On The Cover
Loren Bonner
Jade Ranger, PharmD, and her husband Henry Ranger, PharmD, always joked about opening up a community pharmacy together. The husband-and-wife team met in pharmacy school. Then in 2019, they finally did it.
“We knew about all the issues running an independent pharmacy—the DIR fees, PBMs. It was certainly nerve-wracking and I was hesitant,” said Jade Ranger. “But it’s been a phenomenal journey.”
The Prescription Shoppe is located in Williamsburg, VA, and the majority of patients seen at the pharmacy are white, many over the age of 65.
“We don’t have to convince this population to get vaccinated,” she said.
In fact, the Prescription Shoppe is known as the place to go for vaccinations in the area, and it’s helped the Rangers stand apart and thrive as a small, independent pharmacy.
“Vaccines put us on the map,” said Jade Ranger. In 2019, when the Rangers first opened the pharmacy, the Shingrix vaccine was hard to come by, but they were able to get it in stock.
“Everyone was trying to get that vaccine,” she said. “Since we are not a franchise, we were able to get it, and then it became a word-of-mouth thing pretty quickly.” Patients outside of their community were coming to the Prescription Shoppe to get the Shingrix vaccine—some traveling from as far away as Florida and North Carolina.
“When the COVID vaccine came out at the beginning of this year, it really solidified our presence in the community because we were one of the first to get it,” she said.
Among 5 employees, they have administered over 5,000 COVID-19 shots since January 2021, when this story went to press. When they begin giving a third COVID-19 vaccine dose to patients upon its FDA approval, that number will only rise.
As Black business owners in a predominately white community, Jade Ranger said microaggressions have not been uncommon even though they feel embraced by their community overall.
As one example, some patients asked if they were a franchise.
“People are extremely surprised that we could do this,” she said.
In other instances, some patients questioned how they were able to get the Shingrix vaccine back in 2019 and felt the need to ask them if it was the most recent one.
Jade Ranger went back-and-forth last year about commenting on the death of George Floyd. In May 2020, she wrote a post about it on Facebook that went viral. In June 2020, the Virginia Gazette published her op-ed titled “A different life experience, based on skin color.” The piece was about living in a predominately white area as Black people and some of the precautions they have to take. When the Rangers had to stay at their pharmacy late into the night to finish up yearly inventory around the holidays last year, they called the non-emergency police line to let them know that they would be there after hours. The Rangers wanted to make sure they weren’t mistaken for intruders if a police officer happened to be patrolling the shopping center where the pharmacy is located.
“This was really eye-opening for this community to hear,” said Jade Ranger.
The feedback the Rangers received after the op-ed was published has been overwhelming.
“I got so many hand-written letters, even people coming to me in tears, saying they had no idea,” she said. They even received a letter from a two-star major general, retired from the U.S. Army.
The Rangers have also helped address vaccine hesitancy in the Black community when the COVID-19 vaccine became available. They partnered with local churches and spoke on panels addressing the topic. “You have to go the extra mile and make those connections,” said Jade Ranger.
“The message is that we are not asking you to do something we would not do ourselves, we look like you and we are trying to champion you,” she said.
The Prescription Shoppe is also a student pharmacist preceptor site for Hampton University School of Pharmacy in Hampton, VA. “There are students of color who say they have never seen a pharmacy owned by Black pharmacists and we want to experience that,” said Jade Ranger. “We keep those relationships with those students and support them—sometimes they reach back out to us for career and life advice.”
Your neighborhood pharmacy
From day one, the Rangers have envisioned the Prescription Shoppe as a “mom-and-pop” community pharmacy.
“We have branded ourselves as being a true community pharmacy,” she said. “We have always wanted to focus on genuine relationships with patients, to know patients by name.”
According to Jade Ranger, oftentimes it’s the extra personalized piece, like a hand-written sympathy card, that makes all the difference.
“From these relationships, we have seen [patients’] care improve,” said Jade Ranger.
Rural pharmacy experience opens up policy career path for this pharmacist
Monet Stanford, PharmD, always had an affinity toward public health, and quickly fell in love with pharmacy. “Pharmacy is legitimately in the public health arm of the health care system,” said Stanford. “Pharmacists see thousands of patients on a daily basis.”
While working at Fagen Pharmacy—a rural Indiana community pharmacy—during her community pharmacy practice residency at Purdue University, Stanford was pulled into the world of policy. “This pharmacy was doing such important work in the community, like seeing a broad range of specialty conditions, managing bioidentical hormone replacement therapies, and donating breast milk to HIV-positive women,” said Stanford. She saw how many regulatory hurdles they kept encountering, like drug pricing and practice barriers.
“I really felt like it was preventing the pharmacists from practicing at the top of their education,” said Stanford.
Stanford is now director of policy at the Association for Accessible Medicines. “You can’t do anything with your therapy unless you can access it,” said Stanford.
She said that during the COVID-19 pandemic in the United States, the one thing that remained consistent for Americans was access to medications. A March 2021 MedPac report backs this up.
As a pharmacist, Stanford believes she brings a unique perspective to a trade organization, especially as it relates to the patient experience.
“There are more and more opportunities in these types of roles for pharmacists and their voice is vital,” said Stanford.
In a superman costume, Mayank Amin is on a mission to vaccinate
Mayank Amin, PharmD, owns a small independent pharmacy in the Pennsylvania town where he grew up.
When the COVID-19 pandemic first hit, the pharmacy became the sanitizer plant in the area, soon after that, they were known as one of the few places a person in the Philadelphia area could find toilet paper.
But when Amin’s pharmacy, Skippack Pharmacy in Montgomery County, PA, was approved to receive and distribute the Pfizer vaccine in early 2021, his mission became even greater.
For the past several months, Amin has personally visited homebound patients to administer the COVID-19 vaccine, held small clinics, and helped organize mega-vaccination events, including one that took place at a local firehouse the weekend of Super Bowl Sunday, when a major snowstorm hit the Philadelphia region. He’s even vaccinated some patients at Skippack Pharmacy in the wee hours of the morning.
For one underserved community in Montgomery County, PA, Amin spoke with local leaders and found an organization to help set up a small clinic that was easy for people to walk to if they didn’t have transportation.
“This brought so many different people together, it even brought our communities together,” he said.
According to Amin, none of this would have been possible without the help of volunteers. He’s had over 1,000 people on his volunteer list, including a top cardiologist and a mother of 4 children under the age of 10 years old who was working as a full-time volunteer. Together, they have provided close to 50,000 vaccines.
“Everyone was so humbled and working toward a common goal: to get as many folks vaccinated as possible,” said Amin.
For those who know Amin, it’s not uncommon to see him donning a superman costume. Throughout the pandemic, he’s worn the costume even more regularly and can be seen wearing it at almost any vaccination event.
It not only uplifts people, according to Amin, he said he wants to honor the real superheroes during this time: all the frontline health care workers, and especially all the volunteers who have made vaccinations possible.
“On the last day of one of our clinics, there was a Reuter’s photographer who took my picture and gave it to an artist who made a mosaic of all the last names of the volunteers inside a picture of me with the cape,” said Amin.
Amin is overwhelmed when he thinks about the massive volunteer effort, people, and communities coming together. He never expected himself or his small independent pharmacy to play such a pivotal role in the pandemic.
Highest-ranking pharmacist elected to state office in the country is going after PBMs
Native Delawarean Kathleen McGuiness, RPh, went from owner of a small independent pharmacy in the city of Rehoboth Beach, DE, to Delaware State Auditor—a natural progression, in McGuiness’ words.
“Whether you are counting the exact number of pennies or pills, you are holding something accountable,” said McGuiness, who was elected in 2018 as the first female state auditor in Delaware. McGuiness is not only the first pharmacist to be Delaware State Auditor, she is also the highest-ranking pharmacist elected to state office in the country.
As the “fiscal watchdog,” McGuiness oversees the entire state of Delaware as an independent entity to make sure taxpayer dollars are being used correctly. Recently, she has been working to expose taxpayer waste through PBM misconduct. As pharmacists are well aware, PBMs serve as middlemen between insurance companies, pharmacies, and prescription drug manufacturers, and are supposed to compensate dispensing pharmacies fairly. Instead, they have added layers of secrecy and financial waste to the process through spread pricing, gag clauses, claw-backs, and rebate pumping. Independent pharmacies around the country are closing as a result of PBM wrongdoing.
In a June 2021 report, McGuiness’ office found that the state of Delaware overpaid PBMs for state employees’ prescription drugs by $24.5 million over a 3-year period.
“This is taxpayer money and we are not finished,” said McGuiness. “It’s merely scratching the surface.”
While there is some momentum on this front happening in other states as well, McGuiness said she thinks change needs to be initiated on the federal level.
“To have your community pharmacist gone is losing something crucial in your community,” said McGuiness. Health care providers and patients should not be the ones being harmed—there is no way to justify that, according to McGuiness.
As this story went to press, a bill in Delaware that addresses PBM reform was awaiting the governor’s signature.
The bill takes into consideration at least one of the recommendations from the June 2021 Delaware State Auditor’s report, said McGuiness. “We gave it some oxygen—or at least we hope we gave the legislation some oxygen—and we really hope something materializes.”
Federal pharmacist builds sustainable immunization program at IHS
CDR Carol Cummins, PharmD, saw an opportunity when COVID-19 vaccines started to roll out earlier this year.
As the assistant chief pharmacist at the Navajo Medical Center in Shiprock, NM, and the pharmacy technician supervisor, she started to see her pharmacy technicians taking on bigger tasks—something she had been focused on from day one.
She made some calls, and a partnership with APhA’s Pharmacy-Based Immunization Administration by Pharmacy Technicians program was born.
Through the program, the Indian Health Services (IHS) has been training IHS pharmacy technicians around the country from its Shiprock, NM, location.
IHS delivers training for all IHS pharmacy technicians, mostly through a virtual format.
CDR Cummins has been deliberate in advancing the role of pharmacy technicians within the medical center—even before the HHS directive, which granted pharmacy technicians the authority to immunize during the pandemic.
At the height of their COVID-19 vaccination efforts this spring, the medical center had a pharmacist and technician in the curbside setting the entire day.
Cummins said that allowing technicians to administer vaccinations gives pharmacists adequate time to counsel patients at the clinic or over the phone, as well as work with providers to deliver patients’ medications.
“Right now, the conversation has evolved from the COVID-19 vaccination to the low rates of childhood vaccinations,” said Cummins.
“We want to incorporate technicians into addressing that next.”
Cummins said that investing in a sustainable immunization program not only helps the community, but also gives pharmacy technicians at IHS—who are often hard to recruit—more incentive to stay.
Cincinnati pharmacist has her dream job
Sue Paul, RPh, recently pulled out a note written in 2014 when she was devising a business plan.
Part of it read: “A patient who understands their medication has better adherence and better outcomes, which equals a happier physician.”
“I described my ideal client,” said Paul, who works in a Cincinnati Federally Qualified Health Center (FQHC) 3 days a week alongside physicians as a provider.
Paul has her dream job. Working to help patients gain this understanding is what she does today. At the FQHC, she’s on the schedule and sees her own patients for 30-minute appointments.
“The best day is taking a patient off insulin, or any medication, because they are following our recommendations,” said Paul. “And then having the doctors appreciate it.”
One physician she works with said she couldn’t practice any other way.
“Pharmacists’ skillsets are needed,” said Paul, who is founder of SyneRxgy Consulting, a non-dispensing concierge pharmacy.
Paul mostly educates patients about their medications and adjusts the prescriptions based on their responses.
For instance, a patient Paul recently saw complained that her suboxone was wearing off too quickly. Paul asked the patient how she was taking the medication and she responded that she was swallowing 2 tablets a day in the morning.
When Paul informed her that she needed to let the tablets sit under her tongue and dissolve, the patient said she couldn’t stand the taste.
Paul spoke with the patient more, and a decision was made to switch over to Zubsolv sublingual tablets. The change was discussed with the physician onsite and the prescription was immediately sent over to the pharmacy.
While Paul acknowledged that making care plan decisions, documenting the plan, and then presenting it to the provider might be new for pharmacists, she said it is certainly within their skillset.
“Pharmacists have the knowledge to do this, they just need the confidence,” said Paul.
She notices that student pharmacists who come into the FQHC on rotation point out how new it is for them to run an appointment.
“It’s definitely a different patient interaction, especially [regarding] documentation and coming up with a plan,” said Paul.
Paul wasn’t taught this skillset, but picked it up as she went. She worked most of her career in nursing homes and often thought to herself that if pharmacists had gotten to these patients before they needed this level of care, they may not need to be here.
After 16 years as a consultant for nursing homes while simultaneously working in an independent pharmacy, Paul moved on to hospital pharmacy and saw the same disjointed medication issues with patients. She decided it was time to start her own business to truly help improve patient care.
“If there is a problem or gap in health care where you can make a difference, that is an opportunity to create a business,” said Paul.
Paul has been working at the FQHC since 2016. During this time, she has also incorporated pharmacogenomics testing into patient care.
They have performed over 1,000 tests, primarily for patients taking medications for mental health issues.
“I think of it like a blood glucose machine—it’s just a tool,” said Paul, who is also co-founder of PGx101, a certificate training program in pharmacogenomics for pharmacists.
The FQHC recently gave Paul the go-ahead to hire another pharmacist. “There is so much work for us to do,” she said.