(calm music) >>You are likely to talk to your pharmacist and see them more than a medical provider.

They are actually the most trusted profession.

>>What we've lost over time was, remember your doctor was your local neighbor?

And so was your pharmacist.

And now it's all corporatized.

>>You know, when I first started as a pharmacist, someone come in and they didn't have the money, it was just they trusted you to be like, you know, just add a few dollars and just help 'em out.

But it's not like that anymore so... >>One thing that people struggle with is the cost of healthcare.

Not only for us as consumers of healthcare, but also providers of healthcare, in particular our community health systems.

>>It's a struggle with the way the system is set up here in the United States.

Boots on the ground, primary care and local community pharmacies.

It is hard to break even.

>>There's a lot of space between the manufacturer who makes the pill, and then the end user who uses it.

So, a pill X that costs $10 to make, by the time it makes it to the end user may be 300.

>>We've seen people try to cut their prescriptions in half or take it every other day.

It's some of the high dollar medicines people really can't afford that these days.

>>We're talking about life or death.

And these are decisions in America you shouldn't have to make.

(woman speaking in Spanish) >>We wanna be healthy.

Why do we have to choose, do we wanna be healthy or do we wanna live?

>>To a large extent, the financials of pharmacy are hidden from the staff.

AWP, average wholesale price, in this one it says it's 567 bucks.

I paid 38.95 for it.

There's maybe 20 pharmacies in the country that operate the way we do.

The role of independent community pharmacies in the healthcare system in smaller towns, it's a big part of why we've had such success here.

>>Being a small community hospital allowed us to sort of get buy-in.

We couldn't do this by ourselves.

We could not have one of these neighborhood clinics by ourselves without the help of the community.

>>It started first with Dr.

Merrit and I taking a leather bag, right?

It's going to talk to people.

This is why we go into medicine.

This is why we do what we do.

>>We're just like a normal pharmacy, but just a little extra.

This is a job that I wanted.

This is what pharmacy should be.

(calm music) ♪ In the heart land ♪ ♪ We rely on ourselves and one another ♪ ♪ Hand in hand we must stand ♪ ♪ In the heart land ♪ >>Production funding for "Life in The Heart Land" was provided by the Chrisman Family Foundation, and by... >>All right, good luck.

That's the fourth prescription that's over $500 so far this morning.

(calm music) Public thinks because they walk in and they pay a $600 copay for a brand drug, the pharmacy must be making out like bandits.

Almost all the cases nowadays, the pharmacy is likely losing money on that transaction.

>>We are actually paying more for medications than we're getting reimbursed, so we are losing money on prescriptions now.

>>Thanks Penny.

>>That is a medication used to keep prostate cancer at bay.

Standard retail price for this drug at the most common chain pharmacy in the country, it was $20,000.

So, you walk in, you've gone to your doctor, tell 'em your name, they bring your bag over, and they say, "Okay, it's going to be $996 so that you don't have a recurrence of your cancer this month."

This costs me $75.

This box.

Right?

Doesn't seem fair, does it?

Yeah.

So, where does that money go?

The fault lies almost entirely with insurance companies and chain pharmacies.

(calm music) (metal clanging) (calm music) (air whooshing) >>What we have is a real problem with the pricing of these drugs in the marketplace.

There are pharmacy benefit managers, PBMs, that actually dictate costs.

(calm music) (air whooshing) They're acting as the middleman between the manufacturer, the creator, and the end user.

(calm music) (air whooshing) And that's driving up prices for prescription drugs enormously.

(calm music) >>Almost all insurance company contracts are one-sided.

Pharmacies don't get to say, "Your payment's not good enough, we're not taking that."

(calm music) >>There are only four independent pharmacies in our 2,500 square mile service area.

Four.

(calm music) I am the CEO of Tri-Area Community Health.

We're a community health center in Southwest Virginia.

>>This is me getting my hair fixed.

She was from the city, so she made us a country pharmacy.

(calm music) I was born and raised here in Laurel Fork.

I grew up here all my life and I feel like I was born to help people.

Here's Kirby and you pour pills under Kirby.

>>Community Health Centers are funded by the federal government.

There's about 1500 across the country to provide care to those who otherwise can't receive it.

(calm music) >>Our CEO, he had already mentioned this place as somewhere he had saw that really needed access to pharmacy and healthcare.

It's just a very rural town and like I said, there's only like 400 and I think 44 people in this town.

He just felt like it was a really good place that needed a community health center.

>>People don't know how to pronounce the word Fries.

It looks like Fries.

So, we say Fries in the winter, and fry in the summer.

When I first came it was very difficult to get a physician.

There used to be a facility just to see the doctor and sometimes she was in and sometimes not.

>>I guess we're ready.

>>Yeah, I guess.

>>It seems like just yesterday that we came together to welcome the Tri-Area Community Health Clinic to our town.

Today, we stand here to celebrate the opening of their new pharmacy, a much needed addition to our community.

>>What I often say is, we don't want people to have to choose between medications and milk.

She brought the big scissors.

Hey Sheila, can you do a 3, 2, 1.

>>3, 2, 1, cut.

(crowd applauding) >>Thank you so much.

Appreciate your support.

>>Pharmacy, I mean, love pharmacy, I love helping people, I love feeling like I make a difference.

And in the beginning it was like, you know, we were the most trusted profession, we were the go-to.

But I do think with the push for just revenue generating big pharma, those types of things has really changed profession.

If the pharmacists were allowed to be like it was 20 years ago, people would've a lot better health outcomes I think.

>>Do you know if she called our location or she called the Laurel Fork location?

>>The work that Tri-Area does in this area is very important.

It's nice to see, you know, that they opened up here in Fries, and now to add to pharmacy service, that's real important to the community so we think the pharmacy here will make a big difference.

>>I'm glad I got to finally meet you, put a name to a face.

>>You're not just patient 36, you are Zach who lives down the street and our children go to school together.

How are we gonna continue to help people?

How am I gonna continue to keep people employed?

The pharmaceutical companies wanna charge as much as they can.

The insurance companies wanna pay as little as they can and so we have to figure out how we can still take care of you.

>>It's tough, and I know for my staff, you know, they have questions for me a lot because they're like, "Okay, we submitted this medication to the insurance and they're paying us less than what we paid.

What do we do, you know?"

We can't really turn people away.

We can't say, you know, sorry, you know, we lost money on that.

But a lot of the community pharmacies are having to do that.

(calm music) >>This is the second largest county in Virginia.

Not counting us, there's two left in the county.

There used to be four independents just in Staunton.

But people would drop us the most random stuff.

These are neat, just these little ones but... Independent just means that it's not owned by a conglomerate.

I don't have to call a corporate and ask permission to give Mrs.

Smith a discount on a prescription.

You're not expect to be an expert at it, that's why my job is.

(laughs) All right, we'll talk to you as soon.

Yes ma'am.

The nickname for pharmacy, at least in North America, was the most accessible healthcare professional.

You don't usually make appointments to come into the pharmacy.

>>Beautiful.

>>Thank you too.

>>Trelegy is- >>Good morning y'all.

>>So, Trelegy comes in two primary strains, a 100 microgram and 200 microgram.

We treat pharmacy like you would treat any other retail business.

Wholesale costs on what we would pay for one of those inhalers is $638.

Wholesalers aren't the bad guys in my opinion.

There is negotiating room with them.

Certainly, big pharmaceutical manufacturers make billions of dollars a year and they're the driving force behind the high cost for brand drugs.

But brand drugs only make up a small percent of what's dispensed in the US.

>>I'm sorry, this is Lora, how can I help you?

>>Within the last three or four years, the percent of brand to generic drugs has changed dramatically.

So we thought, "Well, let's try for that 90 plus percent and see if we can make a go at it."

It's not pharmacy if you're not multitasking.

(calm music) (container thudding) We don't accept insurance.

The insurance company contracts have forced the pharmacies to jack the prices up because in that contract it says that we can't charge anyone else any less than what we would bill the insurance company.

That is why the cost of prescriptions in the United States stay high even though we have never had a larger number of medications available as a generic.

(capsules thudding) Like coordinator.

It's been a dream of ours to have a pharmacy for a couple of decades.

Every day we have customers come in, can't get in to see their doctor, they don't know if they should believe the things that people have brought in and had us take a look at.

>>Have a good weekend.

Y'all take it easy man.

>>There's a special place for community pharmacy in a small town.

We have given some space to local creatives and business owners.

We wouldn't be able to have done this model pharmacy without community support.

We're doing this in a way that is not supported by the industry.

You know, the industry's built around billing insurance, you know, and basically blind transactions .

There is one drug out there that can do the same thing that has a generic, the drug's called Pradaxa.

Shouldn't have even left the office with that script.

>>All right, let me... Just one second to get you to the pharmacist so that he can do the official approval on that, okay?

>>I don't talk about it a whole lot except for my family that I suffer from chronic pain.

It's messed up back.

I think it's put a lot of perspective on the innate suffering that is just life, right?

(laughs) (calm music) >>And watching my father fight cancer for 14 years was really a life changing moment for me.

One, it proved that life is fragile.

But two, what it really proved is, life is worth fighting for.

And that's the fight I wanna be in.

(calm music) Down here in Southside Virginia, people pay 36% more for their prescription drugs than they do in Staunton.

I understand the free market, I'm all for the free market, but a person who needs that drug is a captive audience.

Some of us on both the Democrat and Republican side who live and represent people in these rural areas really saw that we had a problem.

And so what we were creating was a pharmacy board made up of individuals and citizens of the Commonwealth of Virginia who don't have any bias or conflict of interest, non-legislators who would look at drug pricing and see where we could do better to make 'em more affordable or more accessible so that people in our areas, in our rural areas, were not overpaying for medication that they needed.

We have this opportunity, this honor and this obligation as legislators to actually put something together that's gonna change somebody's life.

(calm music) >>Senate Bill 274, Prescription Drug Affordability Board established drug cost affordability review report.

>>Two thirds of all Virginians have regularly are supposed to take prescription drugs.

And similar, two of every three Virginians worry they won't be able to afford their medicine this year.

>>We're gonna be spending money to set this up and we are not gonna see the benefits.

We all want lower prescription prices.

>>One of the reasons why these boards have not been as successful in other states is because they've been stripped of a lot of their power by some of the interests I want to keep prescription drug costs higher.

>>The question is, shall the bill pass in the enrolled forum notwithstanding the objections of the governor?

Those in favor of that motion will record their votes, aye.

Those opposed, no.

>>It seemed like a very common sense solution and a good start.

Not the finish, but a good start.

But yet got vetoed by our governor.

>>We can't educate Congress enough or the general assembly enough to offset what the pharmaceutical companies or the insurance companies can do.

In the United States, we're capitalistic society, and so their incentive is to make as much as they can, which again in a capitalistic society makes sense.

But from a human perspective, you get lost in that.

(calm music) (woman speaking in Spanish) >>If we don't provide this service, people are going to get really sick.

Bad things will happen and we can act on it now.

(calm music) (tractor revving) >>We realized through COVID that there were large segments of our population who did not have access to care.

(car revving) >>It's really far from a pharmacy, and really far from healthcare providers taking healthcare to people in a location that it was easier for them to get to made a lot more sense.

>>What you're gonna do is, you're gonna hold on to these- >>Okay >>and just show them to the nurse.

>>Okay.

>>So, a lot of people have said that, you know, I don't know what I would do if you all weren't here at this particular location.

(woman coughing) Vientitres (23).

(crowd chattering) >>As our healthcare system has changed, people don't get to see the same provider each time.

A lot of times they'll see a provider one time and then that person will be busy, they'll have to see somebody else in the clinic and it's really nice to be able to see the same provider over and over again 'cause that does build relationship and builds trust.

>>See y'all.

>>See you.

>>Thanks for coming too.

>>Of course.

>>I really like living here.

It's laid back and I wouldn't live in a city unless I had to of course.

(laughs) My ex-husband lives on Hankey Mountain and I go to his house all the time, take him hot pepper cheese and different stuff.

>>Oh, that's nice.

>>Make him apple pies.

>>Oh wow.

>>Well, so cold out.

That relational aspect of medicine is so imperative.

>>Get my blood pressure down.

>>Oh, you'll work on that, right?

This is a A1C machine.

It's a little temperamental with the temperature.

Just in our clinic alone, ER visits are down almost 20%, urgent care visits are down 40%, and hospitalizations are now 60%.

>>Darryl has a... >>Was at one time the largest buck killed in the state of Virginia.

He is a huge- >>Oh- >>Huge.

>>Wheeler over there.

>>Hi Kim.

>>Hi there.

How are you sir?

>>I'm ready Kim.

>>You're ready?

>>And then you can bring them in (indistinct).

>>Well, we've had 45 people register so far today, which is quite a lot considering we've only been open for just over an hour.

(speaking in Spanish) (calm music) >>Augusta Health is one of five remaining community owned health systems in the Commonwealth of Virginia.

The focus is community health and wellbeing and not maximizing profits.

Community hospitals were very common in the United States.

Many of them could no longer sustain their mission because of finances, because of losing their populations, the rural populations.

(calm music) I grew up in Monrovia, Liberia, and that is in West Africa.

My great grandmother was a practitioner of traditional medicine looking to nature to take care of those things that nature can take care of and respecting pharmacology when it is necessary.

We're trying to move away from focusing on providing care to the sick, to keeping people healthy.

>>Yeah, so this is the old Yoder Farmstead.

It used to be a dairy operation.

>>We have one and a quarter acres farm here on campus, what we call our Food FARMacy Program.

>>Access to healthy foods and, you know, proper nutrition are key in preventing these chronic diseases such as diabetes that's so widespread in our area.

(calm music) >>The American diet is severely lacking in fiber.

So, we focus on growing a lot of that so that we can meet that nutritional need.

It's one of those things nobody like comes to the hospital for fun.

Like I think everyone knows that.

>>Yeah.

>>So, by being able to offer a place that has respite, and like a purpose that is... It is preventative in the long run, but it is connecting so much more than just like a physical ailment.

>>It's a great stress reliever too to come and get your hands in the dirt and just kind of unplug.

(calm music) >>The system is in place.

There are health centers covering all of Virginia.

We're not unique, we're not special, we're part of a bigger system.

It's just a matter of making it work for us.

We need to fix the bigger healthcare system.

(calm music) >>Essentially providing a problem, the company to give.

>>Yeah, I bet.

>>A fair amount of the product away.

>>I'm still by myself today.

I have to scan these.

I started driving medicine in 2000.

My mom had a med for her lupus that was outrageous.

I mean it was like $400 just for one pill.

It's like you have to choose now whether you want your meds or you want your mortgage.

I am from North Carolina.

I'm so country and my mom is Vietnamese so I'm like Asian country.

(laughs) He's still sick.

He's on the phone right now.

>>Hey there, you're taking care of yourself.

>>Hey, Ms.

Donna.

>>You having chicken soup?

>>Yes ma'am.

There's so much that comes from just making a little sick stops bro.

And we deal with this medicine every day and, you know, it's so much more to a job.

>>Yeah.

>>Like we don't even know all the people that we helping by getting the medicine there early.

>>For me it was just job and money and numbers at first.

And then as I started going, I realized that people need this.

Here I am 1:30 in the morning driving an hour and a half away with diabetic socks.

And when you get there and you see the relief on the patient's face, you're like, "Wow, okay.

Yeah, I think I did make a difference."

(calm music) I wish they would get a hold of it so that everybody could feel like they are going to be taken care of regardless of their health situation 'cause I would be scared to get sick, you know, in a nation like this.

(calm music) >>You can't plan an illness.

It's always unplanned, and when you're in that situation where you're living paycheck to paycheck to begin with, and something happens and now you've gotta make life or death choices.

(calm music) >>I think the whole town was without power.

I'm not sure how many days it took him to get power.

>>Can you get to Laurel Fork?

>>No.

>>With the hurricane, everybody didn't get out.

>>Yeah, we had all of 'em scheduled that week didn't we?

>>Yeah.

(door thudding) >>And so you're saying the water came?

>>Yeah, it came all the way up to the (indistinct).

>>Everything else from my river lot.

We lost all that, trees fell on the camper.

The camper was flooded.

That was everything I had so... But the two neighbors on both sides, their campers went over the dam so they lost both campers and everything inside.

(river roaring) (calm music) >>How can we help each other either get through something?

As a community, that's a challenge.

Let's say with the weather incidents that are happening now, or a fire or something along those lines.

Or you're struggling with a health condition or you lost somebody and so now you need some support.

(calm music) >>How do we fix it?

How do we still make sure we're staying afloat?

If it was every script that we lost money on, then, you know, we wouldn't be able to be here.

>>It keeps me up at night to think about, you know, what could happen if we can't continue to provide the medication, the healthcare to people, it's, I'm gonna get emotional.

It's hard to think about.

It's just the right thing to do.

(calm music) (woman speaking in Spanish) (man speaking in Spanish) >>There are many people who are very interested in taking care of their neighbors and that's the good work that I hope that we continue to do, working together.

(calm music) >>We don't have to rip people off to make a profit.

We're ready for about now.

Thank you.

(calm music) The doctor's office will see in 12 to 20 patients a day.

You know, pharmacy's gonna see 200.

Independent pharmacy is still the lifeblood of pharmacy in many areas.

We're in places where chain pharmacy is, don't feel like there's enough profit, but we need to come back and be at the heart of healthcare in every community.

(calm music) >>All right, we're gonna be a dollar today.

(calm music) >>There's very few to compare it to, but there's more coming.

(laughs) Many more coming, I hope.

>>Okay, I'm gonna let you talk to the pharmacist.

Hold on just a minute.

(calm music) >>Production funding for "Life in The Heart Land" was provided by the Chrisman Family Foundation, and by... ♪ Babbling brook reminds us, flowing holy ♪ ♪ Plow the Earth and plant and weed ♪ ♪ Watch your children grow ♪ ♪ Day breaks into nightfall ♪ ♪ Soon we'll reap in all we've sow ♪ ♪ And who belongs ♪ ♪ Is it you, is it me ♪ ♪ Is there room ♪ ♪ For us in the heart of the land ♪ (calm music)