Earlier this month, the Pharmacy Foundation of Oregon announced it was awarded more than $5 million from the Oregon Health Authority to expand pharmacy access in rural and frontier communities.
The need is particularly acute in Oregon. According to an analysis by AP in 2024 using data from the National Council for Prescription Drug Programs, Oregon has the second fewest retail pharmacies per capita in the nation. Pharmacy closures can be particularly hard for patients in rural areas who may have to drive hours to the next available pharmacy to fill their prescriptions.
To help this population, PFO will use the OHA funds to install secure lockers in Burns, Baker City, Gold Beach and other locations for patients to pick up their prescriptions. The nonprofit will also roll out a prescription delivery service staffed with a community health worker who is also a bilingual pharmacy technician to serve customers in Heppner, John Day, La Grande and other locations. PFO is also hoping to launch a telepharmacy service where a pharmacist would be available for video consultations with patients and would be able to remotely supervise a technician as medications are dispensed.
Brian Mayo is the executive director of the Oregon State Pharmacy Association and the Pharmacy Foundation of Oregon. Ann Murray is a pharmacist and the co-owner of Murray’s Drug, an independent, family-owned pharmacy with locations in Heppner, Condon and Boardman. Murray and Mayo join us to discuss the OHA grant and the challenges facing pharmacies and the rural communities they serve.
Note: The following transcript was transcribed using AI and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. According to a recent analysis by the Associated Press, Oregon has the second fewest retail pharmacies per capita in the country. Pharmacy closures can be particularly hard for people in rural areas. The Pharmacy Foundation of Oregon wants to change this. It announced earlier this month that it was awarded more than $5 million in state money to expand pharmacy access in rural communities. The new grant will be used to install secure prescription lockers, create a new delivery service, and launch a telepharmacy program.
Brian Mayo is the executive director of the Oregon State Pharmacy Association and the Pharmacy Foundation of Oregon. Ann Murray is a pharmacist and one of the owners of Murray’s Drug, which has locations in Heppner, Condon, and Boardman. They both join me now. It’s great to have both of you on Think Out Loud.
Ann Murray: Thank you.
Brian Mayo: Thank you, Dave.
Miller: Brian, I want to start with that stat I mentioned because it came from 2024, that stat saying that Oregon had the second fewest retail pharmacies per capita in the country. Is that still the case?
Mayo: That’s a great question because I haven’t seen an updated version of that. The only state that we trailed was Alaska at that point, but last year we had the Rite Aid closures that hit Oregon significantly, so we might be the worst state in the country at this point.
Miller: What’s driving these closures?
Mayo: It’s the reimbursement aspect that comes from the pharmacy benefit managers, usually known as PBMs. They’re a problem not only in Oregon but throughout the country, and we just haven’t passed the PBM legislation that’s effective to keep pharmacies open, and it’s affecting not only the independent pharmacies, but also the grocery stores and the chains.
Miller: Ann, can you describe Murray’s Drug?
Murray: Sure, my husband and I own Murray’s Drug, that’s a family business. His parents started it in 1959. We have two out of our five kids that are pharmacists, and our stores serve over a 3,000 square mile area from the Columbia River south to Lake Mitchell. We serve Morrow, Gillam, Wheeler, and Sherman counties too, because Wheeler and Sherman don’t have any pharmacies at all.
Miller: The entire counties have no pharmacies?
Murray: Correct. The town of Fossil is in Wheeler County and our Condon store serves those people. We deliver down there. In Boardman, we serve several towns that have no pharmacies. We serve Arlington, Irrigon, and Umatilla with delivery service right now. In our Heppner location, we take care of Lexington and Ione, and there’s outlying areas outside of those towns, the farmers, the ranchers, so it amounts to a really big area, yes.
Miller: What are the challenges of being a pharmacy owner in Oregon these days? Brian was talking about the closures just last year of Rite Aid, and we’ve talked before that about this shocking number, that the second fewest per capita retail pharmacies in the nation. What are the challenges for you as an operator?
Murray: Yes, reimbursement by the PBMs is the biggest driver of closures, not only of rural independents, but also of chains. For people that don’t understand PBMs, and they’re getting to understand them more, but they stand for pharmacy benefit managers. They started in the 1980s – and America was the only country that has PBMs – but basically, in a nutshell, they control the contracts to the pharmacy that reimburses or pays the pharmacy for the prescriptions that are dispensed. The patient may pay a co-pay. They don’t necessarily know what the drug really costs. The PBM, they say they’re gonna save the insurer money by controlling what drugs are covered, how much is paid, things like that.
But when we’re paid by the PBM below what it costs us to buy the medication, and when our dispensing costs, what it costs us overhead-wise to dispense, is about 15, and they’re paying like 0 to 10 cents, you can see quickly how you can’t stay open. And when pharmacies close, that means the other pharmacies that are left, like the chains, the bigger stores, their volume can double, but they can’t necessarily hire more staff because you’re losing on several prescriptions or many of them. So that equates to patients having long lines, long wait times for a new one, and it’s a dangerous situation for the atmosphere in the pharmacy. You can’t speak to the patient. You have to rush.
Those are the situations in the large chains that are left. But independents are getting fewer and fewer. There’s still some really, a few nice ones. You’re lucky to have them in the urban areas, Brooklyn and Milwaukie, Beaverton. There’s a couple in the Hollywood District like Fairley’s and Lecare and Bowman’s Hillsdale. But they mostly have gone out of business and even the chains, like Bi-Mart and Rite Aid, they have really caused problems for people, especially waiting long, long times to have a prescription filled, but the reimbursement is the main thing. When you can’t afford to buy those drugs and dispense them, you can’t stay open.
Miller: Brian, with these pharmacy benefit managers being a nationwide phenomenon, is this worse in Oregon?
Mayo: It is, unfortunately, because the laws that we have in place aren’t reining in the PBMs like they are in other states. Other states are having much more success being able to pass laws to provide for pharmacies to stay open and also for new ones to open. That’s the other thing, is that without having PBM reform done in Oregon, we’re going to continue to see more pharmacies close. So we are at a point where we’re grateful to have this funding from the Oregon Health Authority to be able to put a band-aid over the pharmacy patient access problem at this point, but we’ve got to do PBM reform to put some laws on the books to keep the pharmacies open and be able to allow those college graduates that are coming out to open new pharmacies as well.
Miller: All right, so let’s turn to, as you say, the band-aid here, and I’m sure we will talk again about the larger context for what’s causing this, the PBMs and the efforts at PBM reform. But Brian, so this is over a $5 million state grant from the Oregon Health Authority, and as I understand it, the money will go to three different programs or initiatives. One of them have been called prescription lockers. So what are these?
Mayo: Basically, it’s a safety deposit box that your prescription medication is placed in by a critical access pharmacy and you can go and pick it up 24 hours a day depending on what the hours are for the location that it’s placed in. With the locker, the ones that we’re getting have a main unit, but it also has a refrigerated unit so that those folks who need drugs that need to have temperature controls like insulin have that availability. And then the console has a screen and a phone on it so that you can have a consultation with the pharmacist directly there while you’re picking up your prescription medications.
Miller: Ann, my understanding is that you’ve actually, along with your husband, put in one of these lockers in Fossil, a place that does not have a pharmacy. Can you describe how it’s been working there?
Murray: Yes, it’s good. It’s great. It’s in the Asher clinic, which is an FQHC clinic, a federally qualified clinic. It works great because we fill the prescriptions, we deliver them down there. We put them in a certain box, and the patient gets a text or an email with a code, and they go in and they type in their code, the box will open. And if it’s a new one, they can pick up the phone and speak to our pharmacist. We’re not 24 hours a day. It’s indoors inside of a clinic, so it’s dependent upon the hours there, but they’re a great clinic. They are open every day of the week, not weekends, but Monday through Friday.
Miller: How many people are being served by this locker?
Murray: Well, we also are delivering some to the homes. So, we deliver a lot of prescriptions. Probably, I’d say 30 to 40 prescriptions can get delivered down there. Some go directly to the home delivery, but the locker is nice for the people that live out of town. And in our home deliveries that we do, we only do it when the patient is home. We don’t leave them or anything, so that can be limiting too. So it’s very convenient for people that live out of town or they are not home at a certain time that we come down.
Miller: So, Brian, as I understand it, there is a sort of pilot program in Fossil that Ann has been a part of. How much will you be able to expand that? How many more prescription lockers will be going into various parts of Oregon through this grant?
Mayo: So it’s a two-year grant and over that period of time we’re going to be able to add an additional 24 lockers throughout Oregon. We’re going to look at all areas that are rural and frontier for replacing them: Eastern Oregon, the coastline, Southern Oregon, everywhere to help out those patients that are experiencing those pharmacy access issues.
Miller: Another piece of this grant is a kind of beefed up version of prescription delivery. Can you describe the model that you have in mind?
Mayo: Yes. The Murray’s have had a successful program with the deliveries from a grant with the Roundhouse Foundation, and in our grant application to OHA, we said we wanted to take this model and expand it so that we could do one of the other locations for the Murray’s and then also an additional five throughout Oregon. But the delivery, it’ll be a purchase of a delivery vehicle and it will be manned or staffed by a person that’s a community health worker. So when they’re making those deliveries to the person’s homes, it will help the seniors with aging in place and be able to offer those resources that a community health worker can can provide like resources for Meals on Wheels, questions regarding financing, transportation issues, all those types of elements that come from the experience of a community health worker.
Miller: Community health worker and a pharmacy tech or the community health worker sort of will be doing double duty?
Mayo: They’ll be doing double duty.
Miller: But it does seem like you’re talking about a more robust community health intervention than just, say, making sure that people have access to blood pressure medication. You’re talking about checking up on people and doing a little bit of an in-person check-in to see how they’re doing. How is this model financially sustainable going forward?
Mayo: So thankfully, the Rural Health Transformation Project grant funding is going to be able to to help us make that purchase for the vehicles, but then also provide a salary for those community health workers for two years. This is part of a five-year grant process. So we hope to continue to receive funds in future years once we sow the success of it to help pay for those salaries.
Miller: Ann, what have you learned from doing deliveries over the last decade?
Murray: Oh, we, for example, a quote we had at one of our Boardman patients, “It was life-changing.” A lot of those patients we delivered to, they really can’t afford the gas. It’s so expensive now anyway, to go into the town of Hermiston, say. They just really, really appreciate it. Also, some of them may be able to drive, they don’t have the time to wait in line and all that. And we’re able to deliver pretty much the same day. If they’re called in and before noon, we oftentimes can get them out. Although Boardman starts earlier, cause we go to Arlington first, and then we go to Irrigon and Umatilla. But really quite quickly.
But just having the local store there, I mean, access to an in-person pharmacist is just invaluable. That’s why when PBMs force their patients to get it in the mail, I mean, mail order is forced on people. That means they can’t go to our pharmacy. And we get a lot of people coming in saying, I didn’t get it in the mail. Can you help me out? I’m completely out, or my insulin is sitting out in this heat, and I don’t think it’s working correctly.
So, not just reimbursement with PBMs, but they force people to use their pharmacies and they own them. It’s called vertical integration. They own the whole gamut, so they’re controlling where the business is. That’s why so many pharmacies have closed too, taken away our business. But the delivery is really, really, it took off during COVID because everyone needed it so much, even though we had started before COVID, but it’s really been popular. We also have bilingual staff. And in our Boardman location, we have many patients that are not English-speaking. So that’s been really important.
Miller: I’m interested in your take on the shortcomings of mail delivery, whether it’s USPS or UPS or FedEx, just because what you’re describing here is, especially if it’s going to involve a community health worker, it’s a much more robust, but I also think a more expensive way to deliver medicine than existing delivery models. So how much slack can safely be taken up by prescription by mail? I mean, it’s a very common thing for people getting all kinds of prescriptions every day by mail already all over the country. Why can’t that do a lot of this work?
Murray: Mail order is wasteful for one thing. It’s wasteful for the people buying it like the companies that have the insurance, because they often times send 90 days when the patient stops it, changes it. They don’t have the interaction with their local pharmacist to get questions. So, if you don’t take your medication correctly or if you don’t get it at all, you end up in the hospital and that increases overall healthcare costs also. As far as the community health worker, we’ll see how that goes. I mean, but any help at all, getting a delivery vehicle, which is huge, or helping pay for the expensive gas.
I mean, that is the number one most important, the healthcare worker would be great. It would be icing on the cake. But getting it delivered, I mean, is a lot faster than you can get it in the mail or Amazon’s trying to get involved, things like that. Mail is bad out here. If we have to mail something from Heppner, it goes to Portland first, and then a lot of times it’s getting lost. It goes to like Iowa, San Francisco, because some of the places that we can’t deliver to, like our Heppner patients, some of them out of town, if we mail it, it gets lost a lot of the times and it takes like 10 days to two weeks. And our patients sometimes get mail three days a week delivered out here.
Miller: Brian, I want to turn to one more program that will be funded through this grant, telepharmacy expansion. How will this work?
Mayo: So currently Oregon only has one telepharmacy in the state and it’s located in Vernonia, but it’s operated with the Beaverton Pharmacy. So what a telepharmacy is, is a physical location that has a pharmacy technician working in it that’s able to be there on site to help dispense medications to the patients, but it’s overseen by a pharmacist that’s in a different location, in this case, Beaverton Pharmacy. So the pharmacist is there to be able to supervise the technician and have the consultations with the patients as they come in to pick up their prescriptions.
So because of this model only being in one other location, we’re taking it and want to expand it to another area to help out rural communities. So with this grant, we were very fortunate that all three projects were funded and we’ll be able to take the data from these projects and be able to determine what’s going to be best for the future as we continue with this five-year program with the Rural Health Transformation Project to determine different rural and frontier communities that could use a certain resource, whether that is the telepharmacy, the delivery vehicles with the community health workers, or a pharmacy locker.
Miller: Brian and Ann, thanks very much.
Murray: You’re welcome.
Mayo: Thank you.
Murray: Thanks for having us.
Miller: Brian Mayo is the executive director of the Oregon State Pharmacy Association and the Pharmacy Foundation of Oregon. Ann Murray is a pharmacist and one of the co-owners of Murray’s Drug.
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