EAGLE GROVE, Iowa — It’s a story heard across the state: pharmacies are struggling to keep their doors open, and communities are losing access to healthcare.

The latest community that’s fearful for their local pharmacy’s future is Eagle Grove, a town in Wright County about an hour and a half north of Des Moines with a population of around 3,500 people.

Residents say the Eagle Grove Pharmacy is more than just a pharmacy.

Pharmacist Mickey Cooper’s husband, Tom, originally owned a carpet store in the town’s downtown square. In 1984, they converted the store into a pharmacy so Mickey could work for herself. At the time, it allowed her to care for her children and work at the same time.

“We started with a typewriter, no computers, and just us,” she said.

Now, over 40 years later, the pharmacy has grown to be a community staple, and Mickey Cooper is a well-known figure within a 30-40 mile radius. Her impact goes beyond the four walls of the pharmacy.

“Mickey probably saved my husband’s life not too many years ago,” said Colleen Bartlett, a lifetime Eagle Grove resident. “It was a graduation weekend. We were getting ready to go to some graduations. Bob didn’t feel well, and I didn’t know what to do… so I called Mickey.”

Mickey advised Colleen and Bob Bartlett to stop what they were doing and go to the hospital. When they arrived, they found out Bob was having a heart attack.

“I’m really blessed, truly blessed that we had Mickey. Otherwise, I wouldn’t have known. I probably would’ve been home and I wouldn’t be here today,” said Bob.

But, if you ask Mickey, she’s not a heroine.

“I don’t think about it much because to me it’s my job. It’s just what you do,” she said, holding back tears.

According to Mickey, anyone in the same position would do the same, but small-town pharmacies have more of these kinds of stories.

“It’s not that other people don’t get those things, but I don’t think they’re as available as we are,” she said. “We’re very available. You can stop us anytime. I get stopped at the grocery store a lot.”

Four years ago, Mickey sold the pharmacy to Andrew and Rachel Wagner. The couple got married on December 31, 2020, and purchased the pharmacy the next day.

But, Andrew wasn’t a new face for patients. He grew up in Eagle Grove and started working at the pharmacy in middle school.

“He helped me count my first perpetual inventory,” said Mickey.

Andrew studied pharmacy at Drake University and later returned to town. Now, he and his wife are raising their two sons, 3-year-old Archie and 1-year-old Wyatt, in the pharmacy. Residents frequently see the boys playing in the pharmacy and even helping out.

“Archie does deliveries sometimes. He loves it, knocking on doors and giving people medicine,” said Rachel.

Eagle Grove Pharmacy is also heavily rooted in the community. There’s a board inside with different community events posted, and they help the local schools.

“There are so many things that I rely on them for,” said Beth Wilson, the elementary school nurse.

According to Wilson, in the last three years, the elementary school saw high numbers of students with strep throat, Influenza, and COVID. However, she said there is inadequate access to healthcare providers in the community. So, the Eagle Grove Pharmacy started to do testing for all three.

“And not only that, but Andrew was able to, if you had a positive strep test, he was able to fill a prescription for that as well. And I think that eased the burden,” she said.

Wilson also said that the Eagle Grove Pharmacy provided emergency medications to students, even if parents had to wait until pay day to pay for the medication.

“They are an invaluable resource to us as school nurses,” said Wilson.

The pharmacy has also helped physicians, like Tiffini Toliver. She is a lifetime resident of Eagle Grove and a family practice provider in Clarion, a town northeast of Eagle Grove.

Toliver said she’s made calls to the pharmacy countless times on weekend evenings for last-minute medication for hospice patients.

“It’s never a concern. It doesn’t matter what they’re doing, what the weather’s like. They make it happen,” she said.

Despite strong community support, the future doesn’t look certain for the Eagle Grove Pharmacy. Andrew recently posted on Facebook expressing his worries for the future of the pharmacy if state lawmakers don’t pass reform legislation.

In the post, he said that in the last year, over one-third of the prescriptions the pharmacy filled were at a loss. This is a direct result of the corrupt practices of pharmacy benefit managers (PBMs), who are the middlemen between insurance companies and pharmacies.

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

Last year, 31 pharmacies closed in Iowa as a result of PBMs. Several Iowa pharmacy owners have voiced concerns over the last year against PBMs because pharmacies 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, and a Colfax pharmacy that projects it will close its doors this year.

Andrew said he hopes to grow the practice, but he may have to come up with an exit strategy in the next five years. However, he and his family don’t want to leave Eagle Grove.

“We just want to stay in Eagle Grove and raise our family here, and be able to send them to college one day. That’s the most important thing for us. And then our staff, that they can keep their job, have good-paying jobs they can afford to live,” he said.

If Eagle Grove Pharmacy closes, the nearest pharmacy for residents will be roughly 15 miles away, and the distance will be devastating for some residents.

“We also live in a poverty, a high poverty area. Some people don’t have a car to drive 30 miles. Some of them don’t have the gas money to drive that far. That means some of our families wouldn’t go get the medication,” said Wilson.

Andrew and other pharmacy owners are advocating for PBM reform. There is a bill in session that would require PBMs to reimburse pharmacies for their cost and enable patients to choose the pharmacy they want to receive care from.

Last year, similar reform legislation didn’t pass because it wasn’t brought to a vote. Many pharmacists are worried this bill will meet the same fate this year.

Critics of the bill say it will cause premiums to increase. However, similar legislation has been passed in several other states across the country, and data collected in these states does not suggest an increase in the cost of premiums.

The Iowa Senate filed a fiscal note and an amendment to the bill last week, but has yet to vote on the bill.