MENDOCINO CO., 2/18/26 — In November 2025, Genoa Healthcare in Gualala, the sole pharmacy along a 60-mile stretch of Mendocino County coast, shut down. Its closure turned the surrounding region into a “pharmacy desert,” where medication access is so limited that some must travel over an hour and a half to fulfill their prescriptions.
Genoa is the fourth pharmacy to close in the past 12 years in Gualala and the neighboring city of Point Arena. The inability of south coast pharmacies to stay open reflects a broader national trend. According to a study in the journal Health Affairs, the U.S. lost nearly 30% of its pharmacies between 2010 and 2021. In 2024 alone, 2,800 pharmacies in the US shuttered their doors.
While many in the region have adapted to the lack of a local pharmacy by getting their prescriptions delivered, there are still instances when brick-and-mortar drugstores are necessary.
After coming home to melted medication on her doorstep, Robyn Cota Cann decided she was done with mail-order prescriptions. She now travels two hours from her home to Santa Rosa to pick up her medications, bringing ice packs to keep her perishable prescriptions cool on the ride back.
Cann, who is in her 70s, considers herself lucky she is still mobile enough to make those trips. “I don’t know what I would do if I had something really serious, and I couldn’t go to Santa Rosa,” Cann said. As she watches her neighbors age, and in some cases, leave the south coast, she wonders how access to medication will affect her and her husband’s future in Mendocino.
“At some point, we might have to leave because of the availability of different kinds of care and a pharmacy. I hope not, but I don’t know,” said Cann.
An elderly population at risk
The loss of Genoa Healthcare is particularly concerning in an area where a substantial portion of its population is elderly. According to the US Census Bureau, 23.2% of south coast Mendocino residents are 65 years old and over. These older adults are more likely to be dependent on prescriptions and the medical services that pharmacies provide.
Like Cann, Jeanette Schnell, who recently turned 68, worries about how the lack of medical care in the region will become a greater challenge to her as she ages.
Schnell was diagnosed with scoliosis at 16, and has since developed chronic pain and cranial headaches. To manage her condition, she has tried many different drug regimens, including the prescription of restricted painkillers. The controlled nature of these medications means Schnell must drive an hour and a half to pick them up, as most health service companies have ceased or placed limits on the home delivery of Schedule II drugs.
“I wish I could get consistent access, I wish I could get consistent health care, it is the one thing that drives me batty about living here,” said Schnell.
“When we got here in 2017, our daughters were concerned about our access to health care, and we just kind of blew them off. Now they look at us like, ‘We told you so.’”
Trained staff can’t find housing
A major hurdle to pharmacies in rural regions such as coastal Mendocino is staffing. Manning Genoa Healthcare had been difficult from the start. Six weeks after opening, RCMS, the medical clinic partner to Genoa Healthcare, noted in a blog post that “it has been difficult to recruit the necessary pharmacy staff in the face of a limited candidate pool, housing difficulties, etc. These issues have slowed down operational goals for our pharmacy somewhat.”
In February of 2025, the problem remained unsolved. The CEO of RCMS at the time, Ara Chakrabarti, acknowledged the pharmacy’s struggle in a community note. “We continue to have difficulties with our Genoa pharmacy staffing. We know it is difficult to recruit qualified professionals here,” he wrote. By the end of the year, Genoa Healthcare was forced to close.
Four years prior, Gualala Community Pharmacy also succumbed to a staffing shortage. After losing its pharmacist and technicians, RCMS announced the business’s imminent shutdown. The pharmacy had been open for less than a year.
In Mendocino, two major factors — a small local talent pool and a lack of available housing for relocated workers — have contributed to its staffing shortage. According to Michael Murphy, senior advisor at the American Pharmacists Association, with every rural pharmacy closure, the problem is compounded. The reduction in jobs following a closure may compel health care professionals to leave that area, making it difficult to staff future businesses.
“There is definitely concern that as we see more pharmacies close … that you lose the health care professionals that were living in those communities, serving those communities, because there’s no longer a place of employment for them,” said Murphy.
Margins are slim to none
Business practices by pharmacy benefit managers have also contributed to the widespread shuttering of pharmacies.
Widely referred to as PBMs, these companies act as middlemen between drug manufacturers, insurance companies and pharmacies. PBMs determine how much a medication will cost the consumer, how much cost insurance will cover, and how much the pharmacy will be reimbursed.
PBMs can turn a profit by reimbursing pharmacies at a lower rate than a drug’s wholesale value, forcing pharmacies to dispense medication at a loss.
“The unfortunate reality that we’ve seen over the past 10 to 15 years is a dramatic reduction in the reimbursement of drugs from pharmacy benefit managers to pharmacies,” said Murphy. “More regularly, pharmacies are operating off of slimmer and slimmer margins.”
The three biggest PBMs are Optum Rx, CVS Caremark, and Express Scripts. These major companies also run their own large-scale pharmacy chains, and stand to benefit from driving independent pharmacies out of business. At least one small business in the south coast Mendocino region, Jack’s Pharmacy, was overpowered by losses due to insufficient reimbursements.
In a 2015 interview with Gualala radio station KGUA, Jack Chladek, owner of Jack’s Pharmacy in Gualala, cited inadequate reimbursements as the prime reason behind his pharmacy’s closure.
“Really, it was the progression of declining reimbursement on third-party insurance pay,” he explained. “The more I grew the prescription end of the business … the more money I was starting to lose. So it just got to the point where I could no longer keep up with the bills, I could not keep up with the wholesaler.”
New funds but new cuts
This month, a new federal policy aimed at curbing PBMs’ power was signed into law. Included in the bill, called the Consolidated Appropriations Act of 2026, was legislation meant to increase transparency around reimbursement. The legislation also set aside funding for investigations of complaints made by pharmacies, empowering individual pharmacies to demand fairer treatment.
Another recent policy that stands to benefit rural pharmacies is the Rural Health Transformation program, a federal initiative established under legislation also known as the One Big Beautiful Bill Act. The program has allocated a total of $50 billion over a period of five years to strengthen rural health care across the country.
On Dec. 29, 2025, California received $233,639,308 through the initiative. The California Department of Health Care Access and Information wrote in its project plan that part of the money will be used to “build and sustain a homegrown rural health workforce” by offering retention bonuses, relocation bonuses and funding for onboarding and temporary housing. The department proposes spending $20-30 million annually toward this kind of workforce development for the five years the federal funding is available.
Exactly when and how this funding will affect the south coast of Mendocino is unclear. If the funding can overcome the bill’s historic rollback of federal support for health care coverage is another unknown. Along with the rural health care funds, the bill also created an estimated $1 trillion federal spending reduction to Medicare over a period of 10 years.
According to KFF, a health policy think tank based in San Francisco, cuts to Medicare created by the bill might negate any funds it generated. Using Congressional Budget Office estimates, KFF concluded that “federal Medicaid spending in rural areas could decrease by $137 billion over 10 years — about $87 billion more than is appropriated for the rural health fund.”
California alone will experience a $4.09 billion reduction in federal Medicaid spending over the 10-year period. These deficits will greatly impact rural areas, which tend to be home to high percentages of Medi-Cal and Medicare beneficiaries. With fewer people able to access their prescriptions or have them reimbursed, pharmacies could struggle to stay afloat.
The Rural Health Transformation program is also a temporary solution to a persistent problem. Under the program’s terms, all program funds are required to be spent before Oct. 1, 2032. Once the money runs out, other legislation will be vital to the long-term future of rural health care.
If a new pharmacy opens on the south coast of Mendocino, its sustainability will demonstrate the efficacy of these new policies. An enduring business would signal the success of health care reform. For now, however, the south coast remains a pharmacy desert, leaving its residents driving for hours to fill needed prescriptions.