How a pharmacy’s past can cut off care for whole communities

By Alexander Fernandez, Reporter

Life News Today

In many small American towns, the local pharmacy is more than a place to pick up a prescription. It is where neighbors fill blood pressure pills, find antibiotics for sick children and pick up a last-minute inhaler before the weekend. In rural communities with limited medical infrastructure, losing access to a pharmacy can be as consequential as losing a clinic or a hospital. Yet an increasingly common problem is emerging across the United States. When a pharmacy location has a history of regulatory violations, that past can follow the address indefinitely, even after it has been sold to new owners who had nothing to do with the original mistakes.

Regulators argue that strong oversight and continuity of enforcement are required to prevent the diversion of controlled substances and protect public safety. Regulatory records show that enforcement conditions tied to a location’s past can carry over to new owners, limiting their ability to rebuild operations or reestablish full pharmacy services in underserved communities, according to DEA and state board disciplinary filings. The clash between these perspectives is reshaping how small towns access medication, and in some cases, whether they can access it at all.

Under federal law, any pharmacy that handles controlled substances must hold a registration from the DEA. State boards of pharmacy license both the premises and the professionals who work there. When a pharmacy is cited for recordkeeping failures, dispensing without valid prescriptions or other violations of the Controlled Substances Act, boards and the DEA can suspend, revoke or place strict conditions on those licenses and registrations.

Those conditions do not always disappear when the business is sold. In a 2024 disciplinary order involving a CVS-branded pharmacy in California, the state Board of Pharmacy placed the permit on three years of probation and stated that all terms and conditions apply to the licensed premises and to “all owners, managers, [and] officers” associated with it, according to the California State Board of Pharmacy (CSBP). The order explained that any change of ownership would not erase the probation. Instead, the obligations and reporting requirements follow the permit and address.

In practice, that means a new owner who buys a pharmacy with a troubled regulatory history may inherit quarterly reporting, surprise inspections and detailed compliance conditions before a single prescription is filled. If regulators have revoked a previous DEA registration or state license, the DEA may also deny a new application for the same site until it is convinced that problems have been fully resolved, according to the DOJ DEA Division Control.

 Recent reports describe “pharmacy deserts” as neighborhoods where residents must travel long distances to reach a pharmacy, often 10 or more miles in rural areas. One tool developed by the National Community Pharmacists Association and researchers at the University of Southern California uses those thresholds to map shortages and found that about 1 in 8 United States neighborhoods lack adequate pharmacy access, with rural areas hit hardest.

Local news investigations have raised alarms that a growing number of closures are leaving patients “high and dry,” forcing them to drive long distances or wait days for essential medicines. Physicians interviewed for those reports warned that living in a pharmacy desert increases the likelihood of medication nonadherence and serious health complications, according to Ned Milenkovich, chair of the health care law practice at Much Shelist.

“Pharmacy deserts are not just a local inconvenience; they are a national economic and health issue,” Milenkovich said.

In a small town that already has only one pharmacy, a history of violations at that address can compound the problem. If the previous owner lost a DEA registration because of sloppy controlled-substance records, a new owner may be reluctant to buy the business. If they do purchase it, they may decide not to stock certain medications that draw intense scrutiny, such as opioid painkillers, ADHD stimulants or some anxiety medications, for fear that a single audit could put them out of business.

Rules that were designed to protect patients from dangerous prescribing practices can make it harder for law-abiding patients with legitimate prescriptions to get the drugs they need.

These tensions are increasingly showing up in courtrooms, where pharmacies and patients argue that regulators have overstepped. While not all these cases involve rural towns, they illustrate the legal arguments that new owners and their communities raise.

In Wedgewood Village Pharmacy v. DEA, a New Jersey pharmacy challenged the DEA’s move to summarily revoke its registration, arguing that the agency violated its Fifth Amendment due process rights by cutting off its ability to dispense or receive controlled substances without meaningful hearing. Wedgewood maintained that DEA registration is a property interest, and that losing it threatens not only the business but also the patients who rely on its services. The case highlighted pharmacies’ contention that abrupt enforcement without clear procedures can have broad consequences for patient access.

Walgreens filed a high-profile lawsuit against the DEA in federal court in Texas earlier this year in 2025, alleging that the agency unlawfully imposed new requirements on pharmacists to resolve “red flags” on prescriptions and refuse to fill prescriptions from “suspicious” prescribers, even though those rules were never formally adopted through the regulatory process, according to court documents and Alex Fernandez’s 2025 WUSA9 report, “Walgreens to pay $300 million to settle allegations of illegally filling opioid prescriptions.”

Walgreens argued that the unwritten standards put pharmacists in a “no-win” position: fill the prescription and risk being accused of enabling diversion, or refuse it and risk harming legitimate patients, including those in rural areas where alternative pharmacies are scarce.

Other lawsuits have accused the DEA of “heavy-handed” regulation that worsens drug shortages. In 2023, two federal suits claimed that DEA mismanagement of manufacturing quotas and enforcement practices threatened to drive a specialty pharmacy and drugmaker out of business and exacerbate nationwide shortages of ADHD medications. Advocates for patients argued that rigid enforcement, without accounting for real-world demand and access, harms children and adults who depend on those drugs to function at work and school.

Federal and state regulators, for their part, stress that pharmacies are not ordinary retail businesses. The DEA’s pharmacist manual emphasizes that the agency focuses on cases with “the highest level or most significant impact” and may seek to revoke registrations when state boards have already pulled licenses.

Recent enforcement actions underline that message. In 2025, a North Carolina pharmacy agreed to pay $204,000 to resolve allegations that it violated controlled-substance recordkeeping requirements. Federal officials said such violations undermine the safeguards that prevent diversion and ensure that medications reach only patients with legitimate prescriptions, according to the DEA.

State boards have also made it clear that disciplinary orders are meant to apply to the entire enterprise, not just a single individual. In the California CVS case, the board’s probation terms explicitly applied to all owners, officers and managers of the licensed premises, according to the CSBP. From a regulatory standpoint, that makes sense: a pharmacy is a system of people, processes and controls, and its history can be an important predictor of future risk.

Health policy researchers say there are ways to protect patients from unsafe dispensing while also preserving access in small towns. One avenue is telepharmacy. Advances in remote verification, video counseling and automated dispensing cabinets can allow a single pharmacist to supervise multiple rural sites that might not support a full-time pharmacist on staff, according to healthcare lawyer, Michael A. Dowell, Telepharmacy is already being used in several states to bring services back to communities that lost their local drugstore.

“Telepharmacy can transform access to healthcare in underserved communities,” Dowell wrote on his X, formerly Twitter, account.

A prior 2023 survey by the National Association of Boards of Pharmacy (NABP) states that regulators could maintain close oversight of a high-risk location while tailoring probation terms to the new owner’s compliance track record, rather than automatically treating them as an extension of prior misconduct. Risk-based audits that focus on current data, such as dispensing patterns and inventory reconciliations, may be more effective than blanket restrictions that linger for years after a sale.

Legal scholars have also suggested that antitrust and competition policy may have a role, particularly where enforcement actions interact with market consolidation to deepen pharmacy deserts. Work on “pharmacy deserts and antitrust law” points out that as independent pharmacies close and hospital systems and chains merge, some rural regions become both healthcare and pharmacy deserts, according to the Boston University Law Review. In that context, decisions that drive away potential new owners at a troubled location may unintentionally entrench monopolies or leave communities with no access at all.

The core question in these disputes is not whether patient safety matters. Everyone agrees it does. The real debate is how to weigh historic violations at a specific address against the needs of present-day patients who had nothing to do with those problems.

On one side, regulators and law enforcement agencies insist that firm, consistent standards are necessary to prevent diversion and fraud. On the other, new owners in small towns argue that rules tied to a location’s past can make it nearly impossible to rebuild trust, attract investment and stock the full range of medicines needed.

As more pharmacies close and rural health systems strain under workforce shortages, finding a better balance will become more urgent. Whether through targeted court challenges, legislative reforms or creative use of technology, communities are searching for ways to ensure that the past does not permanently lock them out of the medicines they need to live, work and age in place.