26984 iPLEDGE pharmacy deserts exist across major metropolitan cities in the United States

Abstract

Early treatment for acne is crucial to prevent long-term consequences; however, racial disparities in treatment and maldistribution of dermatologists hinders access to care. A study in the District of Columbia demonstrated limited access to iPLEDGE pharmacies in regions with low income and high nonwhite population. This study expands the evaluation of iPLEDGE pharmacy distribution. Twenty cities with a population greater than 500,000 were randomly selected; 4 cities per region. A list of pharmacies was obtained from the Board of Pharmacy and public sources and verified for iPLEDGE enrollment. The association between iPLEDGE pharmacy and demographic data obtained from the 2013-2017 American Community Survey Estimates was evaluated using Poisson regression. Of the 708 ZIP codes surveyed, 5237 total pharmacies were identified of which 2847 were registered in iPLEDGE. For every $1000 increase in median household income, rate ratio of iPLEDGE pharmacies increased by 10% and 12% in the Midwest and West, respectively. Overall, for every percentage increase in nonwhite individuals, rate ratio of iPLEDGE pharmacies decreased by 9%; the most prevalent decrease was in the Southwest by 30%. The rate ratio of iPLEDGE pharmacies decreased by 22% for every percentage increase in individuals below the poverty line; the most prevalent decrease was in the Southwest by 30%. For every unit increase in dermatologist density, iPLEDGE pharmacy density increased by 0.66 units. The administrative burden of processing isotretinoin may be discouraging pharmacies from registering in iPLEDGE. Restricted access to iPLEDGE pharmacies may contribute to the racial and socioeconomic differences in isotretinoin treatment.