”

Since the Honesdale Rite Aid closed after the company filed for bankruptcy a second time, former customers are now being covered by the borough’s Weis Pharmacy — a smaller pharmacy with limited staff located in the grocery store Weis Markets. But the pharmacy is struggling to handle the influx of patients from the borough or towns nearby like Narrowsburg to their store, and residents like Montesi are having to deal with significant delays to their prescriptions.

As pharmacies increasingly close in the region and across the country, residents are having to move to the remaining pharmacies in their area. Since January 2024, Pennsylvania has lost 200 pharmacies, and in Honesdale alone, the borough has lost five of their pharmacies in the last 30 years. Both chain and independent pharmacies are being driven out of business due to the low reimbursement rates on prescriptions set by pharmacy benefit managers (PBMs). Rite Aid, Walgreens and CVS are all set to close hundreds of their stores this year. Independent pharmacies are especially struggling to stay afloat while dispensing prescriptions at a loss as they fight an uphill battle against PBMs, resorting to cutting low-reimbursement prescriptions like GLP-1 drugs that are mainly used for diabetes and weight loss.

In Honesdale borough, there are still options — including Weis Pharmacy, CVS Pharmacy, Walmart Pharmacy and the locally-owned, independent Stephens Pharmacy. However, these pharmacies are now facing an increase in patients even as they face the same economic challenges that led the Honesdale Rite Aid to close in the first place, Wayne Stephens, head pharmacist at Stephens Pharmacy, described in an interview with Radio Catskill. From his friendships with the other pharmacists in Honesdale, Wayne Stephens said he’s been able to see how these closures are hurting pharmacists and subsequently the patients they serve.

“They are a little overwhelmed in these places, and it’s the way it’s gonna be,” Stephens said, “And it’s the bad part of pharmacy. As places go out of business, you can’t absorb all their employees. The reimbursement is not there. And that’s what the bottom line is. If we all could make a decent amount of money on dispensing a prescription…we wouldn’t be in this situation and we could flourish and we could grow and we could help more people. But as pharmacies go out of business and there’s consolidation, there’s less folks working at the next pharmacy.”

Todd Stephens, who works alongside his brother Wayne as the Chief Operating Officer of Stephens Pharmacy, said their pharmacy is diversified in its service for this reason — unlike many other independent pharmacies. The store sells medical equipment and even builds accessible ramps to make up for the losses from their pharmacy and to continue serving Honesdale as they have been doing for 24 years.

But what these closures mean for residents is a potential decrease in the quality of and access to their pharmaceutical care, which comes as Americans are already facing major federal cuts to Medicaid. In addition to having to navigate technical issues, such as the failed transfer of automatic refills that Wayne said are common when it comes to closures, patients might have to deal with longer wait times for their prescriptions or their local pharmacy announcing that they have to stop dispensing certain prescriptions to stay in business.

”So you’re talking about delaying access to the needed therapies that they’re getting from pharmaceuticals that are being supplied,” Stephens said.” In addition to that, if they can’t get access you’re talking about an increase in both chronic health issues as well as acute issues, and these folks are gonna wind up in the emergency room. So is it better to have access to a pharmacy where you can get medications or wind up in the emergency room where you have to be treated? From a cost standpoint, obviously it’s night and day. It’s far more expensive to check into the ER than it is to get that generic medication that keeps your blood pressure in line or keeps other chronic health conditions like diabetes under control.”

Although initial issues of unanswered calls and long lines have easened, Montesi said she’s been having to maintain herself on 5-day supplies of Lexapro provided by Weis Pharmacy rather than her prescribed 30-day supply after her automatic refill failed to transfer over from Rite Aid, which required her to reach out to her primary care doctor who has since been unresponsive. While not fatal, Montesi said that not having access to her Lexapro prescription has demonstrated effects to her physical and mental wellbeing.

“I can’t speak for all SSRIs, but for me, with Lexapro specifically, I notice that after about three days of not having it, I start to get these brain zaps,” Montesi said. “It feels like electricity is sort of like zapping your brain. It kind of hurts. I definitely notice that I start getting irritable. I start getting really impatient. I feel a lot more emotional… I just don’t feel like myself. It’s hard to keep things in perspective. I worry a lot more.”

The growth of what could be referred to as pharmacy deserts are especially felt in rural communities like Honesdale, where options for pharmacies are already few and far between and residents face barriers like transportation costs. Montesi, who had mainly lived in cities like Memphis and New York City before moving to Sullivan County, explained that navigating rural healthcare has been a learning curve.

“You know, in Brooklyn, if a pharmacy closes, it’s like no big deal. You simply go to the other one like a couple of blocks away. Multiple pharmacies could close, and you would still have many options,” Montesi said. “But another thing that I’m realizing about life in Sullivan County and in these rural areas is that not only do you have fewer pharmacies — if one pharmacy closes, that’s the pharmacy. So now you might have to go a lot farther away, and that takes time. If anyone’s working, people don’t necessarily have two hours round trip just to go get medication, and then if you go there and they don’t have it, you just blew two hours and a lot of gas money.”

Transportation is a particularly major point of concern, especially because Honesdale skews older in age and over 70% of its population is at or below the Asset Limited, Income, Constrained, Employed (ALICE) line, Honesdale mayor Derek Williams, whose mayoral platform is built on increasing Honesdale’s walkability, explained. While Wayne County does have its own transportation service for seniors and those with qualifying medical conditions, Williams said Honesdale, where major highways like Route Six pass through, is still biased towards automobiles and has historically made access to pharmacies that much more difficult.

“There’s a big barrier, particularly when you’re talking about something like Rite Aid, which pops up in the kind of the commercial highway land use zoning areas of the county,” Williams said, “Those areas are really hard to get to if you’re walking or biking… Our Rite Aid [was] down by Weis Plaza. That’s maybe a little over two miles probably from our downtown — certainly within everyday walking range, yet it’s super uncomfortable to walk down there. So for anybody who’s gotta go down there for work or to visit people or to do any shopping for essential services, it’s difficult to be walking along this very limited shoulder of Pennsylvania Route Six.”

Furthermore, Todd argues that pharmacists are often the “most accessible healthcare provider” available for rural residents, and these growing barriers only work to strip these communities of an essential resource.

“I think what the public doesn’t necessarily know is this is a big health crisis that no one’s talking about,” Stephens said. “Access to pharmacies is one of the most important healthcare aspects that we have in our country because you can walk into a pharmacy and you have access to a highly trained health professional. That person’s been to school for several years. They know drug interactions like the back of their hand, to a greater extent than most of the prescribers in all honesty, because that’s what they focused on. So when you see rural pharmacies closing, you are basically shutting down access to folks who live in rural areas to the most accessible healthcare provider they’ve ever had.”

As pharmacies continue to close nationwide, with pharmacists pointing to PBMs as the source of profit loss, Todd said what’s needed is legislative action.

“Obviously, we’re optimistic, that’s why we’re still here. That’s why we haven’t closed our doors,” Stephens said. “We have 40 employees who depend on us to support their families, and we’re passionate about that. But something has to happen. Legislation has been promised for years. The healthcare lobby is the largest lobby in the country, so it is really difficult to make this a top legislative priority. Fortunately, there is some legislation in Congress now sponsored by a representative named Buddy Carter, who is a pharmacist that could potentially end some of the practices that are suffocating pharmacies. If that passes, things will get better. We’re optimistic, but we absolutely need action at the governmental level to stop the egregious practices of insurance companies and PBMs.”

Image: Exterior of Rite Aid (Photo credit: riteaid.com)