Community Pharmacies Face Critical Sustainability Challenges in the United States: Academic Pharmacy Can Help

Community pharmacies in the United States (US) face an increasingly unsustainable future due to declining third-party reimbursement (remuneration) and ongoing cash flow challenges following the elimination of retroactive direct and indirect remuneration (DIR) fees. These pressures have contributed to widespread pharmacy closures, the emergence of pharmacy deserts, and reduced access to care for millions of patients. Despite these challenges, community pharmacy remains the most common employment setting for pharmacy school graduates in the US. However, currently required community pharmacy Advanced Pharmacy Practice Experience (APPE) student rotations may offer limited exposure to business, management, and entrepreneurial activities, potentially leaving students underprepared for practice in this setting. US colleges and schools of pharmacy are uniquely positioned to address this gap by partnering with their community pharmacy APPE rotation sites to intentionally integrate business- and practice-focused knowledge, skills, and attitudes (KSAs) into the APPE. Equipping students with these KSAs may enhance early career readiness while also supporting the financial sustainability of US community pharmacies through the development of innovative, revenue-generating services. These efforts further align with the 2025 Accreditation Council for Pharmacy Education (ACPE) Standards and may help advance the profession. Future research should examine optimal community pharmacy APPE structures, models, and assessment strategies to maximize student preparedness and long-term community pharmacy sustainability.