Deep roots help this Chicago apothecary avoid creating another drugstore wasteland

Deep roots help this Chicago apothecary avoid creating another drugstore wasteland

CHICAGO – Del-Kar Pharmacy in the North Lawndale neighborhood has had a front row seat in history. Martin Luther King Jr. bought his newspaper there when he lived in Chicago in the late 1960s. The local Black Panthers headquarters was a block away, and the pharmacy shared a building with the Conservative Vice Lords, a notorious street gang whose members still control proprietary pharmacist Edwin Muldrow to this day.

When King’s assassination sparked riots in Chicago in 1968, white-owned pharmacies in the area were looted. Muldrow’s father went to check the pharmacy only to be told by the Vice Lords that he had nothing to worry about.

“‘Go home,'” Muldrow said they had told his father. “‘We won’t let anyone touch you.'”

For nearly 60 years, the small pharmacy has survived by building deep roots in the community, selling medicine, food and electronics in a neighborhood largely ignored by large pharmacy chains. Del-Kar is bucking a trend that has undermined numerous other drugstores in Chicago and other cities in the United States. Although pharmacy chains are pulling out of many urban areas, sometimes citing riots or thefts, Muldrow is not giving up.

“Once you respect the community, the neighborhood takes care of you,” said Muldrow, 51, who started working as a pharmacist at Del-Kar in 1992. “They know you’re here and you’re doing something positive.” .

Like other community pharmacists nationwide, Muldrow has seen private insurers refer their customers to their allied chain, mail order and specialty pharmacies. Independent urban pharmacies, particularly those in low-income Black and Latino communities, were more likely to close than pharmacy chains.

And pharmacies of all kinds in these chain, independent communities face a difficult economic situation: they often have a disproportionately large share of customers enrolled in Medicaid or Medicare, paying lower rates than private insurance.

“There is really no financial incentive for pharmacies to open and stay open in minority neighborhoods,” said Dima Qato, professor of pharmacy at the University of Southern California.

According to a recent analysis he worked on, black and Latin American neighborhoods accounted for one-third of drugstore openings in Chicago from 2015 to 2020, but more than half of the closures. As a result, the prevalence of drugstore deserts increased from 33% of black-majority treated to 45% and from 9% of Latin-majority treated to 14%.

“Pharmacies are choosing to open in areas that already have pharmacies, partly because those are also the areas that have higher incomes and insurance that provides higher reimbursement rates for pharmacies,” said Jenny Guadamuz, researcher on health disparities. of the University of Southern California who led the study.

Muldrow said insurance often pays less for a drug than it costs to buy it. For example, he could be reimbursed $ 400 for an Advair inhaler that costs him $ 600.

“The profession is not what it used to be,” he said. “Profitability has been ripped”.

Average delivery fees, set by insurance plans and intended to cover Muldrow’s overheads and salary, plummeted from about $ 3 per prescription 30 years ago to as low as 10 cents, he said. He once sold medical supplies such as lift chairs and oxygen cylinders. But since Medicare implemented new fraud safeguards that require accreditation, he said, he would have to pay $ 1,500 to $ 2,000 per year to continue receiving Medicare reimbursement.

“Now there are older people in the neighborhood who can’t come get stuff,” Muldrow said. “They have to go to the hospital. They have to go through the mail. “

Muldrow keeps his shop open by supplementing the meager payments he receives to fill prescriptions with more income. “The secret of our success here is that we own the property,” Muldrow said. “If I had paid $ 3,000, $ 4,000 or more a month in rent, I would have been blown away.”

Muldrow received job offers from multiple pharmacy chains when he graduated from pharmacy school, but chose to work for his father. “’The only way I can repay you for giving me the opportunity to go to school is to come down here, work and continue what you started,’” he recalled telling him.

Del-Kar Pharmacy in Chicago’s North Lawndale neighborhood is an independent, black-owned business that has been selling medicine, food, and electronics for nearly 60 years. (Taylor Glascock for KHN)

Chicago has encouraged pharmacies to locate in underserved areas, with little success. Qato pointed to a CVS branch that received nearly $ 1 million in incentives to open in East Garfield Park in 2010. A nearby independent pharmacy closed quickly and CVS closed its doors several years later, creating a wasteland of pharmacies.

Illinois launched a program in 2019 to subsidize pharmacies in deprived urban and rural areas. But, Qato said, the program does not adequately target neighborhoods at risk of becoming drugstore desert and excludes large pharmacy chains, which may be the only remaining pharmacies in a neighborhood.

A year into the program, he said, only three of the 80 eligible pharmacies in Chicago have received funding. Muldrow said he hadn’t heard of the program.

Some business strategies actually create deserts. Late last year, CVS Health-owned health insurer Aetna began preventing its Medicaid patients in Illinois from filling prescriptions at Walgreens pharmacies. As a result, some patients could no longer use the nearest pharmacy.

Dr. Thomas Huggett, a family doctor at Lawndale Christian Health Center on Chicago’s West Side, said some of his patients had difficulty getting their medications in the first month of the new policy. One patient, who was homeless and diagnosed with severe mental illness, was unable to receive the prescription. Another had to take two buses to get his injectable antipsychotic drug. A third patient failed to take Suboxone, a treatment for opioid addiction.

“In the midst of one of the country’s hottest opioid overdose spots on Chicago’s West Side, it’s hard to imagine how anyone could justify it,” Huggett said.

In urban areas, Illinois regulations require prescription insurance plans to have at least one network pharmacy within a 15-mile or 15-minute drive radius of their subscribers. But that may be too far to be practical for many customers, Huggett said.

“Most patients who have Medicaid have Medicaid because they are poor and generally don’t have cars,” Huggett said. “Looking at the maps, it’s so clear to see. CVS are intentionally avoiding Chicago’s black zones. “

CVS spokesperson Mike DeAngelis said about half of CVS stores nationwide are located in areas that rank high on the Centers for Disease Control and Prevention’s social vulnerability index, which tracks poverty, lack of access to crowded vehicles and housing, among other factors.

“Maintaining access to pharmacy services in disadvantaged communities is an important factor we consider when making decisions about shop closings,” DeAngelis said in an email. “Other factors include local market dynamics, population changes, the density of stores in a community and ensuring that there are other geographic access points to meet the needs of the community.”

James Spidle, a 66-year veteran with severe heart problems, walks a mile using a cane to catch a bus in the Washington Heights neighborhood, about 13 miles south of Del-Kar, to pick up his prescriptions from a Walmart.

“I walk back and forth as a stress test,” she said. “If I don’t have chest pains, I’ll go ahead.”

A closer option, a Walgreens, closed in 2016. A sign on the door directed customers to another branch that was a mile away in a richer neighborhood and had a grocery store pharmacy across the street. of the road.

Owner and pharmacist Edwin Muldrow outside Del-Kar Pharmacy in Chicago’s North Lawndale neighborhood. Muldrow’s father opened the business in the 1960s. (Taylor Glascock for KHN)

A list of black colleges is displayed at the Del-Kar Pharmacy on Friday, December 17, 2021 in the Lawndale neighborhood of Chicago, IL. The pharmacy has been independent and black-owned since the 1960s, an increasing rarity. (Taylor Glascock for KHN)

The Endeleus Institute, the community development arm of Trinity United Church of Christ, sought to bridge the gap by using church vans to take people to the nearest pharmacies. Melvin Thompson, its executive director, listed four other pharmacy chains that had closed within a three-mile radius of the Walgreens that had closed in Washington Heights.

“We are in the midst of a pandemic here and are losing even more of these vital community services that they cannot afford to lose,” he said. “It is citywide, but appears to be relegated to the black and brown communities.”

Walgreens officials did not answer questions about how the company decides to close stores, but said that about 99 percent of Chicagoans live within 2 miles of one of their stores on the Chicago subway. Walgreens spokesman Kris Lathan said the company has allocated $ 35 million to reopen 80 stores in Chicago damaged during civil unrest following George Floyd’s murder in 2020.

“All but two of those places have reopened,” he said. “The remaining two will open in the first half of 2022”.

Democratic state representative Shawn Ford said closing drugstores meant a loss of access to community health care. “The pharmacy isn’t just a place to get medicine, it’s a health care environment,” he said. “Who will talk to that person when they get the medicine in the mail?”

It can also be a lifeline in other ways. During the pandemic, when the indoor restaurant was closed, Muldrow set up an outdoor grill and served burgers, tacos and other food. This showed him how much the neighborhood needed him – and for much more than drugs. He is planning an expansion to include a bodega with a juice bar and restaurant.

Muldrow was also reminded that the community is there for him in return. During the civil unrest last year, several businesses near Del-Kar were destroyed. But, in an echo of 1968, his shop came out unscathed.

“I had no worries. I slept very well, ”Muldrow said. “The brothers here in Lawndale have been watching over me. If you know people, people take care of you. “

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