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Iowa has a critical shortage of rural pharmacies needed for COVID-19 vaccination

Linh Ta
Iowa Capital Dispatch

Leslie Herron, owner of Sumpter Pharmacy in Adel, has done everything she can to prepare for the expected demand in COVID-19 vaccines next year.

She purchased digital data recorders to monitor her fridges. She hired an additional person dedicated to COVID-19 testing and eventually, immunization.

She ordered a carport, a covered structure that provides rain and snow protection to vehicles. They’re typically against Adel’s city ordinance, but a special exception was made so pharmacists and technicians could provide COVID-19 testing and immunization in people’s cars, Herron said.

For Herron and rural pharmacists across the state, helping immunize people from COVID-19 in 2021 will be one of the biggest feats of their lifetime. But it also comes when small-town pharmacies like Herron’s have struggled for more than a decade to stay afloat.

“Rural areas that don’t have good access to health care or as good as more populated areas, typically what they do have, if they have access to anything it’s going to be a pharmacy. In rural areas, it’s going to be an independent pharmacy as opposed to a big chain,” Herron said.

There are 350 pharmacies that have already signed up to help with vaccine distribution once it opens to the general public, said Kate Gainer, executive vice president of the Iowa Pharmacy Association.

Though there are no specific numbers, Gainer said they will need to add staff to meet both the immunization demands, while also maintaining everyday operations.

But the number of independent pharmacists and rural stores in Iowa have been trending down since 1996, according to the Iowa Pharmacy Tracking System.

At the same time, the number of communities without at least one pharmacist has also steadily decreased.

Since 1996, there’s been a 56% decrease in independent pharmacists, dropping from 693 to 306 in 2018, according to the tracking system. The number of communities with at least one pharmacy also dropped by 12%.

In the last two years alone, about 40 pharmacies closed, Gainer said.

At the crux of the issue is reduced reimbursement levels and pharmacy benefit managers who have been accused of driving independent pharmacies out of business, Gainer said.

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Rural pharmacies also face the same financial challenges other businesses do in these areas — more people are moving away, while fewer people are coming in. There’s also a shortage of licensed workers moving into these areas.

“Unfortunately, some communities in the state have lost their only community pharmacy provider,” Gainer said.

But as Iowans prepare to receive immunizations next year, rural access to pharmacies will be accentuated, particularly since people are easily able to come in and out and are able to get an education.

The demand for vaccines will be high, Herron said.

Herron, who offers rapid antigen testing, already has people drive five to six hours for a test. She’s seen patients come all the way from Wisconsin or Spencer, Iowa.

State Rep. John Forbes, D-Urbandale, owns a Medicap Pharmacy in Urbandale.

When there was the H1N1 epidemic in 2009, Forbes said people lined up outside his store to get a flu shot. They administered 200 shots a day.

“With COVID, I think it’s going to be a much greater demand,” Forbes said.

Cheri Schmidt, director of clinical pharmacy for GRX Holdings, which owns Medicap pharmacies in central Iowa, said she believes there are enough rural pharmacists to meet COVID-19 vaccine demands next year. Schmidt said they may need to collaborate with each other or be willing to adapt like changing their hours of operation to meet increased demands.

For independent pharmacies to stay open, however, she said regulations dealing with pharmacy benefit managers need to change. These “middlemen” in the pharmacy industry process prescription drug claims and reimburse pharmacies. Some of their reimbursement rates benefit larger corporations like CVS/Caremark however, which owns its own PBM and mail-order services.

A Supreme Court ruling earlier this month may change that, however. The court upheld states’ ability to regulate PBMs, according to USA Today.

“We really need to fix this so we can keep our rural pharmacies in business,” Schmidt said. “I think the people who are there are committed to keeping their pharmacies in their communities.”

Find this story at Iowa Capital Dispatch, which is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: kobradovich@iowacapitaldispatch.com.