RENVILLE -- Customers may walk in the doors expecting only to get their prescriptions filled, but they always carry out something more.
Dispensing advice along with the medicine is a way of doing business for Leah Seehusen, owner and pharmacist at Leah's Pharmacy in downtown Renville.
It's been this way ever since 1993, when three months after her graduation from the University of Minnesota's School of Pharmacy she realized a childhood dream. She opened her own store in a small, rural community.
"I've always wanted to be self-employed,'' said Seehusen.
A Redwood Falls native whose family later moved to Olivia, where she graduated from high school, Seehusen said she wanted to own a downtown business even before she wanted to be a pharmacist.
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"It's a wonderful way to combine a professional career with a retail business,'' said Seehusen.
Or, she will tell you these days, it used to be that way.
"I used to (enjoy it),'' said Seehusen. "I am so frustrated and burned out now. It is hard to see the joy in it."
It's also getting hard to see the future in it, a point she made last week to U.S. Senator Norm Coleman, R-Minn., at a health care forum in Montevideo. Seehusen told the senator that changes to Medicare -- the federal health insurance program serving mostly seniors -- have put independent pharmacists in rural communities in a fight for survival.
Seehusen acknowledges that some of the changes have benefited her patients. One customer cried when her new Medicare Part D prescription coverage plan meant that her cost to refill a prescription dropped from $150 to a $5 co-pay.
"I can eat more this month,'' Seehusen said the tearful customer told her.
Yet the change to more reliance on using third-party pharmacy benefit managers has hurt rural pharmacists, she said. Pharmacy benefit managers contract with pharmacists and set reimbursement rates for the prescriptions, as do private insurance providers.
The reimbursement rates paid to Leah's Pharmacy from third-party sources have declined steadily since she opened her business, Seehusen said. The reimbursement sometimes falls below her cost to fill some prescriptions. Under certain contracts, she is reimbursed no more than $3 for filling a prescription that many involve $150 worth of medicine.
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"It's an insult to my profession,'' she said.
Studies by the National Association of Pharmacists show that it costs pharmacists an average of over $8.50 to fill a prescription, when all the costs of operating their business are considered, according to Seehusen.
Blue Cross and Blue Shield is the biggest player. Seehusen does not like the reimbursements offered by the private insurer, but said that she and other rural pharmacists would be hard pressed to decline its contract. It represents a large portion of her customers.
Seehusen is a full-time pharmacist, yet also manages the store and its staff of four. Added to that is her role as a mother to two children, ages 5 and 10, and as a wife. Her husband, Paul, operates his own business in Renville's downtown, Guy's Technology.
She fills an average of 100 prescriptions per day, serving a customer base that includes over 4,000 names.
Her schedule is often hectic, but she said that the pace at the pharmacy counter is the right one. She makes it her practice to visit with customers and check that they are using their medicine properly.
Seehusen also encourages them to make the appropriate lifestyle changes. When a customer came to refill his cholesterol lowering medicine, he received her compliments. Her inquiries had led him to mention -- with a broad smile -- that he has been watching his diet.
The real question is whether the smile can return to the other side of the counter.
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Seehusen said it's now up to Congress to provide the prescription for what ails independent, rural pharmacists. She'd like to see legislation that sets a minimum reimbursement rate on prescriptions.
If Congress does not act, rural pharmacists will. Seehusen noted that she receives letters and calls every week from recruiters offering her jobs with large pharmacy chains. She can always find employment elsewhere, a possibility that grows more inviting with each new third-party contract she reluctantly signs.
"The stress level right now is so huge,'' said Seehusen. "I don't know. After so many years of fighting, sometimes you decide you've lost the battle and pull out.''
