Faced with the increasing number of pharmacy closures in rural areas, health professionals and local elected officials are warning of the risk of "pharmaceutical deserts" in areas where pharmacies often represent the only possible medical recourse.
"A pharmacy that closes is like a light going out in a village, because it is a structuring element of local life," says Gilles Noël, DVG mayor of Varzy, a village of 1,000 inhabitants in Nièvre.
It is even the balance of an entire territory that is threatened, as pharmacies also benefit neighboring communities.
"A pharmacy that closes means an extra 30 or 40 kilometers to travel on weekends or public holidays," warns the elected representative from Nièvre.
In ten years, France has lost 2,000 pharmacies, the number of which has fallen below the 20,000 mark, with 260 closures last year, according to the profession.
In rural towns, the average annual rate of pharmacy closures even "almost quintupled" between the periods 2015-2019 and 2019-2021, notes the Court of Auditors, while it was "multiplied by less than two" in urban areas.
As a result, patient access to pharmacies is "deteriorating" and "the average travel time for policyholders has increased by almost 7% from 2020 to 2023," the financial magistrates noted in a report published in May.
The cause is the growing weakening of the economic model, between the fall in the price of reimbursable drugs, chronic drug shortages, inflation of fixed costs, and the snowball effect of medical deserts.
Added to this is the government's recent decision, since suspended for three months, to reduce the ceiling on commercial discounts on generic drugs, which represent a third of pharmacists' margins.
"We're seeing a lot of small pharmacies closing. In rural areas, owners who retire often can't find buyers due to a lack of profitability," confirms Isabelle Dugelet, mayor of La Gresle (Loire).
However, closure means the risk of the license disappearing, while opening is, according to her, "much more complicated," being conditional on a threshold of 2,500 inhabitants.
– “Stab” –
"We need local pharmacies and a significant territorial network because they are often the only place people can still go when they have a health problem," sighs the elected official.
If many pharmacies are also closing in urban areas, it is often the consequence of excessive density.
"In the city, it's regulated, while in the countryside they are not viable because there are often no more doctors. So we have a medical desert and then little by little a pharmaceutical desert," analyzes pharmacist Bruno Galan, member of the National Council of the Order of Pharmacists.
And it is not the arrival of large private investors in the capital of urban pharmacies that will be able to save the rural ones.
"Groups buy pharmacies, which buy others, but have you ever seen a village of 160 inhabitants courted by a large group to buy its pharmacy?" asks Gilles Noël.
"What is very dangerous is that in recent years, the net has been slipping, meaning that pharmacies that were the only ones in the village are closing," warns Jean-Philippe Brégère of the Federation of Territorial Professional Health Communities.
In this context, the government's initial decision on discounts applied to generic drugs is seen as a "stab in the back", which it says risks "making a third of the network disappear".
"We've reached the bone. Before, medication allowed people to live. Today, there are a whole host of things that pharmacists do that aren't paid, such as preparing pill boxes in nursing homes, delivering medication, dressings, or even refilling medications, which we don't do blindly," he lists.
To save rural pharmacies, the profession is calling for a thorough overhaul of the economic model.
In the meantime, experimenting with pharmacy "antennas", which involves financially supporting a pharmacy that has closed with another nearby pharmacy while its viability is tested, could also be a solution.
English 
French