Basin Pharmacy fills more than prescriptions in rural northern Wyoming. It鈥檚 also the for the town of about 1,300 people and the surrounding area.
It sells catheters, colostomy supplies and diabetic testing strips. The storage room contains things that people rely on to survive, such as a dozen boxes of food for patients who must 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, five hours away by car, for .
Pharmacist Craig Jones makes house calls when no one else can, answers his phone at all hours of the night and stops to chat about bowel movements at church. Yet Jones keeps a pile of his own paychecks on a desk in the back of his pharmacy. Four months鈥� worth, uncashed.
鈥淓very year, it鈥檚 a little worse,鈥� Jones said of the financial pressures on his business.
Rural pharmacies, independent or chain, can be a . The staff knows everyone鈥檚 names and drugs, answers questions about residents鈥� mail-order prescriptions or can spot the signs of serious illness.
But rural pharmacies鈥� business models face unrelenting pressures to the point that sometimes they have to close. Several largely rural states have some of 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 closest pharmacy to Basin Pharmacy is eight miles away in Greybull, and Jones and two other pharmacists opened it after the chain that ran its predecessor went bankrupt.
EFFECTS OF A CLOSURE
When a pharmacy does close in a rural area, communities feel the absence.
In Herscher, Illinois, news came out of nowhere that the CVS would shut down in early March.
Mayor Shannon Sweeney met with CVS representatives and asked them to delay the closure for his village of 1,500 that's 80 miles south of Chicago, but he said the company told him the front of the store was not making enough money.
Pharmacy access 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 directly answer a question about what financial issues led to the store closure.
Tammy McLearen came to the CVS twice a month to pick up medications for her blood pressure and cholesterol on her way to and from work near Kankakee.
She moved her prescriptions to the CVS near work because she doesn鈥檛 want to get them through the mail; her village isn鈥檛 a top priority for snow removal in the winter 鈥� and her late husband鈥檚 heart medications would often get lost in the mail.
鈥淲e鈥檙e losing convenience, a staple,鈥� she said of the pharmacy, which was part of a small statewide chain before CVS bought it in 2017. 鈥淚 hope another pharmacy goes in here.鈥�
Sweeney said that鈥檚 his goal 鈥� preferably an independent one. But in the months since the closure, two promising leads have dried up, leaving the them 鈥渄ead in the water,鈥� he said.
FINANCIAL PRESSURES
Four of Wyoming鈥檚 independent pharmacies closed last year, said Melinda Carroll, legislative director of the state鈥檚 pharmacy association. Two more, one independent and one chain, closed so far this year.
Jones plans to hold out in Basin. He owns two other businesses there 鈥� a caf茅 next to the pharmacy and a grocery store, for which he cashed in some of his retirement accounts to keep it from closing.
But some 25% of the prescriptions he fills today are reimbursed for less than what he bought the medications for. Jones said he lost $30,000 between the beginning of the year and mid-May.
Hence, the uncashed checks.
鈥淚鈥檓 working for free a lot,鈥� he said. 鈥淎nd I don鈥檛 mind. I love to serve the community. But I kind of resent having to do that because of large corporations, huge pharmacy benefit managers, that are making millions of dollars a year.鈥�
, or PBMs, help employers and insurers decide which drugs are covered for millions of Americans.
And the lack of transparency around fees and low reimbursements from PBMs is one of the biggest financial pressures for rural pharmacies, said Delesha Carpenter of the University of North Carolina at Chapel Hill, who leads a research alliance of .
But Greg Lopes, a spokesman for the Pharmaceutical Care Management Association that represents PBMs, disputed PBMs鈥� role in closures and noted that some companies work with rural pharmacies to get higher reimbursements for drugs.
Jones came back to the Basin area after pharmacy school. His daughter Camilla would come into the pharmacy with him on Sundays and he鈥檇 quiz her on different medications.
She's now the president-elect of the state pharmacy association and helps run the Basin pharmacy.
鈥淲e鈥檝e definitely tried to do everything we can to run lean to find other options to try and make money to keep our doors open so we can continue to serve patients,鈥� Camilla Hancock said. 鈥淏ut when you鈥檙e working so hard and you鈥檙e trying your darndest to accomplish these things, and you just kind of get kicked in the gut over and over, it鈥檚 really disheartening.鈥�
If it weren鈥檛 for the 鈥渄evastating鈥� impact on his daughter鈥檚 future, Jones admitted, 鈥淚鈥檇 pack it in.鈥�
鈥淚 wish I could say I had this healthy, wonderful business I could hand off to my daughter,鈥� he said. 鈥淏ut I worry whether it鈥檚 even going to be worthwhile for her to take it over if we can鈥檛 make a profit on it or even pay our own wages.鈥�
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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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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
Devi Shastri, The Associated Press
