Advancing Health Podcast Summary

Episode: "Pharmacy Deserts, Rising Demand, and the Future of Pharmacy Access"

Date: December 8, 2025
Host: Dr. Chris Diurenzo, Chief Physician Executive, American Hospital Association
Guest: John Pastor, President of Fairview Pharmacy Services
Podcast: Advancing Health (American Hospital Association)

Overview

This episode dives into the urgent issue of pharmacy access in America, focusing on the alarming rise in “pharmacy deserts” as nearly one third of US pharmacies closed between 2010 and 2021. Featuring John Pastor of Fairview Pharmacy Services, the episode spotlights Fairview’s innovative approach to preserving pharmacy access, expanding the pharmacy’s role in health care, and planning for the future amid rising demand for medications—especially considering an aging population and more complex pharmacological treatments.

Key Discussion Points & Insights

The Expanding Crisis: Pharmacy Closures and Access

• Role of Pharmacies in Health Care Access

  • Pharmacies are "the first point of healthcare access for many people" and often where patients interact with health care most frequently—sometimes even more than with their primary care doctor. (John Pastor, 01:42)
  • Closures affect not only rural communities but also urban and suburban areas, challenging traditional assumptions. (John Pastor, 01:42)

• Data on Pharmacy Closures

  • Nearly 30% of US pharmacies closed between 2010 and 2021, with higher rates among independent pharmacies, particularly in Minnesota. (Dr. Diurenzo, 02:14; John Pastor, 02:36)
  • Some Minnesotans now travel 40–60 miles for a pharmacy. This represents a “multi hour round trip just to get prescriptions for your heart or neurologic medicine.” (Dr. Diurenzo, 02:56)

• Rising Demand & Medication Complexity

  • Expanding medication options—especially for chronic and previously untreatable conditions—intensify the need for reliable pharmacy access. (Dr. Diurenzo and John Pastor, 03:12–03:34)
  • The aging population increases the prevalence of polypharmacy.

Fairview’s Pharmacy Model: Solutions in Practice

• Evolution Beyond Prescription Dispensing

  • Fairview’s pharmacy services began in 1990 and have evolved into “a provision of care and focused on outcomes business,” supporting both acute and chronic disease management. (John Pastor, 04:09)

• Comprehensive Pharmacy Services

  • Fairview operates 26 retail pharmacies (many embedded in hospitals), centralizes specialty and mail services, home infusion, wholesale, and compounding pharmacies, plus services across 11 hospital locations. (John Pastor, 05:36)
  • The system has had to expand physical capacity dramatically—moving from a 15,000 sq ft facility in 2001 to a newly designed 150,000 sq ft facility that’s already at 90% utilization. (John Pastor, 07:14)

• Integrated Patient Care and Outcomes

  • Integrated pharmacy and health records streamline care: “Keeping our health system patients within Fairview is very important from an outcome standpoint… it makes it easier for our providers to do their work too.” (John Pastor, 08:42)
  • Example: Discharge coordination involving home infusion is seamless due to cross-access to records between care providers and pharmacists. (John Pastor, 09:48)

Innovation, Scalability, and Looking Ahead

• Automating Pharmacy Functions

  • Fairview continues to invest in sophisticated automation—from dispensing to business office functions (revenue cycle, prior authorizations)—to handle both current volume and anticipated growth. (John Pastor, 10:39)
  • Automation is key to efficiency and scalability, especially as demand rises and workforce challenges persist.

• Meeting Community Needs and Filling the Gaps

  • Advice for other hospital operators: First, ensure all internal health system needs are met; second, perform a community assessment to identify “pharmacy deserts” and unmet needs—including specialty and infusion services. (John Pastor, 11:51)
  • Fairview’s specialty pharmacy now serves all 50 US states, showing the scalability and impact of their model. “From the specialty pharmacy standpoint, nearly half of our prescription volume comes from external to our own health system.” (John Pastor, 11:51)

Notable Quotes & Memorable Moments

• “In some instances, the pharmacy is the first point of healthcare access for many people… more frequently than they're seeing their primary or specialty care physicians.”
  John Pastor, 01:42

• “We've seen pharmacies all across the country close at an alarming rate. And so access is a challenge for many, even in some large urban and metropolitan areas, not just in our rural communities.”
  John Pastor, 01:42

• “We've had to build a new central services facility ... because that growth was occurring at such an alarming rate, we simply didn't have the space to continue to expand.”
  John Pastor, 05:00

• “It's built for efficiency and design, to make it convenient and accessible for patients that come here. But as well our staff who do a lot of work inside the four walls.”
  John Pastor, 08:06

• “Keeping our health system patients within Fairview is very important from an outcome standpoint, a patient satisfaction standpoint. And frankly, it makes it easier for our providers to do their work too.”
  John Pastor, 08:42

• “From the specialty pharmacy standpoint, nearly half of our prescription volume comes from external to our own health system… actually across all 50 states in the U.S.”
  John Pastor, 11:51

Key Timestamps

• [01:42] — The central role of pharmacies in health care access
• [02:14–02:56] — National and local pharmacy closure data; consequences for patients
• [04:09] — How Fairview transformed pharmacy practice and built capacity
• [05:36] — Scope of Fairview’s pharmacy network: retail, hospital, and specialty services
• [07:14–07:59] — Facility expansion: from necessity to future growth planning
• [08:42] — Benefits of integrated pharmacy services for outcomes and provider workflow
• [09:48] — Example of seamless care: hospital discharge and home infusion
• [10:39–11:22] — Automation as a focus for future-proofing pharmacy services
• [11:51] — Advice for other health systems: assess and address local pharmacy gaps; Fairview’s nationwide specialty impact

Episode Takeaways

• Pharmacy access is critical and endangered; closures affect diverse communities.
• Health systems can play a transformative role by integrating and scaling pharmacy services well beyond traditional dispensing.
• Innovative models can fill major gaps, including advanced automation, specialty pharmacy, and seamless integration with hospital and outpatient care.
• Assessing local and regional needs is essential for addressing pharmacy deserts, and the Fairview model demonstrates both local depth and national reach.

This summary encapsulates the main content of the episode, preserving the speakers’ voices and the urgent tone around the future of pharmacy access in the US.