Millions of Americans live in communities where the nearest pharmacy is miles away, out of reach without reliable transportation, or simply no longer open. Behind that physical gap sits a quieter shift: the infrastructure of how Americans get prescription medication is moving from the corner store to the cloud. Tebra analyzed pharmacy desert prevalence, medically underserved area density, and online healthcare search behavior across all 50 states to map where the brick-and-mortar pharmacy network is failing — and where digital prescribing infrastructure is being asked to absorb the load.

The findings point to a clear and accelerating shift: as brick-and-mortar pharmacy access shrinks, demand for digital healthcare solutions is rising fast. For private practices, that shift represents both a challenge and an opening.

Geography and population density shape how easily residents can pick up a prescription, and for many Americans, the answer is not easy at all.

When it comes to pharmacy access, residents in 5 states faced the greatest combined barriers, factoring in both pharmacy desert prevalence and medically underserved area density:

On the opposite end, Michigan, California, and New York ranked as the states with the fewest combined access barriers. Access the full ranking table here. 

Washington state presented a notable case: it ranked 10th for pharmacy desert prevalence and first in the nation for online healthcare search demand, suggesting its residents are already actively seeking digital alternatives to meet their needs.

The 5 states with the highest pharmacy desert prevalence were:

At the other end of the spectrum, Vermont (9.33%) and New York (9.35%) had the lowest shares of pharmacy desert tracts, followed by Kentucky (13.09%), West Virginia (13.4%), and Maine (13.51%).

The scale of the problem becomes clearer when looking at raw household counts. Texas led the nation with 2,831,223 households located in pharmacy deserts, followed by Florida (2,642,069) and California (2,522,974).

When patients cannot easily access a pharmacy in person, many turn to the internet, and search data reveals just how urgently that behavior has accelerated.

Searches for "prescription refill online" climbed 440% since 2022, making it the fastest-growing term in the category. "Online pharmacy" rose 179.4% over the same period, and total online pharmacy search demand increased 152.8% since 2022.

Washington led all states in overall per capita online pharmacy search demand at 436.6 total searches per 100,000 residents, with New Hampshire and New York following in second and third place. New Jersey led all 50 states for per capita "online prescriptions" searches at 68.3 per 100,000 residents.

Wyoming offered one of the most telling data points in the study: it ranked fifth on the overall pharmacy desert index and led all states in per capita searches for "prescription refill online" at 37.8 per 100,000 residents.

The states facing the most severe pharmacy access gaps were increasingly the same ones where residents searched hardest for online solutions. Wyoming ranked fifth for pharmacy desert prevalence and first for "prescription refill online" searches per capita. 

Alaska, which led the nation in pharmacy desert tract coverage at 51.41%, ranked among the lowest states for online healthcare search demand, likely reflecting the compounding barrier of limited broadband access in remote communities. South Dakota, North Dakota, and Montana, all in the top 5 for combined access barriers, similarly showed that physical isolation did not always translate cleanly into digital demand, but where it did, the signal was loud. 

For private practices operating in or serving patients from underserved regions, the data made a strong case for meeting patients where they were increasingly looking: online and on their own terms. In states where physical pharmacy access has thinned the fastest, electronic prescribing — the system that sends prescriptions directly from the provider's EHR to a patient's pharmacy of choice, including mail-order — has become less of a convenience feature and more of a connective layer in the broader telehealth infrastructure that now substitutes for the closed corner store.

To rank all 50 states by pharmacy access barriers and digital healthcare demand, Tebra constructed a composite Pharmacy Desert and Digital Demand Index using three signals, each normalized to a 0 to 100 scale via min-max scaling before weighting.

Pharmacy desert prevalence (40%): Share of census tracts classified as pharmacy deserts, sourced from Cencora. Four states, Alabama, Arkansas, Maryland, and Massachusetts, had duplicate figures in the source data; national averages were substituted, and these states are excluded from individual pharmacy desert rankings.

Medically underserved area (MUA) density (40%): Number of federally designated Medically Underserved Areas per 100,000 residents, sourced from HRSA's Bureau of Health Workforce shortage area database. MUA designations are determined by HRSA using the Index of Medical Underservice, which factors in physician supply, poverty rate, elderly population, and infant mortality.

Online healthcare search demand (20%): Combined search volume per 100,000 residents for 5 keywords, "online pharmacy," "online prescriptions," "prescription refill online," "buy antibiotics online without prescription," and "cheap insulin online," aggregated across 2025 to 2026. Per capita figures use US Census Bureau Vintage 2025 population estimates.

Limitations: Cencora pharmacy location data reflects a May 2023 snapshot and may not capture subsequent closures or openings. MUA designations measure broad healthcare access, not pharmacy proximity specifically, and may understate rural access gaps in states with strong urban healthcare systems. Search volume may reflect demand, not confirmed utilization. Rankings are relative comparisons among the 50 states studied and should not be interpreted as absolute measures of access adequacy.

Tebra, headquartered in Southern California, empowers private healthcare practices with AI and automation to drive growth, streamline care, and boost efficiency. Our all-in-one EHR and billing platform delivers everything you need to attract and engage your patients, including online scheduling, reputation management, and digital communications. For practices looking to expand their reach to patients in underserved areas, ePrescribing tools can help bridge the gap between where patients are and where care can reach them.

The data and findings in this article may be used for noncommercial purposes only. If shared or republished, proper attribution to Tebra with a link back to the original article is required.