Flow’s Pharmacy has been serving the Columbia area since 1974, with an emphasis on filling prescriptions in 10 minutes or less. Randy Flow moved to Columbia in 1972 and worked at a chain pharmacy before purchasing a pharmacy that had been in business for ten years. Around 20 years ago, Flow took on Dan Cornell as a partner and opened a second store, on Keene Street, shortly after. “We have a lot of good, loyal customers who have been with us a long time,” Flow says.

“I’d say the most fulfilling thing is solving problems within the store and with customers,” he adds. Flow also enjoys “helping patients with questions they may have about their prescription or over-the-counter medications.”

Competition has changed a lot over the years. Originally, competition would have been among the independent pharmacies, but the evolution of the pharmaceutical industry has brought many changes in how pharmacists deliver services to their customers. “Then came chain drug stores, grocery stores and big-box stores, and mail order followed soon after,” says Flow. “Now, for all pharmacies, the hardest thing to deal with are PBMs [Pharmacy Benefit Managers]. They tell pharmacies, patients and physicians what they are going to pay for and how much.”

PBMs originally served as a computerized way to track prescriptions that were being filled, insurance coverage and what customers’ co-pays and deductibles would be. In this regard, the service aided efficiency. Flow and others now say it is difficult to work with the PBMs because they dictate so much of the market in terms of how much reimbursement costs are and which prescriptions to use. Flow sees the PBMs as the biggest problem in the pharmaceutical industry right now. “All of us, the independents, and even the chain stores and the public would benefit in looking into the practices and policies of PBMs,” says Flow, adding his thoughts that more transparency is needed in the health care industry in general.

All local pharmacies are now competing against mail orders and the big-box stores, rather than with each other. The local focus is more on customer service. “I think we’ve always had to do that, but it’s much more important now — service, friendly personnel, getting to know the people and being helpful is how you compete now,” says Flow. “You’re really not competing on price.”

Flow remembers when customers came in and paid cash for their prescriptions, even if they had insurance; then, at the end of the year, they would submit their claims to the insurance companies and get reimbursed for them. This system led pharmacies to keep records for the customers so they could submit those claims. “It used to be customary for pharmacies to keep handwritten patient profiles, with a record of each prescription filled, the price, etc.,” says Flow. “The customer would then come in at the end of the year, and we would total their purchases up and give them a copy to turn in to their insurance. Now, customers can come in and get a print-out from our computer in seconds.”

The aging baby boomer population has increased the amount of prescriptions being filled, as older people tend to take more medication. Flow says another change has been in the evolution of generic drugs, products comparable to a certain brand of drug in terms of the medicinal qualities it portrays — like a grocery store brand of a pain reliever versus a name brand pain reliever you see advertising for. Regulations have also increased throughout the years, and Flow says they spend more time dealing with paperwork and red tape now.

Flow says one of the biggest lessons he has learned during his career has been to “always be ethical — do what’s right for the patient.” To make an independent pharmacy successful, Flow says it all has to do with people and customer service. “One of the big things for all the independents is hiring good employees, good technicians who are good with people, who know their job and do it well,” he says. “We’ve been really fortunate with that.”

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