WELLMAN

When Washington County Hospital and Clinics announced its purchase of the medical clinic in Kalona last month, patients in Kalona may have breathed a sigh of relief, assured that they would continue to have easy access to health care. However, Kalona’s gain may be Wellman’s loss, as nurse practitioner Meagan Squires is moving her family practice from downtown Wellman to the Kalona clinic.

One imagines Squires’ patients will adapt by making the 15-minute drive one town over. However, Squires’ neighbor, Pharmacy on 8th, can’t pick up and relocate, nor does it want to.

Pharmacy on 8th and Wellman Family Practice aren’t connected businesses, although their proprietors are friends.

“We’re a totally separate entity,” Tess de Jesus-Roetlin, pharmacist and owner of Pharmacy on 8th, says. Patients may have seen her over at Wellman Family Practice because “sometimes when I needed them, I just went back there. We have a good relationship.”

But Wellman’s pharmacy isn’t going anywhere. Squires’ patients can continue to have their prescriptions sent electronically to Pharmacy on 8th, where they will be ready to pick up as usual.

“I’m hoping not much will change,” de Jesus-Roetlin confirms.

However, the pharmacist does see a health care gap looming for residents of Wellman in Squires’ absence, and she is taking steps to help fill it. She hopes to be able to offer point of care testing, which would allow the pharmacy to administer rapid tests for things like flu, strep, and Covid; provide and fill prescription medication (such as antibiotics) immediately; and inform a patient’s primary care provider of the diagnosis and treatment.

This may reduce the need for trips to a more distant quick-care clinic in the event of illness.

De Jesus-Roetlin already offers many of these tests, including the aforementioned flu, strep, and Covid, and as well as others, such as hormone tests. Customers can take the saliva and urine tests while at the pharmacy, which are then sent out to a lab overnight. Results are usually available the next day.

But feeling poorly is not the only reason one might come into the pharmacy to take a test. A quick, noninvasive assessment of something like antioxidant levels can provide a snapshot of general health; if levels are low, suggestions for diet, exercise, and stress reduction are available. One can then make changes and come back to be retested to measure their improvement. In this way, maintaining good health and preventing disease becomes more achievable.

“It’s like coaching them,” de Jesus-Roetlin says of her service.

She works with customers to figure out what works for them; for example, if more fruits and vegetables in one’s diet are recommended, but unlikely to be something one would eat, then the pharmacist can suggest a supplement instead.

“If you don’t like [fruits and vegetables], then there’s a pill that would replace a little bit of what you don’t have,” she says.

De Jesus-Roetlin is all for preventative and functional alternative medicine; she has been researching and recommending supplements since 2016. The pharmacy has a variety of supplements in stock, and what she doesn’t have, she is happy to order. She uses Fullscript’s extensive catalog of professional-grade supplements.

However, she also believes in prescription medication when one already has a condition needing treatment.

“You need your prescriptions because you already [have a condition] that cannot be reversed, it can just be modified,” she says. “People have to take their medication if they’re already on it, and then add the lifestyle changes so that it does not progress.”

Patients taking medications to manage diabetes or high blood pressure, for example, may not be able to stop taking them, but they do have the ability to make positive changes to improve their lives and keep their conditions in check. De Jesus-Roetlin wants to help her customers with this, and as a small-town pharmacist, she has the time to do so, unlike a big box or mail order pharmacy.

A personal interest in her customers is one of the things that set her apart from her larger, pharmacy-chain counterparts. She sees it as her purpose to help patients manage their medications by making sure their medications don’t interact with each other; by addressing any nutritional deficiencies they might cause; and by researching lower cost alternatives should price be an issue.

“[We’re] more caring,” she says. “It’s a bit beyond what you expect, but we’re here to help people get well.”

“But it’s really a struggle with those PBMs,” she adds.

PBM stands for Pharmacy Benefit Manager. These third parties play a key but hidden role in negotiating drug prices and reimbursements for insurance companies, employers, and health plans. They control which pharmacies are included in a prescription drug plan's preferred network, as well as how much the pharmacies will be paid.

Essentially, PBMs control which medications you get, where you get them, and how much you pay for them. And they profit from this, collecting discounts and rebates from drug manufacturers, and fees from pharmacies in exchange for inclusion in their preferred networks.

The situation is lose-lose for both patients and small, independent pharmacies like Pharmacy on 8th.

De Jesus-Roetlin gives an anecdote about a recent customer who was spending $400 a week on insurance that covers prescription drugs. The customer asked if the drug they were taking could be found cheaper as a generic. It turned out, the answer was yes. Much cheaper.

“It was 90 days for $13,” the pharmacist says. “Now he’s going, ‘Do I really need this insurance?’”

“So, where’s that money going?” she says. “I mean, we’re not benefiting from it.”

In all likelihood, some of it is going to PBMs.

PBMs have escaped government regulation for many decades. This legislative session, HF 2401 passed the Iowa House of Representatives, but did not continue through the Senate. The bill would have curbed the power of PBMs by prohibiting spread pricing, which allows PBMs to charge health insurers more than what they pay to pharmacies for medications.

For small towns like Wellman to keep their local pharmacies, residents may have to start pressuring their legislators to protect the pharmacies from PBMs.

Residents will also have to make a point of supporting places like Pharmacy on 8th themselves.

“We urge everybody to patronize or come in . . . to get their prescriptions, or over the counter [meds], or even the testing [we offer],” de Jesus-Roetlin says. “Because that’s the only way we’ll survive.”

Pharmacy on 8th is located at 221 8th Ave SE, Wellman. Hours are Monday – Friday, 9 a.m. to 5 p.m., Saturday 9 a.m. to noon. Contact them at 319-209-8188.