Pharmacy Deserts, Rising Demand, and the Future of Pharmacy Access

00:00:01:05 - 00:00:23:06
Tom Haederle
Welcome to Advancing Health. At a time when reliance on lifesaving drugs plays a more important role than ever in patient care, nearly one third of America's pharmacies have closed since 2010. In today's podcast, we learn about one forward thinking health system is doing about it.

00:00:23:08 - 00:00:43:29
Chris DeRienzo, M.D.
Hi everyone, this is Dr. Chris DeRienzo. I am the chief physician executive for the American Hospital Association. Welcome to this episode of our Advancing Health podcast. You know, we haven't had a chance on this podcast to talk about the crucial role that pharmacies play in caring for people, for patients all across the country. But today is the day.

00:00:44:02 - 00:01:03:13
Chris DeRienzo, M.D.
I am very excited to welcome John Pastor. He is not only the president of Fairview Pharmacy Services, he is also a pharmacist himself. And I'm excited to welcome John to the podcast, because we have a lot of learning to do around pharmacies and the challenges that folks are facing with access in the country. So, John, welcome to the podcast.

00:01:03:16 - 00:01:05:16
John Pastor
Great. Thanks so much for having me.

00:01:05:19 - 00:01:18:01
Chris DeRienzo, M.D.
And Fairview actually is a health system who just won one of the AHA's most prestigious awards, the 2025 Foster McGaw Award. And John, thank you for joining us and congratulations.

00:01:18:03 - 00:01:31:17
John Pastor
Thanks so much. I can speak on behalf of Fairview Pharmacy Services and Fairview Health Services, and just say how proud we are to be the 2025 recipient of this award and what it means for us in serving our communities.

00:01:31:19 - 00:01:43:27
Chris DeRienzo, M.D.
You know, John, I wonder maybe we can start our conversation with just giving listeners a sense of the role that pharmacies play in the access continuum to care, and perhaps even locally, to you all up in Minnesota.

00:01:43:29 - 00:02:06:25
John Pastor
In some instances, the pharmacy is the first point of health care access for many people. It's the point of health care that they access most frequently, oftentimes more than they're seeing their primary or specialty care physicians, and certainly more than they're seeking hospital care in most cases. The concern is, is that we've seen pharmacies all across the country close at an alarming rate.

00:02:06:27 - 00:02:14:18
John Pastor
And so access is a challenge for many, even in some large urban and metropolitan areas, not just in our rural communities.

00:02:14:20 - 00:02:36:21
Chris DeRienzo, M.D.
You know, you're exactly right. There are some numbers around that that between 2010 and 2021, nearly 30% of pharmacies around the country closed. And I spend a lot of my time on the road. And sometimes, you know, if you're visiting a small town in rural America, there might only be one pharmacy. And so if that closes, we're talking about not just access to care, but access to medications.

00:02:36:24 - 00:02:56:21
John Pastor
Yeah. That's correct. And I think in the state of Minnesota, we've seen that number be even higher for independent pharmacies, a little bit lower perhaps for our chain pharmacy partners. But that number is just alarming. And there's certain parts of the state where people may have to drive, you know, 40 or 50 or 60 miles to get to a pharmacy

00:02:56:21 - 00:02:58:04
John Pastor
in some cases.

00:02:58:06 - 00:03:12:19
Chris DeRienzo, M.D.
That's a multi-hour round trip just to get the prescription for your heart medicine or your neurologic medicine. And we know that with America's aging population, the number of Americans who are on one or more drugs only continues to go up.

00:03:12:21 - 00:03:34:11
John Pastor
Drug therapy continues to grow every year as more and more new, you know, medications are identified and approved by the FDA for use to treat conditions that in some cases couldn't be treated before. So drug therapy continues to increase, is sort of a mainstay of treating many, both acute as well as chronic diseases.

00:03:34:14 - 00:03:54:26
Chris DeRienzo, M.D.
You know, I'm a neonatologist and you couldn't be more right. There are things that we can treat today that the ten, 20, 30 years ago were not problems that we could help patients solve. But in order for the medication to work, first you've got to be able to take it. And again, this is a not only a national challenge, but one it sounds like that has been particularly acute

00:03:54:27 - 00:03:57:08
Chris DeRienzo, M.D.
where were you all are located up in Minnesota.

00:03:57:10 - 00:03:58:15
John Pastor
Yeah, that's correct.

00:03:58:17 - 00:04:09:08
Chris DeRienzo, M.D.
Well, tell us a little bit about the challenge that that specifically your health system faced. And, you know, where did you turn to try to begin solving that challenge for the communities that you serve?

00:04:09:10 - 00:04:41:24
John Pastor
Well, we started with, you know, pharmacy services in our system back as early as 1990, when we had our first retail pharmacy in Edina, Minnesota, and we were providing retail pharmacy services and home infusion services out of that pharmacy. But over the last 35 years, the business has grown and clearly has transformed quite some time ago from being, you know, a prescription dispensing business or a medication dispensing business to a provision of care and focused on outcomes business.

00:04:41:26 - 00:05:10:16
John Pastor
So not only has our volume grown over 35 years, but the scope of our work has grown exponentially in how we contribute to the care and the outcomes of patients. Frankly, we had to build a new, central services facility for our corporate pharmacy location, which houses many of our essential pharmacy functions, including our specialty and mail services pharmacy, our home infusion pharmacy, our compounding pharmacy, and our wholesale pharmacy.

00:05:10:18 - 00:05:17:05
John Pastor
Because that growth was occurring at such an alarming rate, we simply didn't have the space to continue to expand.

00:05:17:07 - 00:05:33:13
Chris DeRienzo, M.D.
That is a wide range of services that you're describing. You know, when I think of a pharmacy, it's I get a prescription from my doctor, I go to the pharmacy, it comes in a little orange, you know, pill bottle. And then and I bring it home. But you're describing what what sounds like a much broader range of services that your patients are needing.

00:05:33:13 - 00:05:36:15
Chris DeRienzo, M.D.
And it sounds like struggling to find access to elsewhere.

00:05:36:18 - 00:05:47:12
John Pastor
Correct. And what I didn't even include in those numbers is we have 26 retail pharmacies in our community, and we also provide the pharmacy services across our 11 hospital locations.

00:05:47:14 - 00:06:05:11
Chris DeRienzo, M.D.
Wow. So let me rewind for a second. You operate 26 retail pharmacies totally separate from the hospitals, and then you have the internal pharmacy as well that not only, I imagine provides the medications that hospitalized patients need, but then offer some connectivity to when they get discharged.

00:06:05:13 - 00:06:17:02
John Pastor
Correct. Correct. To the point of clarification, some of those retail pharmacies are actually located in our hospitals and serve as a discharge pharmacy, as well as a community pharmacy for people that live in the area.

00:06:17:04 - 00:06:26:17
Chris DeRienzo, M.D.
Fascinating. I haven't heard of this model being, you know, deployed at this level of scale too much around the country. What prompted you all to go down this road and how's it going?

00:06:26:19 - 00:06:49:08
John Pastor
Say it first, it's going very well. As I mentioned, we continue to grow from both a volume and a scope year over year. And that's in part just due to organic growth internally within our health system. But also as we talked about earlier, just the pressures in the community with access to pharmacy services from some of our, you know, other pharmacy partners out there.

00:06:49:10 - 00:07:00:11
John Pastor
But the growth has continued year over year, and we've had to continue to evolve and change our footprint and expand our footprint in many cases in order to meet the needs of our patients.

00:07:00:13 - 00:07:14:22
Chris DeRienzo, M.D.
And so when you're planning for those needs, because these kinds of physical plants, for lack of a better word for them, they don't just magically pop up overnight. You know, it takes a lot of planning and effort and logistics to make them happen.

00:07:14:24 - 00:07:40:17
John Pastor
The previous location that we were in from a central services facility we had been in since 2001, and I think we actually started with about 15,000ft². And by the time we started our move this fall to a new location, we were using at that original location about 105-110,000ft². So that's over the period of about 23 or so years.

00:07:40:19 - 00:07:59:20
John Pastor
The location we moved into, we built within tension based on our current and anticipated future needs. There's a 150,000 square foot facility, and we're using a little over 90% of it right now, with the rest of it being intentionally shelled out for strategic growth in the future.

00:07:59:22 - 00:08:06:15
Chris DeRienzo, M.D.
Goodness, you're already at 90% capacity within this brand new space that you've built.

00:08:06:18 - 00:08:20:17
John Pastor
And it's built again with intention. So it's built for efficiency and designed to make it convenient and accessible for patients that come here. But as well, our staff, who, you know, do a lot of work inside the four walls.

00:08:20:20 - 00:08:42:17
Chris DeRienzo, M.D.
We were talking about this a little bit earlier, that it's an interesting space for a health system to be in. When you're talking about, you know, sort of the core of hospital and even ambulatory services. Operating pharmacies at this scale, and the production needed to go into that is fairly unique. But you all obviously have a firm belief in why this is a space you need to be in.

00:08:42:19 - 00:09:14:12
John Pastor
We've learned over the years that it's important for us to provide all the pharmacy care for our patients. Keeping our health system patients within Fairview is very important from an outcome standpoint, a patient satisfaction standpoint, and frankly, it makes it easier for our providers to do their work, too. Our physicians and our advanced practice providers being able to, you know, have access to the records that our pharmacies keep, as well as us be able to see the records that they have in the electronic medical record.

00:09:14:14 - 00:09:33:13
Chris DeRienzo, M.D.
Well, I certainly worry that that I have had, you know, as a neonatologist, if you're discharging a baby home and they need to be on, you know, multiple medications, which frequently they're not on for the rest of their life. But if they're not taking it in those immediate months after discharge, it can be pretty challenging. But, getting access to the you know, was the prescription filled?

00:09:33:13 - 00:09:48:23
Chris DeRienzo, M.D.
Was it then dispensed? Are they taking it? Are they refilling it? That that can frequently be challenging to secure. You want to avoid that patient not being able to access this one medication that without it ultimately leads to them needing to be hospitalized again, right?

00:09:48:26 - 00:10:09:03
John Pastor
Yeah. And a great example I could give you is a physician discharging a patient from one of our hospitals can send a referral to our home infusion team. Maybe that individual needs antibiotics. Maybe they need I.V. or parenteral nutrition for some period of time. And they have access to all of the records that the pharmacy has in terms of progress

00:10:09:03 - 00:10:25:27
John Pastor
notes - notes that the nurse who goes into the home and completes the infusion would put into the record. And so that type of I'll call it seamless care for the patient, but as well as our providers too, being able to have that level of seamless sort of transition is important.

00:10:26:00 - 00:10:39:03
Chris DeRienzo, M.D.
Well, obviously y'all have done an enormous amount of work to build this program and to serve the community the way you are. Looking through the windshield, where do you see your efforts continuing to go over the next several years?

00:10:39:06 - 00:11:02:26
John Pastor
I think our primary focus over the next several years is to continue to build in processes that we can automate. And by that, I mean we've already done a really good job, I think, automating our dispensing process at our new facility. We have some state of the art equipment. More importantly, we have a lot of, I'll say, kind of behind the scenes functions that need help with even further automation.

00:11:02:26 - 00:11:22:20
John Pastor
So our, you know, our business office, our revenue cycle team that manage that. Folks that do prior authorizations with our payers and insurance companies, many of those things we need to continue to further automate to make it more efficient so we can handle the growth and the volume that we expect to continue to get.

00:11:22:23 - 00:11:43:06
Chris DeRienzo, M.D.
Yeah, I mean, it sounds like a demand that isn't going down anytime soon. And recognizing that a lot of our listeners are folks who are operators in hospitals today. What one piece of advice would you give to them when they're looking at the needs of their community? They're saying, man, what the folks at Fairview are doing to close this pharmacy gap makes a lot of sense to us.

00:11:43:11 - 00:11:51:17
Chris DeRienzo, M.D.
But I want to learn more. What would be your first point of reference for folks to learn more about how they might could bring a similar service to their community?

00:11:51:19 - 00:12:20:21
John Pastor
Yeah, that's a great question. I think first and foremost, you know, making sure you're meeting the needs internally for your internal patients, right?
Make sure you're able to capture and provide all the pharmacy services that your internal health system or hospital patients need. But then, doing a community assessment. What's the unmet need in your community? Where are those pharmacy deserts as they describe where people just don't have access to a community pharmacy?

00:12:20:23 - 00:12:49:01
John Pastor
And I'll add one other layer to that is where people don't have access to a specialty pharmacy or home infusion or infusion services. Those gaps exist, too. And frankly, we fill a lot of specialty medications for patients outside of our health system. From the specialty pharmacy standpoint, it's nearly half of our prescription volume comes from external to our own health system, much of it locally, but actually across all 50 states in the US.

00:12:49:04 - 00:12:50:06
Chris DeRienzo, M.D.
All 50 states.

00:12:50:13 - 00:12:52:00
John Pastor
All 50 states, yup.

00:12:52:03 - 00:13:10:27
Chris DeRienzo, M.D.
You heard it here first, folks. Up in Minnesota, they are serving the folks in Alaska and Hawaii. That is fascinating. Well, John, this has been a real privilege again, thank you for helping me and our listeners learn more about the role that access to pharmacy and pharmacy services plays in the community. Congratulations on everything that y'all are doing.

00:13:11:01 - 00:13:14:08
Chris DeRienzo, M.D.
We can't wait to stay tuned and hear how it keeps going.

00:13:14:11 - 00:13:17:24
John Pastor
Well, thanks so much for having me on. It's been great talking with you today.

00:13:17:27 - 00:13:19:07
Chris DeRienzo, M.D.
Thanks so much.

00:13:19:09 - 00:13:27:21
Tom Haederle
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