BAKER CITY — Rick Meis drives an hour and a half through a winding canyon from his home in Halfway every six weeks to pick up his prescriptions at a Safeway pharmacy in Baker City.

It’s an onerous process that has only become tougher. One local retail pharmacy in Baker City closed shortly after Meis moved to the rural Eastern Oregon community seven years ago. Last fall, retail chain Bi-Mart then announced it was getting out of the pharmacy business entirely. That left just five pharmacies in all of Baker County — two of which are in hospitals or clinics and less accessible, and one which Meis says is currently without a full-time pharmacist.

The result for customers has been long lines and difficulty contacting overworked pharmacy staff. Meis spent several days in December calling Safeway before he was finally able to get through to someone who could tell him his prescription was ready. He arrived at the pharmacy shortly after it opened but still had to wait 30 minutes to get his medication. Friends have said they waited two hours at busier times later in the day.

“It’s truly a crisis for people who live rurally, especially older people,” said Meis, 69.

Between closures and pandemic-related staffing shortages, pharmacies are becoming less accessible to many Oregonians at a time when their services are in greater demand than ever.

There are 731 active retail and hospital pharmacies in Oregon, according to data provided by the Oregon Pharmacy Bureau. That is 41 fewer than in 2016.

Roughly 60% of the counties in the state have fewer than two pharmacies per 10,000 residents. Two, Wheeler and Sherman counties, don’t have any pharmacies at all.

Even before the pandemic, independent pharmacies said they were being squeezed by rising costs and declining reimbursement rates that made it harder to stay open, much less hire sufficient staff.

The pandemic has exacerbated those issues. Pharmacies have become the first stop for many to receive COVID-19 tests and vaccines, but staffing shortages have made it harder for pharmacies to keep up with demand.

“You’re seeing burnout with a lot of pharmacists in Oregon and across the country,” said Huy Hoang, a pharmacy professor at Pacific University and a floating pharmacist for CVS/Target. “You’re seeing a lot of pharmacies closing down, mainly in the independent pharmacy sector, and now even the big chains are having to close some of their stores because they’re trying to catch up on two to three weeks of prescriptions.”

He said independent pharmacies have watched their profit margins shrink as pharmacy benefit managers have reduced their reimbursements. There’s little they can do, he said, because only three corporations control 75% of the U.S. market, according to Drug Channels, a pharmaceutical economics newsletter.

Open jobs skyrocket

Oregon Democratic Sen. Ron Wyden has pushed for reform in the industry and an investigation into business practices by pharmacy benefit managers.

“Pharmacies are one of the most accessible health care provider services that communities have,” Hoang said. “When closures happen, patients, especially in rural communities, have to travel a lot farther for the nearest health care provider service and that just makes it more difficult for people to get the care they need.”

Oregon Employment Department estimates indicate that the number of open jobs at pharmacies has skyrocketed during the pandemic.

There were an estimated 680 postings for pharmacist jobs and 1,303 job postings for pharmacy technician jobs in Oregon per year from mid-2019 to mid-2021, according to an employment department analysis of online job posting data from Help Wanted Online. That compares to an estimated 211 pharmacist job postings and 458 pharmacy technician job postings in a normal year.

That mirrors what those who work in the industry have seen on the ground.

Hoang said there has been a spike in burned-out pharmacists and underpaid pharmacy technicians leaving the industry as the pandemic has increased the workload. In some cases, he said, a lack of technicians is forcing pharmacists to take on even more work to keep pharmacies open.

During the public health emergency, Oregon is allowing companies to hire pharmacists who hold licenses in other states in an attempt to fill the void.

Ryan Thueson, a regional pharmacy leader for Rite Aid who manages pharmacies in Central and Southern Oregon, has seen firsthand how challenging it is to fill vacant pharmacist and pharmacy technician jobs right now. The Rite Aid in Florence has been without a full-time pharmacist for three months and has only been able to open when a floating pharmacist is available to come to the store.

“There are a lot of pharmacies right now that are limiting hours, limiting days because there’s a lack of staffing, both with pharmacists and pharmacy technicians,” Thueson said.

Those temporary closures are causing uncertainty for patients who may find themselves with fewer COVID-19 testing and vaccine options, or may be unable to fill prescriptions when they need them.

Caroline Butler learned that the Rite Aid pharmacy in Florence no longer had a full-time pharmacist when she went to fill a prescription in November. Staff told her the pharmacy was closed, and they didn’t know when it would reopen.

Butler said the store’s website still showed regular hours for the pharmacy. At one point, Butler said the pharmacy was still accepting appointments for COVID-19 testing and vaccinations, only for patients to learn when they arrived that those services weren’t available. (That issue has since been fixed, Thueson said.)

“It ended up being several days before I got my prescription because I had to have it transferred to Florence Pharmacy,” Butler said. “I was having health issues at the time, and it definitely made it much worse.”

‘It is life and death in a pharmacy’

Bi-Mart pointed to increased costs and declining reimbursements, along with Oregon’s corporate activity tax, when it announced its decision to close its pharmacies last September. Those closures alone have put a significant strain on Oregon’s pharmacy industry.

Bi-Mart had said its patient files would be transferred to nearby Walgreens locations and that Walgreens staff would operate pharmacies within Bi-Mart locations in areas where the drug store didn’t have a nearby location.

But that hasn’t been the case in many locales. Walgreens is operating pharmacies inside only six Bi-Mart stores across Oregon. While patient files have been transferred to Walgreens stores in many cities, that still leaves 31 communities with fewer pharmacy options than before. And in locations where there aren’t any nearby Walgreens stores, other pharmacies have had to pick up the slack.

Jeanne Mendazona, the owner and pharmacist at Hometown Drugs in Madras and owner of three other independent pharmacies in Oregon, said she had taken on many former Bi-Mart patients. Hometown Drugs and Safeway are the only two retail pharmacies operating within the city.

With the influx of new patients and the added responsibility of providing COVID-19 testing and vaccinations on top of other vaccinations, Mendazona said she has often worked until midnight filling prescriptions. That schedule isn’t sustainable, she said, and it could in fact be dangerous if pharmacists are asked to continue to take on more responsibility in the face of ongoing closures and staffing shortages.

“It is life and death in a pharmacy,” Mendazona said. “We’re not making hamburgers. If I put mustard on your burger and you don’t like mustard, you’re probably not going to die.”