Geographic variation in pharmacy competition and social vulnerability proximate to Walgreens

In March 2025, Walgreens Boots Alliance announced plans to close more than 1200 stores in the United States over the next three years. Retail pharmacy closures can disrupt medication access, but the availability of alternative pharmacies likely varies by local market structure and community social vulnerability.

To quantify county-level community pharmacy competition near Walgreens, relate competition to social vulnerability, and identify counties where closures may pose a risk to pharmacy access.

We conducted a cross-sectional analysis of U.S community pharmacies. Pharmacy information was drawn from the 2023 National Council for Prescription Drug Programs (NCPDP) dataQ®, and county sociodemographic measures were obtained from public sources. To determine the availability of alternative pharmacies near Walgreens, we calculated a pharmacy competition index (PCI), comparing pharmacies per capita within 2 miles of any Walgreens with the national pharmacies-per-capita rate. Counties were classified as low competition if PCI was below the national average. Competition was overlaid with social vulnerability to derive four quadrants (Q): sparse-vulnerable (Q1), crowded-vulnerable (Q2), sparse-resilient (Q3), and crowded-resilient (Q4).

We identified 8743 Walgreens locations in 1570 counties. On average, each Walgreens store had about 4 competitors within 1 mile, 11 within 2 miles, and 46 within 5 miles. Of the 8743 Walgreens stores, 1024 (11.7%) had at least one Walgreens neighbor within 1 mile; 4017 stores (45.9%) had at least one neighbor within 2 miles; and 7113 stores (81.4%) had at least one neighbor within 5 miles. Among counties, 231 were high competition counties, and 1339 were classified as low competition. Stratifying counties by both competition and vulnerability resulted in 334 sparse-vulnerable counties.

Pharmacy competition around Walgreens was uneven and closely intertwined with community vulnerability. The 334 sparse-vulnerable counties identified should be prioritized when evaluating pharmacy access as Walgreens continues its phased store closure plan.