The pharmacy is often the last healthcare outpost left in small municipalities: where clinics, post offices and schools close, the green cross stays lit. But not everywhere. According to Ministry of Health data updated to 2026, Italy has 20,794 active pharmacies, distributed however far from uniformly: 7,258 municipalities have at least one pharmacy, which means around 638 Italian municipalities have none at all.
These are the so-called pharmacy deserts: territories, almost always small and mountainous, where collecting a medicine means travelling to the next town. In this analysis we look at pharmacy density per 10,000 inhabitants, municipality by municipality, discovering a geography that overturns expectations: the positive records are in micro-villages, the most striking gaps in some medium-sized cities.
The 10 municipalities with the most pharmacies per 10,000 inhabitants
Pharmacy density per population: the highest values in Italy
The small-village paradox
At the top of the density ranking there are no cities but tiny villages: Montegiordano, in the province of Cosenza, leads with 20.03 pharmacies per 10,000 inhabitants, followed by Santo Stefano in Aspromonte with 19.98 and Bolognano, near Pescara, with 19.94. The ranking also includes Liberi in the Caserta area, Crognaleto in the province of Teramo, Petrella Salto near Rieti and Radicofani in Tuscany.
The paradox is only apparent: in a municipality of 500 inhabitants, a single pharmacy produces a rate of 20 per 10,000. These record values are actually a sign that the rural pharmacy system works: Italy's planning system, which assigns pharmacy licences based on population but guarantees outposts even in minor centres, and the subsidies for rural pharmacies have kept alive businesses that the pure market would have closed long ago.
The 10 municipalities with the fewest pharmacies per 10,000 inhabitants
Pharmacy density per population: the lowest values among municipalities with at least one
The Sardinia case: the gaps are in medium-sized towns
The opposite ranking holds the real surprise: the least served municipalities are not remote hamlets but medium-large centres, and Sardinia dominates the list. Olbia is last in Italy with just 0.49 pharmacies per 10,000 inhabitants, followed by Arzachena with 0.74, Villacidro with 0.78, Carbonia with 0.79, Iglesias with 0.82 and Sant'Antioco with 0.96. Six of Italy's ten least served municipalities are Sardinian.
To these are added municipalities born from recent mergers, such as Figline e Incisa Valdarno in Tuscany, Terre del Reno and Valsamoggia in Emilia-Romagna: territories where the aggregated population grew faster than the adjustment of the pharmacy licensing plan. The case of Olbia, a city growing strongly both demographically and touristically, shows that the pharmacy desert is not only a mountain problem: it can also be supply lagging behind exploding demand.
Rome and Milan: the big numbers
In the metropolises the issue is not density but capillarity. The municipality of Rome counts 833 pharmacies, the highest absolute value in Italy, and Milan 428: relative to population that means roughly 3 pharmacies per 10,000 inhabitants, close to the average of urban centres, where the distance to the nearest pharmacy is measured in hundreds of metres rather than kilometres.
Why pharmacy deserts matter
For an elderly person without a car in a mountain municipality, the absence of a pharmacy means depending on someone for every therapy. The roughly 638 municipalities without a pharmacy are almost all centres below a thousand inhabitants, the same ones topping the fragility index: the map of pharmacy deserts overlaps with that of depopulation. Solutions exist, from pharmaceutical dispensaries to home delivery to service pharmacies, but they require seeing the pharmacy for what it is in small municipalities: an essential healthcare outpost, not a shop like any other.