Q&A: How Pharmacists Can Make a Difference Beyond the Counter

In the wake of the COVID-19 pandemic, the Prescription Shoppe demonstrated community commitment by actively combating misinformation and maintaining patient care. Jade Ranger, co-owner and pharmacist at the Prescription Shoppe, discusses the increased social media presence and partnering with the Virginia Department of Health to debunk myths to educate the public about vaccines, while also participating in local news campaigns to spread accurate information.

Despite facing substantial financial challenges from pharmacy benefit managers (PBMs) and DIR fees, the pharmacy remained focused on patient-centered care. By offering innovative services like compounding and point-of-care testing, and maintaining strong community engagement, the Prescription Shoppe has positioned itself as more than just a medication dispensary, but as a critical health care provider that goes "#MakingADifferenceBeyondTheCounter" through personalized patient interactions and proactive health advocacy.

Jade Ranger, co-owner and pharmacist of the Prescription Shoppe, discusses how her pharmacy put patients first during the COVID-19 pandemic. | Image Credit: Halfpoint | stock.adobe.com

Drug Topics: How did you adapt your patient counseling and education strategies during the pandemic, especially with the influx of information and misinformation?

Jade Ranger, PharmD: We were very active on social media at that time. That really, kind of, I think, it was a time frame in which, while we had been somewhat active on social media, it increased significantly because we were constantly trying to get the word out, constantly trying to get information out, making sure that we were posting things that was accurate, that had been vetted, that was from the CDC and reliable sources. We also participated in a few; the Virginia Department of Health here, they did kind of their own campaign commercials that they were putting out, and they invited us to participate in that, and it was called Myth Busters, and we were talking about some of the misinformation that was out there, and trying to correct that information. Additionally, we actually were featured on several local news stations here within the Hampton Roads area in which we were kind of interviewed about the misinformation, and kind of helping to try to get the word out, so that we were able to educate patients on the importance of the vaccine, and if we want to return to a state of normalcy, this is the fastest way to do it, but we need patients to be on board and work with us as a partnership.

Drug Topics: What are the biggest opportunities and challenges you see for independent pharmacies in the post-pandemic landscape?

Ranger: Well, the biggest, I think, challenge by far, it's still going to be, the PBMs and the DIR fees. That has only gotten worse through the season, unfortunately. So, to give you an example of that, in the previous year, in 2024, we did 10,000 more prescriptions than we did in 2023. So obviously that's way more work. Obviously you have to increase staff, but unfortunately, our sales was almost a quarter million dollars less than 2023, so trying to put that into your perspective, and trying to just manage the books, we're a booming business. We do extremely well, very popular, well received, well supported in the Williamsburg, greater Williamsburg area. But you're still behind the scenes trying to make payroll because you have to hire additional people to keep that same level of patient care.

So that is something, I think, that we have seen across the board, and not just for community independent pharmacies, but even the big boxes of the world. That's why you see Walgreens closing 1200 stores and CVS closing. So that is going to always be, I think, at this point, the number one challenge. The good news is that, you know, we are still fighting legislatively. With the Virginia Pharmacy Association, with the National Community Pharmacist Association, American Pharmacists Association, everyone is on the same page legislatively of what we need to do to increase that transparency to overall help us as it relates to not just better reimbursements, but actually, not taking so many losses. I think that's a lot of the misinformation out that surrounds that specific top where a lot of people think that we're complaining because we want better reimbursements, when in fact, we're just trying to break even and not take losses, and so that is something that we have seen increase significantly from where we were when we first opened in 2019, 2020 to 2025 right now is that change in the structure of DIR fees and how that has negatively impacted our business, and we saw a lot of that, specifically in 2024.

Drug Topics: How do you think independent pharmacies can continue to play a vital role in community health and patient care in the future?

Ranger: I think we have to continue to do what we've always done, which is engage with our community. My favorite hashtag to put on social media is #MakingADifferenceBeyondTheCounter. Yes, you come in, yes, you can see your pharmacist behind the counter, and we can be playing a part in the dispensing and verification all of your prescriptions. But we're so much more than that. We're not just robots back there. We are advocating on behalf of our patients. We are checking drug interactions. We are checking contraindications. We are calling and following up with [physician's] offices. When we see that there's an issue, maybe in therapy or dose needs to be changed. But then also, we're working hand-in-hand with our patients, because that trust in that relationship is there, right? Like our patients see their primary care providers maybe once or twice a year. I see some of my patients on a weekly basis because they just stop by and they're picking up something over the counter. But we actually know each other, and so we're able to help them on their overall health care journey, and so as that relates to things like, I had a patient who was consistently complaining about [gastrointestional] issues, stomach issues, couldn't figure out the issue. Turned out, in regular conversation, I discovered, 'oh, he's taking a NSAID, Advil, every day on empty stomach in the morning, and that was causing him issues with his stomach.' In that conversation, I was able to give him better advice. He made that adjustment, and he comes back a couple weeks later. He's like, 'Oh my gosh, that made a huge difference.' And so just little things like that, you're able to really impact your patients lives on a day-to-day basis, and so, I think we have to keep that part at the forefront, reminding people of the valuable role that we play on any health care team because [physicians] have a semester of pharmacology; we have 4 years of it, so this truly is our specialty, and so we are able to bring that type of value to patients overall, which ultimately helps the overall health outcomes.

Drug Topics: Do you have any recommendations for policy changes or support systems that would help independent pharmacies better serve their communities?

Ranger: I would say, for sure, definitely being active within your associations, and I know that is something that, across the board, a lot of our national organizations have talked about seeing such a decrease in membership numbers, people not really finding the value in it anymore, not wanting to pay the memberships. But what my husband and I have found at the Prescription Shoppe is it actually provides a network of support because whether I am tapping into a pharmacist that is in the Pennsylvania area or California that I've met at a conference, I'm able to use them now as a resource, and so an example of this is we opened another pharmacy in September 2023 that is a closed-door, long-term care pharmacy. We were able to tap into a pharmacist in the Pennsylvania area that we had developed a relationship with, where that was her specialty. She gave us a significant amount of mentorship and guidance, and so just having those people that you are able to tap into, to give you that additional support that maybe can answer questions for you, help you bounce ideas off, is incredibly beneficial. Because when you're in places of trying to figure out, okay, what can I do in my business to make sure that A. we're still financially viable that but that we have longevity in our community, so we're able to still bring that same level of care. You need that additional support, so I highly recommend having memberships in the National Community Pharmacists Association, having memberships with your local state association, but then also with your chamber of commerce as well. There's value in that. We work very closely, have great relationships with the Greater Williamsburg Chamber of Commerce. They have supported us significantly through the pandemic. They advertise on our behalf, consistently recognizing us for different awards, which is always getting our name out there in the community, and showing that we are a trusted resource, and so through these different memberships, I think we have specifically seen the benefit for ourselves at the Prescription Shoppe, and I always encourage other pharmacists to do that as well.

Drug Topics: Is there anything else you would like to add?

Ranger: A last thought would just be always thinking about how you can serve your community, but your specific patient population. My husband and I have a business on the side called Ranger Consulting, and with that, we talk to pharmacists who are interested in opening their own community pharmacies, and the first thing that we start telling them is, what is your community lacking? How can you fill the gap? And that is going to change based on the community. But I think it's really important that you don't paint that with a broad stroke because our patients needs can be different, and once you are able to identify how you can specifically serve your community, it's really important that you do that and you capitalize on those opportunities, while also trying to make sure that what you're doing is profitable for your business. So, an example of that is compounding. For us, that is something that has been extremely beneficial, that is not something that we have to worry about DIR fees because we don't bill insurances for, but it is something that is mutually beneficial for us and the patient because now that is something we don't have to worry about the clawbacks as it relates to PBMs and DIR fees, but it is something that we're able to make a profit on, and while also for our patients, if you have patients that need a certain medication that is not commercially available under certain formulation, we're able to fill that gap for them. So that is something where it helps our business, but it still helps the patient. As it relates to point-of-care testing, that's something that we've incorporated into our business. We had done that even previously, prior to COVID, but it has really increased since COVID where we offer rapid strep and flu testing. That is a cash price. People come in, they pay those $20 for those tests. If the results come back positive, we are then able to give them the appropriate therapy. If they have insurance, we will bill it through their insurance. If not, they'll pay a cash price for that as well. So just finding ways that you can try to make sure that financially you still have stability, but still by being a resource and serving your community at the same time.