Bridging the Healthcare Gap in Rural Virginia—One Community Pharmacy at a Time

On a balmy spring morning, a middle-aged woman pulled her red pick-up truck to the Rite Aid drive through in Craigsville, Virginia. While discussing a prescription, Dr. Ryan Minnich, 29, also let her know that she was overdue for a vaccine booster.

“I can mix that up right now. Would you like to come in and get that squared away?” he asked. Within minutes, the woman had her prescription in hand and booster complete.

Minnich helped to open a small footprint 3000-square foot Rite Aid in Craigsville, population 900, in November 2022. The town is nestled in the Shenandoah Valley’s Augusta County, on the western edge of Virginia. Minnich has practiced in larger, suburban pharmacies but prefers his new set-up, which allows him to “build a better patient-pharmacist relationship and really dive into each patient's health concerns. At first, the town’s people can be a little hesitant, but once you show them you actually care—that they can trust you with everything—they listen to your recommendations.”

Before the Rite Aid opened, his patients had to travel far—with high fuel prices—to the next larger town to get the care they needed, said Minnich, who received his Doctor of Pharmacy degree from Shenandoah University. “There is also no immediate access to doctors or healthcare providers, so patients struggled to find someone whom they could quickly ask questions that they could trust to have the knowledge to guide them in the right direction.”

More than sixty-five percent of primary care shortage areas are in rural communities, according to the Rural Health Information Hub, and the Government Accountability Office reports that 101 hospitals in rural areas closed from January 2013 through February 2020. When hospitals close, the median distance rural Americans travel to access common health care services increases by about 20 miles. The reduced access and increased distance disproportionately impacts rural Americans and those with mobility problems, especially the 50% of seniors who experience transportation problems and the 68% of seniors who live alone.

For Augusta County resident James Ramsey, the pharmacy’s opening has been “wonderful.” He says he has been impressed by the attentive care he receives from Minnich.

“Ryan is wonderful to interact with,” Ramsey said. “He's knowledgeable about what he's got. I have one or two scripts that are very similar. And the first time he filled them, he said, ‘You're taking this one and this one, right?’ And he said, ‘You know, they do the same thing.’ Yeah, I did. But I said, “My doctor feels like the combination of the two is better for my particular situation than a double dose of one or the other.”

And the pharmacy fits the community, said Ramsey. “It feels like a business does that we as a community are used to. We're still in Appalachia, right? Where you were still used to the old country store mentality, at least to us older folks, where you knew the guy who was waiting on you…you had a rapport. I mean, you didn't necessarily go to each other's households for barbecue, but it wasn't just a faceless person on the phone, press-one-for-English- conversation, right?”

Nearly one in five individuals who live in a rural setting are 65 years or older, according to the National Rural Health Association. And one in three adults in rural America suffers from poor health, with nearly half managing at least one chronic condition, such as obesity, hypertension, or diabetes, per a study published in the American Journal of Pharmaceutical Education.

Those stats mirror those of Minnich’s patient population, which is largely more than 50 years old, with the main comorbidities of heart conditions and diabetes. “My patients typically have a low health literacy and limited income to afford name-brand or costly medications,” he said.

Kimberly Campbell, 27, is a certified pharmacy technician who assists Minnich and has worked in larger retail pharmacy settings. She’s also Craigsville born and raised, where everybody knows everybody, she said.

“A lot of folks are thanking us for being out here,” Campbell said. “I so enjoy really being able to interact with the patients and knowing we’re making a difference in their healthcare access.”

Rite Aid opened other small-format pharmacies in Greenville, about 40 minutes from Craigsville, and in Scottsville, which straddles Albemarle and Fluvanna counties, in April of this year. All three stores are part of a Rite Aid pilot program aimed at increasing access to pharmacy services in underserved communities in rural Virginia. Fluvanna County, for example, is experiencing an extreme shortage of primary care providers, with only six physicians to serve more than 26,000 residents, according to Surescripts data. And one third of Craigsville’s residents live in poverty.

“We are excited to introduce Rite Aid to these local Virginian communities and provide vital pharmacy services and healthcare much closer to home,” said Rite Aid Chief Pharmacy Officer Karen Staniforth. “Pharmacists play an important role within a community and can help customers understand their health conditions, stay adherent on their medications and vaccinations and provide over-the-counter product recommendations. Our local pharmacy teams look forward to becoming an integral part of these communities and serve as trusted care advisors and help our customers achieve whole health for life health.”  

Rite Aid is clearly on to something. According to a recent Surescripts report, nearly half of all U.S. counties, 3,233 in total, have too few primary care providers (PCPs), with just one PCP for every 1,500 people. By 2034, the U.S. may face a shortage of up to 124,000 physicians. Pharmacists have opportunities to fill gaps in primary care: 61% of counties with a relative PCP shortage also have a high or medium volume of retail pharmacies, an opportunity for pharmacists to address unmet needs in patient care—with many in rural areas of the Midwest and South.

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U.S. Counties with Relative PCP Shortage

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Minnich also enjoys the opportunities to provide clinical care that his patients might not otherwise receive. “We’re already making life-changing alterations in people’s lives. We’re able to catch vaccinations that my patients need; we have time to do medication therapy management and improve adherence…we also counsel everybody on any medication. And if it’s a first fill, say for diabetes, we go a little deeper, saying ‘Hey, how often do you check your sugar? What’s it usually like?’”

Minnich accesses patient-specific health information through a robust software system. It enables him to electronically contact doctors for refill requests, prescription changes and electronic prior authorizations. The system also prioritizes patient health by showing vaccinations that may be appropriate for each patient based on age and disease state – functionality Minnich said he used with the patient who arrived for a refill and left with a booster.

“So, when you first got here, the woman that had pulled up in a pickup is a great example. I saw that she was due for a few shots, so I said, ‘Hey, do you need a pneumonia shot? My system says you’re due for one.’ And then I just talked with her about it. She then shared, ‘Oh, I need my second shingles shot as well.’ The system really helps to identify the patients and get them into the pharmacy for the care they need.”

Just nine miles down the road in the town of Goshen, Craigsville resident Glenna Lawhorn took a break from running her restaurant, BG’s 2. She said everyone she’s talked with has had a positive experience with the new Rite Aid, noting that she’s transferred all her prescriptions from a hospital 30 miles away.

“I was glad to hear that Rite Aid moved in,” said Lawhorn. “They make contact with you, like I called in a prescription today that I am trying to get transferred and Ryan called me saying that he was going to call the doctor to get the milligrams right. They’re personal.”

Crystal Burke, of Goshen, who was having lunch at the restaurant, has been impressed, as well. She’s had both her mother and daughter’s prescriptions transferred from a large chain store to the Craigsville Rite Aid. “I called Dr. Minnich and he called the store and transferred everything,” she said. “One prescription was slow to come in, so he gave my mother three-days’ worth. And he got the medication in the very next day.”

For his part, Minnich says he’s determined to fiercely advocate for what’s best for his patients, whether with their doctor or the insurance company. And he wants to build lasting connections with the people of Craigsville.

“Having the opportunity to care for the people of Craigsville means the world to me,” said Minnich. “To have a community that I can rally behind and who can take pride in me and the pharmacy is a treasure not many will ever get to experience.”

Pharmacists are well-positioned to fill gaps in care—if they can get the tools, information and support they need.

• Policy is already evolving to support pharmacists in delivering more clinical care. For example, almost every state has laws permitting collaborative practice agreements between physicians and pharmacists that allow pharmacists to provide clinical care.
• Reimbursement is seeing a shift toward value-based care models, which can align pharmacists and traditional PCPs to work as one care team.
• Enhanced technology is needed to support changing models of care and embrace interoperability. For example, systems must be able to exchange and use information easily and securely. Collaboration and communication tools must seamlessly bring providers together.