EIHC initiative will provide high-tech solution to ‘pharmacy desert’

The Eastern Iowa Health Center's (EIHC) plans for a new, largely automated pharmacy in the heart of its service area will not only help expand the organization’s stated mission — “exceptional health care for all” — but will address the pharmaceutical crisis in southeast Cedar Rapids, created with the closing of the First Avenue Hy-Vee earlier this year.

And not only will the new pharmacy be a state-of-the-art facility, it will be available to the community as a whole — not just EIHC patients.

“With the closing of the First Avenue Hy-Vee, the Wellington Heights and Mound View neighborhoods have essentially been turned into pharmacy deserts,” said Stacie Eastman, director of development and community outreach for the Eastern Iowa Health Center. “Our pharmacy will increase access to low- and no-cost prescriptions by removing the barrier of transportation and high prescription costs, both issues that marginalized populations experience on a daily basis, while also increasing medication adherence, which will help to eliminate treatment failures, deaths, and 25% of hospitalizations that occur every year due to this lack of adherence, thus resulting in healthier individuals, families and communities.”

Latest step in EIHC’s history, growth trajectory

The addition of pharmaceutical services is the latest chapter in the evolution and growth of the Eastern Iowa Health Center over nearly two decades as a comprehensive provider of health services.

The EIHC traces its roots to 2006, when St. Luke’s Hospital, Mercy Medical Center, the Cedar Rapids Medical Education Foundation, the Community Health Free Clinic, Linn County Public Health and other local leaders came together to address the lack of accessible medical services for low-income community members.

Organizers submitted an application for a Federally Qualified Health Center (FQHC) with an emphasis on medical education and homeless services, and Linn Community Care, now known today as the Eastern Iowa Health Center, was founded as a FQHC in 2008.

In the first year, the center had roughly 11,000 patient visits, and after a nomadic existence in its early days, the EIHC moved to its current home at 1201 Third Ave. SE.

The organization expanded in 2017 to include three health facilities: The Eastern Iowa Health Center Pediatric and Family Medicine, Eastern Iowa Women’s Health Center and Eastern Iowa Dental Center.

A new $5.6 million dental facility, with cutting-edge equipment and a full range of dental services, opened in November 2023 at 1210 Fourth Ave. SE. And a separate pediatrics facility opened Aug. 5 at 1225 Third Ave. SE.

This year, the EIHC expects to provide services for up to 65,000 patients in five service areas, including family medicine, pediatrics, women’s health, behavioral health and dental care. 

The new pharmacy, which has been in the works for the past two years, is the latest step in that evolution and growth.

Eastern Iowa Health Center president and CEO Joe Lock said that when he began his tenure in January 2015, EIHC had 18 employees and a $3.5 million budget. Today, the EIHC is one of the 15 largest nonprofits in Linn County, employing 130, and is planning a budget of $18.5 million for 2025 – or $20 million, if the new pharmacy is in operation as expected.

“We receive $1.743 million from the federal government every year to make sure that everybody that wants an appointment and needs to be taken care of can be taken care of, because that's the niche that we fill,” Mr. Lock said. “Cost shouldn't be a barrier to you receiving outstanding medical care.”

EIHC pharmacy plans, funding still coming together

Plans call for construction of the new pharmacy to begin in January 2025, with full operation by June 2025.

The new pharmacy, with an up-front cost of $1.5 million will be located at 400 12th St. SE, which most recently was used by EIHC as a respiratory clinic during the height of the COVID-19 pandemic.

The 10,000-square-foot building was the former home of the His Hands Free Clinic, which relocated to the former Wolfe Eye Clinic building in 2020.

It will be remodeled to house not only the new, 2,500-square-foot pharmacy, but a full-service acute care facility, meeting another urgent need – there are currently no urgent care facilities in southeast Cedar Rapids, Mr. Lock said.

The new pharmacy will also offer drive-through services, Mr. Lock said.

“The gap that will be filled is a neighborhood pharmacy that is walkable, bikeable, and busable to make medication access easier,” Ms. Eastman said. “Our impact varies based on prescription and refill capture rates. We anticipate filling between 38,000 and 72,000 prescriptions annually.”

The prescription volume could be even higher if EIHC finalizes two partnerships under negotiation with nonprofit organizations for pharmaceutical services.

Funding for the project is still coming together, Mr. Lock said. Contributions to the project are already in place from the Hall-Perrine Foundation ($300,000), Aegon/Transamerica ($50,000), United Fire Group ($25,000), Corda Credit Union ($25,000) and the TrueNorth Foundation ($25,000). Another $100,000 is coming directly from the EIHC, and a line of credit with Bankers Trust will add $400,000.

Mr. Lock said funding requests have been submitted to a number of other groups, and that he expects the funding for the project to be finalized by the end of this year. Once operational, the pharmacy is expected to be financially self-sustaining.

“The reality is, this is going to happen,” Mr. Lock said. “And so I'm very excited about it.”

Cutting-edge technology on the way

The defining feature of the new pharmacy will be a pair of robotic devices, Mr. Lock said.

One of the devices will package prescription medications in individually-sealed, transparent plastic pouches, each conveniently and clearly labeled with its contents and the time of day each pouch is to be administered. A verification system can then examine up to five pouches per second to ensure accuracy.

That system would address numerous needs for EIHC’s patients.

First, Mr. Lock noted, medication adherence is only about 50% nationwide, across all demographic groups.

“Thinking about the smartest and richest person in the country, and the least educated and least rich person in the country, decades of research shows that only 50% of all people take the right pill at the right time, every day,” he said.

The situation is even more critical for EIHC patients, who often need to make critical financial decisions in a low-income situation.

“When they have to figure out a way to buy food, buy clothes, pay the rent, buy diapers, or pick up prescriptions, guess which one's going to fall off?” Mr Lock said. “A lot of times we write prescriptions that never get filled.”

“We estimate EIHC’s patient’s medication adherence is approximately 20%,” Ms. Eastman added. “What this means is that even if a patient can take their medication, half of the time they do not, because they are uncertain how to take it, or have to prioritize food, clothing and/or shelter instead of pharmaceuticals that are needed for them to be healthy.”

Prepackaged, lower-cost medication would dramatically improve that situation, Mr. Lock said, especially with EIHC’s patients, who speak 44 different languages and may not be fully literate even in their native tongue – and thus, may not be able to read the instructions on their own prescription labels.

In addition, the average adult EIHC patient has eight chronic medical conditions, Mr. Lock said, many of which require pharmaceutical intervention.

“The level of acute sickness in chronic illness is so much higher within our patient population than in private practice,” he said.

A second machine will automatically fill prescription vials with the proper quantities of up to 200 of the most-needed prescription medications, label the vials and place them in one of 1,000 individual cells in a system that resembles a post office box, or a soda machine.

“The robot will scan the medication as it’s dispensed, chooses the right size vial and the right size lid, and as it’s loading, it takes a video of the medicine, puts the label on the vial and spits it out the deal drawer – all in 23 seconds,” Mr. Lock said.

The system, manufactured by Parata, would come at a cost of $410,000, but one individual donor is considering covering the system’s entire cost, according to Mr. Lock.

Beyond the obvious advantages of automation, Mr. Lock said the Parata system would eliminate the need for two full-time pharmacy technicians. An employee would still be needed to load medications into the machines, and a licensed pharmacist would still oversee the system as a whole to ensure accuracy, but the cutting-edge equipment would make the EIHC job much more appealing for prospective pharmacists.

“Realistically, I don't want to pay $140,000 for somebody to count pills all day,” Mr. Lock said. “I want them to be experts. And I have to tell you, we've done a couple of pharmacist interviews already, and they’ve said ‘Wait a minute, are you telling me that I get to consult with patients all day instead of counting pills?’ And I said ‘yes, we want you to be involved in that patient's health and be looking at their patient chart.’ When I go to CVS, they don't have access to my patient chart. So with us, they will be able to look at the entire patient chart, to see their problems or their chronic conditions, make sure they're dispensing the right medication at the right day – really spend their day counseling patients and improving their overall health.”

Goal is to serve community at large

The new pharmacy would address the critical need for EIHC patients – 1,800 of whom were pharmacy customers of the First Avenue Hy-Vee before it closed in June.

And there’s another issue for current patients: EIHC had a contract with three local Hy-Vees, including the First Avenue store, to provide prescription medications to its patients under the federal 340B Drug Pricing Program, which ensures that patients of community health centers, including Federally Qualified Health Centers like EIHC, are able to access affordable prescription drugs.

As an example, insulin injection pens cost an average of $555 over the counter, whereas the same pens are available to 340B program participants for just $14.

However, the local Hy-Vees no longer do business with EIHC, Mr. Lock said, and drug manufacturers, pharmacy benefit managers and insurers are actively working to dismantle the program.

“Big Pharma doesn't like 340B,” Mr. Lock said. “They are still making money on the $14, but would they rather be making $14 or $555?”

Currently, five Walgreens stores are the only pharmacies in the Cedar Rapids area that participate in the 340B drug program, and none of those are near the EIHC client base – making it all the more critical for EIHC patients to have access to a nearby pharmacy.

The new EIHC pharmacy will be revolutionary for those patients, including a delivery option if needed.

“It’s going to be life-changing, improving the health of some of the poorest friends and neighbors around us, because they'll be able to get a prescription for $1 or nothing,” Mr. Lock said. “And with pill packs, medication adherence will skyrocket.”

The pharmacy will also be open to the general public, Mr. Lock said, and hopes  that commercial insurers will consider utilizing the lower-cost prescriptions from the EIHC pharmacy as well.

“We’ll be filling our family’s prescriptions here,” Mr. Lock said. “We hope that everyday Cedar Rapidians with commercial insurance will utilize our pharmacy, to help us pay for those patients that can't afford their medication. When I want to shop locally, I don't want to send my money to CVS, I don't want to send it to Walmart, I don't want to send it to Hy-Vee. I hope we see a behavior modification, where people will help support our pharmacy by switching their prescriptions to us, even if they're not in an economically disadvantaged situation.”

It’ll just be the latest service in a long EIHC legacy of bringing health care services to those most in need – a key achievement for Mr. Lock, a seasoned Corridor executive who turned around three failing nonprofits in Eastern Iowa and has done the same for the EIHC over the past decade.

“We're actually the second youngest FQHC in the state, yet we've had incredible growth, from 18 to 130 people in 10 years,” Mr. Lock said. “And obviously, we've got a lot more growth to go. It doesn’t matter if you're rich or poor. Everybody deserves a great place to go to the doctor. We talk a lot about health equity, meaning that everybody deserves to be treated with dignity and respect. We want to make sure that we're at the front of the battle, carrying that torch.”