Local Pharmacists Fill in Rx Gaps as Big Brands Pull Out of Rural Areas

Bill Mather, a pharmacist in the small Iowa city of Greenfield, wanted to make sure his neighbors could get their prescriptions filled without long driving distances or long waits.

So, as major drugstore and canteen chains began to expand into rural markets, he sold his pharmacy in 2007 to Pamida, a company-owned grocery chain. department store Shopko, in the hope that it keeps his business afloat. Then, in 2019, when Shopko declared bankruptcy, closing more than 360 stores, he and another Shopko pharmacist helped open a new pharmacy for the city of about 2,000 people.

Across the country, pharmacists like Mather are filling the void left by large drugstore chains and large department stores with pharmacies withdrawing from small communities. In some areas, pharmacists who were laid off as major chains closed are now opening new pharmacies, often in the same locations. In other areas, pharmacy owners from neighboring towns are opening new branches. Without them, many communities would not have a pharmacy.

It has not been used in this way. Big stores like Shopko started actively entering the pharmacy market 30 years ago, in the hope that customers would fill their carts while the store filled their prescriptions. The big chains establish hubs in small towns by buying out independent pharmacies or kicking them out of business.

Pharmacist Rachel Hall helps customers at NuCara pharmacy in Greenfield, Iowa. When a Shopko store – and the last pharmacy in the city with about 2,000 residents – closed, patients had to scramble to find a place to buy medicine until NuCara opened. (Kathryn Gamble for KHN)

According to the Bureau of Labor Statistics, the number of pharmacists working in large stores amounted to more than 31,800 in 2012. But as online sales and delivery of consumer goods and prescription drugs increase, so do stores. big box row no reason to stay. By 2019, the number of professional pharmacists has dropped to less than 18,000. (The Bureau no longer reports numbers.)

“The big box stores come to increasingly small communities and, in essence, they outperform all the other pharmacies in the area,” says David Zgarrick, a professor of pharmacy at Northeastern University in Boston. “Now they are completely gone and with them are pharmacy services and everything else they offer. They have left a void in a lot of places like this.”

With recent CVS Health’s notification Given that it will close 300 stores a year over the next three years, more towns could lose another level of pharmacy: the big drugstore chains. CVS has yet to say which stores will close.

“We are looking at a number of factors when making these decisions, including local market dynamics, population shifts, store density and community needs are not being served. “In fact, reaching underserved populations has been a priority for all of us as we get through the pandemic, as is access to the tests and vaccines we have made available. grant”.

Kathleen Bashur, spokesperson for National Association of Drug Stores, says pharmacy chains of all types and sizes play an important role in meeting the health and wellness needs of communities across the country. “The decision to close a store is a difficult one,” she said.

Zgarrick attributes much of the drop in big-box pharmacies to Amazon and other online sellers reducing profits from their over-the-counter sales. In the past, large stores could see pharmacies as the losers and offset that revenue with sales of other items. Now, says Zgarrick, big stores have to ask tough questions about how they allocate their space: “’At the end of the day, how are we going to make the most money per square foot? Is it by having a pharmacy or by selling tires? ‘”

Nelson Lichtenstein, a history professor at the University of California-Santa Barbara, who annals Walmart’s Rise says major stores are constantly re-evaluating their store locations, closing less profitable stores and opening new stores where they think they have can make money.

“They just kept a slow pace,” he said.

Lichtenstein said that the cost of building a large store is about $ 10 million and such stores can generate $ 200 million in annual sales. Therefore, withdrawing from a location is not a big loss for a large company if revenue declines.

“So they’re going to close the stores and leave a town in ruins because Walmart has put the other guys out of business,” he said.

Walmart did not respond to questions about its closure.

When the Shopko big box store in Greenfield, Iowa, closed, the pharmacy’s records were sold to Walgreens 50 miles away, leaving the city’s roughly 2,000 residents with no easy way to get their medication. (Kathryn Gamble for KHN)

An increase in online selections for all types of items, spurred by people shopping from home during the covid-19 pandemic, has added pressure to large stores.

Adam Hartung, a business strategy consultant at Spark’s Partner. “They’re not going to say, ‘Oh, let’s get a prescription and, while we’re at it, walk through the store and look at the vacuum cleaner.” That doesn’t happen anymore.”

Hartung said the US retail market has a 40% surplus of stores compared to other countries and many large box stores are likely to close in the coming years.

But the closure presents an opportunity for regional chains or pharmacists willing to set up their own.

In Orofino, Idaho, the mayor, chamber of commerce and many residents appealed to pharmacist Rod Arnzen after Shopko withdrew. So Arnzen started delivering Orofino goods from his store 23 miles away in Kamiah. He then opened a branch in Orofino in the building left behind by the pharmacy that had previously sold his business to Shopko.

Andy Pottenger, who owns a pharmacy 45 miles away in Lewiston, Idaho, added a second pharmacy in Orofino, population about 3,000, after receiving hundreds of responses to an ad he posted in local newspapers to gauge interest.

“It was overwhelming,” he said. “That kind of reinforces the idea that we should do it.”

In Montana, Mike Matovich, a third-generation pharmacist, opened stores in Roundup and Hardin after Shopko closed there.

Matovich said of Roundup: “It’s a pretty good sized community and there’s a hospital and clinic in town,” and all of a sudden, people were driving 50 miles down the street to dump antibiotics on a kid. ill. ”

Matovich has seen what can happen when a rural community loses its only pharmacy.

“If there was a hospital clinic and a pharmacy there, they would work pretty well,” Matovich said. “Once you lose one or the other, the community starts to suffer because people start leaving for closer healthcare.”

For residents of Greenfield, Iowa, Shopko’s decision means they have to scramble. Shopko sold pharmacy records to Walgreens 50 miles away. Some turned to Hy-Vee grocery stores in the nearby Iowa cities of Atlantic or Winterset, or to Walmart in Creston — each at least a half-hour drive away. Others switched to mail order.

Pharmacist Rachel Hall was seven months pregnant when she learned her owner, Shopko, had closed her large store in Greenfield, Iowa, leaving her without a job and a city without a pharmacy. (Kathryn Gamble for KHN)

“It was absolute chaos,” says former Shopko pharmacist Rachel Hall. “People are trying to figure out what to do, where they should send their prescriptions.”

Mather, Hall and the rest of Greenfield staff were notified just a week after being told they had nothing to worry about. Their pharmacy used to be one of the chain’s fastest growing locations.

“We actually had trophies from Shopko that we threw away when we left,” Hall said.

Former Shopko executives that KHN contacted declined requests for interviews. Shopko Optical, which operates in 11 states, said it is no longer affiliated with Shopko Stores in any way and declined to comment.

Mather and Hall didn’t want to give up Greenfield. They contacted NuCara, a chain with 30 retail pharmacies across 5 states, and it agreed to help them open a pharmacy in their city.

NuCara opened pharmacies in two other communities that Shopko had vacated. In the Minnesota cities of Cokato and Northern Branch, NuCara has partnered with pharmacists who previously sold their pharmacies to Shopko, said Brett Barker, NuCara’s vice president of pharmacy operations.

In Greenfield, Hall and Mather are prohibited from telling customers about the new NuCara pharmacy until Shopko officially closes. Hall said Shopko management wants to preserve the value of the customer base they are selling to Walgreens. So Hall and Mather asked the local chamber of commerce to release the information.

They found temporary space at the local hospital, which relocated the billing office to accommodate them. A year later, they moved back to their old location in the old Shopko building, leasing space from the new owners, who were running a homewares store there.

After serving three generations of Greenfield customers, Mather was relieved the town still had a pharmacy. But he couldn’t get over the way Shopko ended it all.

“The way they slam the door, I’m really not happy about that,” Mather said. “It’s not fair to everyone at the Greenfield pharmacy and the people in Greenfield. Shopko couldn’t care less. ”

However, this move gave Mather a full circle. Greenfield still has a pharmacy, just like when he started at Murdy Drug in 1968. It’s just another store, with a new name on the sign.

NuCara pharmacy in Greenfield, Iowa, moved into the former Shopko pharmacy space a year after the big-box chain Shopko closed stores there and all of its locations nationwide. (Kathryn Gamble for KHN)

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