COLFAX, Iowa — An Iowa pharmacy that has served its community for 120 years is foreseeing its closure if reforms aren’t passed on a state level.

Last year, 31 pharmacies in Iowa closed as a result of corrupt practices by pharmacy benefit managers (PBMs), or the middlemen between pharmacies and insurance companies.

PBMs determine the total drug costs for insurers, shape patients’ access to medications, and determine how much pharmacies are paid.

Several Iowa pharmacy owners have voiced concerns over the last year against PBMs because they are not being reimbursed at fair rates. PBMs often pay pharmacies less money than it costs for the pharmacy to purchase drugs and distribute prescriptions.

This was the case for an Oskaloosa pharmacy that foresaw its closure and a Minden pharmacy that closed its doors in 2024.

Now, owners of a pharmacy in Jasper County announced that they are hanging by a thread.

The Spring City Pharmacy is located in the heart of the downtown square in Colfax. It attracts residents to the square, providing more business to other local shops.

Not only is it a pharmacy, but it’s also a store. Many people stop by for ice cream or to get pop from the old-fashioned soda fountain.

“This pharmacy is basically the hub of our community,” said Nancy Earles, a lifetime resident of Colfax.

The roughly 2,200 residents are now on the verge of losing their only pharmacy.

“When you’re filling prescriptions for less than you buy them for, you can’t even pay the light bill let alone the pharmacist or the tax or buy the labels on the bottles to fill the prescriptions,” said owner Brad Magg.

The pharmacy has been a community staple since 1905. For 110 years, it was owned by a local family, until they sold it to an out-of-state company in 2015. That company closed the pharmacy three years ago.

In an attempt to save the town pharmacy, three locals with no experience in running a pharmacy, including Magg, put their own resources into keeping it open.

“We knew that we weren’t going to make money and that we would be fighting an uphill battle, but we were ready to put in the elbow grease and the work to make it work. Our goal was to break even. Never did we imagine that we would lose so much money. The more scripts we fill, the more we lose.”

Magg said pharmacy struggles with PBMs have been a secret for a long time.

“There’s gag clauses in a lot of the contracts, and for years, pharmacists weren’t even allowed to tell their patients how bad it was. So, we fully didn’t understand how bad it could be,” he said.

In the last three years, Spring City Pharmacy has lost over $100,000 in just negative prescription reimbursements alone.

Brittney Van Houwelling is the pharmacist who works there full-time and one of the co-owners. She graduated from Drake University’s School of Pharmacy in 2016 and has worked at Spring City Pharmacy since. Under the previous owner, she was never exposed to the business side of pharmacy, so she was shocked when she realized the reality of being a pharmacy owner.

“I want to be a pharmacist. I don’t want to have to worry if I fill a prescription for someone if we can handle that financially as a business. That shouldn’t be something that’s even on my mind,” she said.

The thought of closing the pharmacy brought her to tears simply because of the impact that their closure will have on patients in the town she grew up in.

“Some of them can’t leave the town. They can barely make it here. They rely on us to deliver it to them, so it makes it a lot harder for them. They may not get the care that they need,” she said.

Spring City Pharmacy is the only independently owned pharmacy in Jasper County. If it closes, the nearest pharmacy will be 15 miles away.

Residents like Earles are concerned for their access to healthcare.

According to Magg, there were seven practitioners in town around 15 years ago, but the last doctor’s office in town closed five years ago. As a result, the pharmacy is the community’s only source of health care.

“Residents, a lot of them, treat us like a doctor’s office. They come asking Brittney the pharmacist for advice,” said Magg.

Van Houwelling’s main concern is for her elderly patients who live alone. She’s worried they will need to relocate to nursing homes or other communities without easy access to their pharmacy.

While mail prescription services are now an option, residents still want to access their local pharmacies.

“I come here and I get flu shots. I’m not getting that by mail-order,” said Colfax resident John Borts. “When young people invest in a beautiful store like this, I mean this is an awesome store, we deserve the opportunity to enjoy it.”

House File 852, a bill aimed at reforming practices, has seen support in the Iowa House of Representatives. The bill would require PBMs to reimburse pharmacies their cost and enable patients to choose the pharmacy they want to receive care from.

The House placed the bill on its unfinished business calendar ahead of last week’s funnel deadline. This ensured that the bill would still remain under consideration this session.

However, pharmacy owners like Magg are starting to lose hope because a similar bill died in session last year.

“We really thought this bill would pass last year and be our saving grace. We scraped by to this point, but at this point, if there’s no light at the end of the tunnel, we can’t scrape by anymore,” he said.

If the bill doesn’t pass this session, Spring City Pharmacy will close its doors indefinitely in six to eight weeks after serving Colfax residents for 120 years.