Deep Roots Help This Chicago Pharmacist Avoid Creating Another Pharmacy Desert

CHICAGO – The Del-Kar pharmacy in the North Lawndale neighborhood has historically taken a top spot. Martin Luther King Jr bought his daily newspaper there when he lived in Chicago in the late 1960s. The Black Panthers’ local headquarters were a block away, and the pharmacy shared a building with the Deputy Lords. Conservative, a notorious street gang whose members still follow the owner – pharmacist Edwin Muldrow.

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

““Go home,” Muldrow said they 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 drugs, food, and electronics in a neighborhood overlooked by the major drugstore chains. Del-Kar is fighting a trend that has undermined many other pharmacies in Chicago and other US cities. Although drugstore chains are pulling out of many urban areas, sometimes riot quote or steal, Muldrow did not give up.

Muldrow, 51, who started working as a pharmacist in Del-Kar in 1992, said: “Once you respect the community, the neighborhood will notice you.” They know that you are here and that you are. do something positive”.

Like other nationwide pharmacist community, Muldrow has seen private insurers direct their customers to their own chain of alliances, mail-orders, and specialty pharmacies. Independent urban pharmacies, particularly those in low-income Black and Latino communities, have most likely to close than drugstore chains.

And pharmacies of all types in this community, chain and independent, face a tough economic situation: They often have disproportionately high proportions of customers enrolled in Medicaid or Medicare, which pay Lower fees than private insurance.

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

According to a recent analysis She worked, Black and Latino neighborhoods accounted for one-third of the pharmacies open in Chicago between 2015 and 2020, but more than half of the stores closed. As a result, the prevalence of pharmaceutical deserts increased from 33% in black-majority census areas to 45% and from 9% in Latino-majority areas to 14. %.

“Pharmacies are choosing to open in areas that already have pharmacies, in part because those are also areas with higher incomes and insurance that offer higher pharmacy reimbursement rates,” said Jenny Guadamuz, a University of Southern California health disparity researcher who led the study.

Muldrow said insurance often pays less for a drug than he would have to pay to buy it. For example, he could get a $400 refund for a $600 Advair inhaler.

“This profession is not what it used to be,” he said. “Profits have been withdrawn.”

The average dispensary fee, set by insurance plans and intended to cover Muldrow’s costs and wages, has plummeted from about $3 per prescription 30 years ago, he said. 10 cents. He used to sell medical supplies such as elevator seats and oxygen tanks. But since Medicare implemented new fraud protections that require accreditation, he said, it would cost him between $1,500 and $2,000 a year to continue receiving Medicare reimbursement.

“Now you have elderly people in the neighborhood who can’t come pick up,” Muldrow said. “They have to go to the hospital. They have to deliver by mail. “

Muldrow kept his store open by supplementing the meager payments he received for prescriptions with other income. “The secret to our success here is that we own the property,” Muldrow said. “If I pay $3,000, $4,000 or so in rent a month, I’m wiped out.”

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

Del-Kar Pharmacy in Chicago’s North Lawndale neighborhood is an independent black-owned business that has sold drugs, 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 was received in 2010 nearly 1 million dollars in incentives opened at East Garfield Park. A nearby independent pharmacy quickly closed, and CVS closed a few years later, creating a pharmacy desert.

Illinois debut a program In 2019, support for pharmacies in urban and rural areas has not been served. However, Qato said, the program does not fully target neighborhoods at risk of becoming a pharmacy desert and excludes large chain pharmacies, which may be the only ones left in the area. vicinity.

She said one year into the program, only three of the 80 eligible pharmacies in Chicago received the money. Muldrow says he hasn’t heard of the show.

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

Dr. Thomas Huggett, a family physician at Lawndale Christian Medical Center on Chicago’s West Side, said some of his patients had trouble getting medication during the first month of the new policy. One patient, who was homeless and had been diagnosed with a severe mental illness, was unable to fill his prescription. Another had to take two buses to get an injectable antipsychotic. The third patient was unable to use Suboxone, an opioid addiction treatment.

“In the midst of one of the nation’s hottest opioid overdose hotspots west of Chicago, it’s hard to imagine how anyone could justify that,” Huggett said.

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

“Most patients with Medicaid have Medicaid because they are poor, and they often don’t have a car,” says Huggett. “Looking at the map, it’s just very clear. The CVS is intentionally avoiding the black areas of Chicago.”

About half of CVS stores nationwide are located in areas that have high ratings on the Centers for Disease Control and Prevention, said CVS spokesman Mike DeAngelis. Social Media Vulnerability Index, which tracks poverty, lack of transportation, and overcrowded housing, among other factors.

“Maintaining access to pharmacy services in underserved communities is an important factor we consider when making the decision to close stores,” DeAngelis said in an email. “Other factors include local market dynamics, population shifts, community store density, and ensuring there are other geographic access points to meet community needs.”

James Spiddle, a 66-year-old veteran with a serious heart condition, walks a mile on a cane to catch a bus in the Washington Heights neighborhood, about 13 kilometers south of Del-Kar, to pick up a prescription from Walmart.

“I walk back and forth as a stress test,” he says. “If I didn’t have chest pain, I would continue.”

A closer option, Walgreens, closed in 2016. A sign on the door directs customers to another branch a mile away in a more affluent neighborhood with a pharmacy grocery store next to it. across the street.

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

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

Endeleo Institute, the community development arm of Trinity United Church of Christ, tried to fill the void, using church vans to take people to the nearest pharmacies. Melvin Thompson, its chief executive officer, lists four other pharmacy chains that have closed within a three-mile radius of the closed Walgreens in Washington Heights.

“We are in the midst of a pandemic here and we are losing even more of these vital services in communities that cannot afford to lose,” he said. “It’s city-wide, but it seems to only be rated for Black and brown communities.”

Walgreens officials did not respond to a question about how the company decided to close stores, but said that in the city of Chicago, about 99% of Chicagoans live within 2 miles of one of their stores. mile. Walgreens spokesman Kris Lathan said the company has allocated $35 million to reopen 80 Chicago stores damaged during the civil unrest following the killing of George Floyd in 2020.

“All but two of those locations have reopened,” she said. “The other two will open in the first half of 2022.”

Democratic State of the House of Representatives. La Shawn Ford said pharmacy closures represent a loss of access to health care for the community. “Pharmacy is not only a place to get medicine, but also a place to take care of health,” he said. “Who’s going to talk to that person when they get their medication in the mail?”

It can also be a lifesaver in other ways. During the pandemic, when indoor food service was shut down, Muldrow set up an outdoor grill and served burgers, banh tet and other dishes. It shows him how much the neighborhood needs him – and more than medicine. He is planning an expansion, including a bodega with a juice bar and restaurant.

Muldrow was also reminded that in return the community was always ready to support him. Last year, during a period of civil unrest, several businesses near Del-Kar were destroyed. But, in an echo of 1968, his shop emerged as normal.

“I don’t have any worries. I slept really well,” Muldrow said. “The brothers here on Lawndale, they watched me. If you know people, people will look for you.”

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