Rural pharmacies fill a health care gap in the US. Owners say it’s getting harder to stay open
Basin Pharmacy fills over prescriptions in rural Northern Wyoming. It is also the main access point for healthcare for the city with approximately 1,300 inhabitants and the surrounding area.
It sells catheters, colostomy supplies and diabetes test strips. The storage room contains items people rely on to survive, such as a dozen boxes of food for patients who have to eat through tubes. The pharmacy fills prescriptions in bulk for the county jail, state retirement center and youth group homes. Some patients come from Jackson, a five-hour drive away the specialized services.
Pharmacist Craig Jones makes house calls when no one else can, answers his phone all night and talks about bowel movements in church. Still, Jones keeps a stack of his own paychecks on a desk in the back of his pharmacy. Four months’ worth, uncollected.
“Every year it gets a little bit worse,” Jones said of the financial strain on his company.
National pharmacies, independent or chain, can provide a touchstone for their community. The staff knows everyone’s names and medications, answers questions about residents’ mail-order prescriptions or can spot signs of serious illness.
But rural pharmacies’ business models face relentless pressure so great that they sometimes have to close. Several largely rural states have the lowest number of pharmacies per zip code, according to an AP analysis of data from 49 states and the National Council for Prescription Drug Programs.
The nearest pharmacy to Basin Pharmacy is eight miles away in Greybull, and Jones and two other pharmacists opened it after the department store chain that his predecessor ran went bankrupt.
When a pharmacy closes in a rural area, communities feel its absence.
In Herscher, Illinois, news came out of the blue that the CVS would close in early March.
Mayor Shannon Sweeney met with CVS representatives and asked them to delay the closure of his village of 1,500 residents, located 80 miles south of Chicago, but he said the company told him the front of the store didn’t make enough money.
Access to pharmacies is an important consideration, CVS spokesman Matt Blanchette told The Associated Press, but the company also weighs local market dynamics, population shifts and the number of stores in the area selling similar products. He confirmed the meeting with Sweeney but did not immediately answer a question about what financial issues led to the store closure.
Tammy McLearen came to CVS twice a month to pick up medications for her blood pressure and cholesterol on her way to and from work near Kankakee.
She has moved her prescriptions to the CVS near her work because she doesn’t want to receive them in the mail; her village isn’t a top priority for winter snow removal — and her late husband’s heart medications often got lost in the mail.
“We are losing convenience, a key component,” she said of the pharmacy, which was part of a small statewide chain before CVS bought it in 2017. “I hope there will be another pharmacy here.”
Sweeney said this is his goal – preferably an independent one. But in the months since the closure, two promising leads have dried up, leaving them “dead in the water,” he said.
Four of Wyoming’s independent pharmacies closed last year, said Melinda Carroll, legislative director of the state pharmacy association. Two more, one independent and one chain, have closed so far this year.
Jones plans to hold his ground in Basin. He has two other businesses there: a cafe next to the pharmacy and a grocery store, for which he cashed in some of his retirement accounts to keep it from closing.
But about 25% of the prescriptions he fills today are reimbursed for less than what he bought the drugs for. Jones said he lost $30,000 between the beginning of the year and mid-May.
Hence the uncashed checks.
“I work for free a lot,” he said. “And I don’t mind that. I love serving the community. But I kind of resent having to do that because of big corporations and big pharmacy benefit managers that make millions of dollars a year.”
Pharmacy benefits managersor PBMs, help employers and insurers decide which medications are covered for millions of Americans.
And the lack of transparency around reimbursement and low reimbursement is one of the biggest financial pressures on rural pharmacies, says Delesha Carpenter of the University of North Carolina at Chapel Hill, who leads a research alliance of more than 140 national pharmacies and seven universities.
But Greg Lopes, a spokesman for the Pharmaceutical Care Management Association, which represents PBMs, disputed PBMs’ role in closures, noting that some companies are working with rural pharmacies to get higher reimbursement for drugs.
Jones came back to the Basin area after pharmacy school. His daughter Camilla came with him to the pharmacy on Sunday and he questioned her about various medications.
She is now the president-elect of the state pharmacy association and helps run the Basin Pharmacy.
“We have definitely tried to do everything we can to continue to operate lean and find other options to make money to keep our doors open so we can continue to serve patients,” Camilla Hancock said. “But when you work so hard and try your hardest to achieve these things, and you keep getting kicked in the gut, it’s really discouraging.”
If it weren’t for the “devastating” impact on his daughter’s future, Jones admitted: “I’d put it in.”
“I wish I could say I had this healthy, wonderful business that I could pass on to my daughter,” he said. “But I worry whether it will be worth it for her to take over if we can’t make a profit or even pay our own wages.”
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Associated Press data journalist Kasturi Pananjady in Philadelphia contributed to this report. Shastri reported from Herscher, Illinois.
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