Monica Mitchell has lived in South Shore for two decades, and in that time, she’s had to change pharmacies three times.

“I remember there was a Walgreens that was five minutes away [from me] that got closed down,” said the 48-year-old registered nurse. She changed to a Walgreens a few blocks over, but it usually didn’t carry all the items she needed. She changed to a Hyde Park location.

Then came the murder of George Floyd by a Minneapolis police officer in the summer of 2020, which sparked days of protests, civil unrest and looting across the city and the nation. In the aftermath, hundreds of businesses in Chicago temporarily shut their doors, and Mitchell was forced to change pharmacies again. By then, the closest Walgreens was in southwest suburban Evergreen Park, 30 minutes away.

Now, Mitchell says, she gets most of what she needs via mail order, a convenience that she says is not widely used by those who are more comfortable with brick-and-mortar stores or lack internet access or know-how.

A few miles southwest of Mitchell, 68-year-old Renita Johnson has lived most of her life in the Roseland home her family built during World War II. Over the decades, she has seen a number of nearby pharmacies close.

For her neighbors without cars, especially older residents, Johnson said, “if you’re trying to get on public transportation, if you’re a truly elderly person who has difficulty getting around, I would see it as a total nightmare.”

Experiences like Johnson’s and Mitchell’s are not unusual in many parts of Chicago.

Even as drug stores are providing more vital services — including COVID-19 tests and vaccinations, contraceptive counseling and wellness visits — a recent study shows communities on Chicago’s South and West sides have fewer pharmacy locations than other parts of the city.

These areas are called pharmacy deserts. The term was coined in 2014 by Dima Qato, a former University of Illinois Chicago professor now at the University of Southern California. In a pharmacy desert, at least a third of residents live over a mile from a pharmacy, or over a third of residents with “low vehicle access” live more than half a mile from the nearest pharmacy.

In Chicago, North Side residents are far more likely to have easy access to pharmacies than their South and West side counterparts, according to Qato’s research. In addition, the number of pharmacy deserts on Chicago’s South and West sides has increased in recent years.

“Chicago actually has the widest gaps between white and Black neighborhoods in the country,” Qato told the Sun-Times.

And, as Mitchell found, that problem was exacerbated by the civil unrest of 2020, when a number of pharmacies closed. It was particularly an issue in Black neighborhoods where, the city confirmed, about one out of every five pharmacies was shuttered temporarily or permanently, according to a WBEZ analysis of August 2020 city data that tracked the availability of pharmacies.

Meanwhile, a separate WBEZ analysis shows access to the two largest pharmacy chains in Chicago — Walgreens and CVS — is much higher in the city’s white communities than it is in Black or Latino areas.

Now, with the pandemic and women’s reproductive rights front and center in the nation’s conversations about health, pharmacy closings and access to pharmacies have become bigger issues for many Chicagoans.

Contraceptive access

Mitchell, in South Shore, said she saw firsthand the public health effects of pharmacy deserts on her community during the pandemic. She said it took weeks to find COVID testing sites, and she had trouble getting a vaccine while watching her friends in the suburbs get theirs “very easily.” She believes that many deaths in South Shore, at the peak of the pandemic, could have been prevented with better access to pharmacies.

Now, with COVID-19 tests and vaccines less scarce, Mitchell worries about the effects of the U.S. Supreme Court overturning Roe v. Wade. She said pharmacies could play an increasingly important role in making contraceptives more available to residents.

In January, a new Illinois law went into effect that eases access to hormonal contraceptives by no longer requiring a doctor’s prescription for things like the pill, patch or ring. But with so few pharmacies across South and West side neighborhoods, some, like Mitchell, wonder if the law will benefit as many women as it could.

“If you don’t have birth control, if you get pregnant, that’s generational,” said Mitchell. “That’s gonna go down the line, that’s gonna cause you to not succeed as much as you would have if you didn’t get pregnant. I can’t even imagine being 18 and getting pregnant.”

While other states’ contraception laws may offer restrictions on who can access the medication — such as Arkansas’s HB1069, which allows OTC contraceptives only to those 18 or older — Illinois’ law has no restrictions.

“We talked a lot with the health care professionals and they really do feel that it is safer for a young girl to access contraception than it is for her to go through an unplanned pregnancy,” said state Rep. Michelle Mussman, D-Schaumburg, co-sponsor of the bill in the Illinois House of Representatives.

For Black women, especially, a lack of access to contraceptives can have deadly effects.

In 2019, the Chicago Department of Public Health found that pregnant Black women are more likely than any other race to have both short-term and long-term consequences to their health during delivery. They also are more likely to die during or within one year of their pregnancy.

For West Side resident Apriel Campbell, these statistics exemplify why access to contraceptives is vital to ensuring Black women have control over their reproductive health.

“If we want to prevent the maternal deaths, I think that we have to address some of the factors that kind of play into that,” said Campbell.

She added that, in addition to better access to contraceptives, education in topics like birth control and STDs should also be supported — something the new state law requires during patient counseling.

Mussman acknowledged the concerns around pharmacy deserts but said the new law “sure goes farther than where we had been before.”

“A pharmacy, hopefully, is much easier to access than a normal doctor’s office, which we know there’s an inadequate supply of also, and very often they only are open during normal business hours,” said Mussman.

“Some pharmacies are actually open 24 hours and they would not necessarily require an appointment and … if you have to pay directly because you don’t have insurance, they would be a more affordable alternative than attempting to pay for a full-on doctor’s visit.”

But for some Black and Brown Chicagoans, those pharmacies aren’t easy to access.

Pharmacy deserts

In 2020, to identify pharmacy deserts, Qato and her team used census tracts to map things like distance to the nearest pharmacy, racial composition and the percentage of residents with health insurance.

Such a pharmacy desert was found in one West Garfield Park census tract. The population was nearly 97% Black, and 93% of the residents had health insurance — but it was nearly a mile to the nearest pharmacy.

In 2020, nearly 45% of majority-Black census tracts were pharmacy deserts, an increase from about 33% in 2015. Among Latino neighborhoods, about 13% were pharmacy deserts in 2020; that’s up from 9% in 2015. Only 1% of white neighborhoods were defined as pharmacy deserts.

Pharmacies on the South and West sides are also less likely to be those of major chains, like CVS and Walgreens.

“[Chains are] less likely to open because they know they’re not going to profit,” Qato said.

In late 2021, CVS announced plans to close 900 stores throughout the United States over the next three years. The company did not specify which stores would close in the Chicago area.

The June closure of a CVS pharmacy in the majority-Latino neighborhood of Little Village drew protests from the community. Residents and public officials sent a letter to the company and held a news conference demanding that CVS keep the store open. Closures in these communities are noticeable since there are so few CVS pharmacies located there.

Less than 14% of CVS locations in Chicago — that’s nine out of 65 locations — are found in the city’s majority-Black or majority-Latino ZIP codes, despite those areas being home to just under half the city’s population, shows a WBEZ analysis of store locator data found on the company’s website.

However, CVS locations are in abundance in many of the city’s white communities, particularly on the North Side. The WBEZ analysis shows the rate of CVS locations per 10,000 residents is about seven times higher in Chicago’s majority-white ZIP codes than it is in the city’s majority-Black or majority-Latino ZIP codes.

CVS responded with a written statement from spokesman Mike DeAngelis.

Store closings, according to the statement, are “based on our evaluation of changes in population, consumer buying patterns and future health needs to ensure we have the right kinds of stores in the right locations for consumers, and supports the evolution of our stores into community health destinations with new store formats.”

It continued: “Any closures in Chicago this year will be a small percentage of our overall store presence in the city.”

In a statement to the Sun-Times, Walgreens said the company is “focused on driving equitable access to health and wellness services” and removing barriers to prescriptions. The statement added that in the Chicago area, “99% of residents live within two miles of one of our stores.” The company also “committed $35 million to reopen 80 stores in Chicago damaged following the civil unrest events in the summer of 2020,” according to the statement.

By far, Walgreens is the largest pharmacy chain in Chicago, with more than 130 locations. There’s a Walgreens in practically every corner of the city. Nevertheless, those locations are harder to find in Chicago’s Black communities.

The rate of Walgreens locations per 10,000 residents is nearly twice as high in Chicago’s majority-white ZIP codes than it is in the city’s majority-Black ZIP codes, according to a WBEZ analysis of data found on the company’s online store locator.

On the South Side, empty hulking shells of former Walgreens stores and others that have been taken over by other retailers have become common sights for some residents. Those Walgreens closures include a string of locations along 95th Street — at Jeffrey Boulevard, King Drive and Halsted Street — as well as the location at 87th Street and Ashland Avenue.

On the West Side, there haven’t been many Walgreens closed in Black neighborhoods because there weren’t that many to begin with. A WBEZ analysis of the Walgreens online store locator shows just five Walgreens locations among the four majority-Black ZIP codes on the West Side — 60612, 60624, 60644 and 60651. Collectively, it’s an area with more than 175,000 residents. By comparison, there are three North Side ZIP codes — 60618, 60647 and 60657 — that each have six or more Walgreens stores.

But just because a pharmacy is nearby doesn’t mean it is easy to get to, or to use, as Campbell, the West Side resident, has found.

The closest pharmacy for Campbell is a Walgreens at Homan Avenue and Roosevelt Road — a 15-minute walk from her house. But she doesn’t make that trek often.

In her neighborhood, she said, “walking as a young woman isn’t safe.”

But whether walking or driving, there are still issues.

“The line and the wait is just so long,” she said — once, almost three hours long — because “there’s so many people and limited staffing.”

The wait times only intensified during the pandemic, she said, especially after unrest and lootings in 2020. She’s also noticed pharmacists sometimes are suspicious when she fills a prescription for several months at a time.

The diminished presence of large pharmacy chains in some communities has presented opportunities for smaller, independent pharmacies.

“Independents try to enter markets that chains don’t enter,” Qato said. But independent pharmacies may have a smaller selection, and they may be less likely to stock food or household items, serve customers around-the-clock or offer drive-thru service, she added.

And independent pharmacies have struggled with some of the same issues as the chains, including the 2020 lootings and low reimbursement rates from insurance providers.

Howard Bolling has run the Roseland Pharmacy, 11254 S. Michigan Ave., for nearly 50 years. In 2020, he was looted — twice. Now, he’s looking to retire.

“It’s a very aggravating business,” said Bolling. “The only thing that you get to feel good about is if you feel you help someone. But overall the business of trying to make it … the reimbursements are so low.”

Bolling said he’d been offered a contract with a new provider, but the reimbursement rate for medications he’d fill was $0.

Garth Reynolds, executive director of the Illinois Pharmacists Association, calls these practices “restrictive,” and a main reason locally-owned drug stores struggle.

“Prescription products have been notoriously, drastically under-reimbursed,” Reynolds explained. “It may cost $300 to bring in this medication for this patient … but the insurance company or the pharmacy benefit manager is reimbursing that medication sometimes at $150.”

Still, Bolling knows how important local drugstores can be for communities, and that’s what’s been keeping him open.

“Most corner drug stores you can walk up to the pharmacist and talk like we’re talking,” he said. “But you can’t do that at a Walgreens or a CVS.”

Closing the gap

Online pharmacies are another option for residents without easy access to a nearby store. But patients need access to a computer or smartphone, and internet connectivity — something not everyone has.

And, not all health care needs can be met through such services.

So Qato has a policy-based suggestion for how to close the pharmaceutical gaps: reimbursement mandates.

“The vast majority of time, pharmacies in these neighborhoods that are predominantly or disproportionately publicly insured with Medicare and Medicaid are getting paid less per prescription they fill,” she said.

If legislatures can find a way to reimburse the costs Medicare and Medicaid won’t cover, she said, then the pharmacy desert gap could narrow.

For its part, the state of Illinois launched the Critical Access Pharmacy program in 2019 to provide subsidies for pharmacies in some rural and underserved areas. But that program ended up benefiting, almost exclusively, independent pharmacies in rural areas, Qato said, with only three pharmacies in the Chicago area included even though more are eligible.

Qato added the state played a role in the late 2021 change made by CVS-owned insurance giant Aetna, which excluded Walgreens from its pharmacy network. Aetna said at the time that the change was approved by the Illinois Department of Healthcare and Family Services, according to a Chicago Tribune report.

Ultimately, Qato said, “Illinois Medicaid agreed to this contract.”

She added, “If our governments are signing off on agreements that we know could harm their communities, it’s on them.”

Melvin Thompson, executive director of the Endeleo Institute, the nonprofit community development arm of Trinity United Church of Christ, said there is more at play than just reimbursements and revenue when it comes to corporations’ presence in Black neighborhoods.

He rejected the idea that low revenue and theft alone forced pharmacy chains out of the communities, adding that the residents of Washington Heights, where Endeleo is based, and its surrounding neighborhoods are “loyal to a fault” when it comes to brands like Walgreens and CVS.

“They’re gonna go as far as they need to because the Walgreens brand, the red signage, and all of that means something to them,” Thompson said. “But what troubles me about that is … corporations have figured that out about our behavior and our tendencies to say, ‘Hey, you don’t even have to, you don’t have to locate there, they’ll come to you.’ ”

Thompson also said the city of Chicago needs “some real economic policy that stipulates that, if you have any designs on doing business in the city of Chicago, that there is a high percentage of that, that must be done in Black communities … and not a watered-down version of what would be something far superior in a more white, affluent neighborhood.”

For now, Thompson said, “community-based organizations like ours have to fill that void,” especially in communities where diabetes, high blood pressure, dementia and other conditions are prevalent. He said Endeleo and other groups must work to improve the “social determinants” of health.

“If we eliminate the needs, then maybe we don’t need as many pharmacies as we once had,” he said.

Cheyanne M. Daniels worked on this story as a staff writer for the Chicago Sun-Times through the Report for America program. She is now a reporter for The Hill in Washington, D.C.

Esther Yoon-Ji Kang is a reporter for WBEZ’s Race, Class and Communities desk. Follow her on Twitter @estheryjkang.

WBEZ Senior Editor Alden Loury contributed to this story. Follow him @AldenLoury.