She had suffered an injury and was not able to drive.
“I was moving to a city where the only people I knew were the people who interviewed me. All of my family was a plane ride away," Pettitt explained. "When I needed something, I was able to walk to CVS."
When CVS closes in January, the city of Youngstown will become a pharmacy desert.
An urban pharmacy desert is defined as a neighborhood in which most inhabitants live more than a mile away from a pharmacy, if people have access to private vehicles. That distance decreases to a half mile in neighborhoods where most people don't own cars.
“I don’t know where I’m going to go, actually,” Pettitt said. "There was a period of time in my life when I wasn't able to drive because of my injury, and this CVS was a lifesaver for me."
Downtown's Last Pharmacy
The closest retail pharmacies to downtown Youngstown are located on Market Street, Mahoning Avenue, Gypsy Lane and McCartney Road. Each location is at least two miles from downtown.
Downtown's last pharmacy is the one located in the lobby of St. Elizabeth's Youngstown Hospital. It aims to aid patients being released from the hospital by providing all medications prior to discharge.
Currently, the pharmacy only serves hospital patients or people seeing a Mercy Health physician. There are nine parking spaces reserved for pharmacy use at the edge of the parking lot, near the Joanie Abdu Comprehensive Breast Cancer Center.
For those able to get their prescriptions filled at the pharmacy inside St. E's, the experience is less convenient than a visit to a retail pharmacy. It does not sell the sundry items that a customer can find at a CVS or a Walgreens.
Also, the hours are less convenient. The St. E's pharmacy is open on weekdays from 7 a.m. to 6 p.m. and on Saturdays from 10 a.m. to 2 p.m. and closed Sundays and on holidays. The pharmacy hours of the CVS on Park Avenue are 8 a.m. to 9 p.m. on weekdays and 10 a.m. to 6 p.m. on Saturdays and Sundays.
It's possible that Mercy Health will seek to fill the gap left by the imminent closure.
"With recent changes such as CVS exiting that market, we are always constantly in a state of looking at the needs of communities, especially those we're right in the backyards of, and responding to that," said Jonathon Fauvie, Public Relations and Communications Manager for Mercy Health's Great Lakes group.
Dr. Dima Qato, associate professor at the University of Illinois at Chicago's College of Pharmacy, coined the term "pharmacy desert" in the course of researching access to pharmacies in Chicago neighborhoods.
The term builds on the U.S. Department of Agriculture’s concept of a “food desert," or an area with limited access to affordable food.
The distance might seem minimal, but it can be a real challenge for people without access to transportation.
“Low income and elderly patients are our greatest concern in this thing,” said Ernest Boyd, executive director of the Ohio Pharmacists Association.
Getting a ride to the pharmacy "could be easy if you're on a medicine or two every three to six months, but if you're on a lot of meds and you're older, which means you might need to go to the pharmacy every few weeks, that is really a burden," said Qato.
"I know there are a number of people [on the North Side] that aren't driving, that are walking, that are using public transportation or Uber. So now, what for them?" Pettitt asked.
Qato's research shows that the inconvenience has real health implications.
In an investigation published in April 2019, Qato found that pharmacy closures are associated with persistent, clinically significant declines in adherence to cardiovascular medications among older adults. The decline is stronger among people using independent pharmacies.
“There is a tendency for people to just say, 'Well, it’s just blood pressure. I’ll save some copays,’” Boyd explained.
In an era that features more people receiving prescriptions via mail, a convenient place to pick up prescriptions for some isn't the only thing Youngstown will lose when CVS closes.
"Pharmacies are not just dispensers of medication," said Qato. "They're providers of care and of essential products."
As the role of pharmacists expands, many pharmacists develop individual relationships with pharmacy customers and advise them regarding medication.
Boyd explained that insulin-dependent diabetics might rely on their pharmacist to discuss a changing health condition. Additionally, pharmacists have been instructed to screen diabetic patients for gangrene.
Also, many pharmacies provide flu shots and other immunizations.
These services are absent in the solutions to lack of access, such as drug delivery and telepharmacy, which connects patients to pharmacists via video call.
“It’s not that same relationship you have face-to-face with that health professional,” said Boyd. “The theory of telepharmacy is lovely. The implementation Is not as lovely as it seems."
Why are pharmacies closing?
As the Columbus Dispatch has extensively covered, predatory practices by pharmacy benefit managers, which administer insurance plans' prescription drug benefits, are, in many cases, responsible for pharmacy closures.
PBMs, such as CVS Caremark and OptimumRx "have been paying pharmacies less than what it costs to fill a prescription," specifically when it comes to Medicaid, said Boyd. "Our concern is that money that was meant to be given to pharmacies ended up benefiting PBMs."
A report commissioned by Medicaid officials found that PBMs charged Ohio taxpayers three to six times as much to process prescriptions for people on Medicaid as the industry standard, the Columbus Dispatch reported in June 2018.
This severely affects pharmacies in communities where residents are covered by Medicaid.
For example, in late 2017, PBMs were paying pharmacies so little for the drug Naloxone, that many could not afford to stock it. Naloxone reverses opioid overdoes.
Since Medicaid implemented a new pricing model Jan. 1, 2019, the disparity between what PBMs pay pharmacies and what they bill the state has decreased, but there's still a long way to go when it comes to drug pricing reform.
The solution would be for PBMs to pay the pharmacy the cost of the product and a fee reasonable enough to keep the pharmacy open, Boyd said.