A Pharmacy Story. A Profession’s Warning. A Call to Act.
In 1876, a young pharmacist named J.E. Janney apprenticed under Jonah Sands in Spring Valley, Ohio. Together they opened a drugstore in Waynesville. Two years later, Janney struck out on his own and wrote his first prescription on December 23, 1878.
That pharmacy would stand for nearly 150 years.
Janney’s drugstore was more than prescriptions. It was a gathering place warmed by a stove in winter, a lending library before the town had one, a sponsor of local events, and one of the social anchors of a small Ohio town. He practiced for over thirty years, retiring in 1922, having set a standard that would echo across generations.
Stewardship passed hand to hand. The Loveless family carried it through the mid-20th century. In 1987, the Fields family took the reins. Eventually, responsibility fell to Kyle Fields alone. Kyle grew up in Waynesville, biked its streets as a child, delivered prescriptions as a teenager, and raised his own family in the same town the pharmacy had served since Reconstruction.
Think about what this pharmacy outlasted.
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Floods that swallowed Main Street when the Little Miami River rose. Epidemics such as smallpox, influenza, polio, HIV/AIDS, COVID-19 when the pharmacist was often the most accessible healthcare professional in town. Economic disasters: the Panics of the 1800s, the Great Depression, farm collapses, the Great Recession. When money was tight, credit was extended, pills were split, and neighbors were helped quietly without paperwork or prior authorization.
It survived when Route 42 and State Route 73 diverted traffic away from Main Street. It survived corporate chains, mail-order medicine, big-box pharmacies. It survived every war America fought after its founding including both World Wars, Korea, Vietnam, the Gulf War, Afghanistan, Iraq. Sons and daughters left. Some never came home. The pharmacy remained.
More than two dozen presidents. Dozens of governors. The pharmacy adapted every single time.
• • •
And then it fell.
Not to floods. Not to war. Not to pandemics or depressions or corporate competition.
Pharmacy Benefit Managers killed it.
PBMs. Pharmacy entities Janney never could have imagined, and most patients today still don’t know exist accomplished what 150 years of American history could not. They made it financially impossible for an independent pharmacy doing everything right to survive. Reimbursements fell below the cost of dispensing. Fees were clawed back months later. Pricing became opaque. Every reasonable effort was made. It did not matter. The system was designed to extract, not sustain.
• • •
If you are a pharmacist reading this, you already know this story.
Maybe not this pharmacy but one like it. Maybe yours. You know what it feels like to dispense a medication you were reimbursed less than cost to fill. You know the DIR fees that appear months later. You know the prior authorizations that serve no clinical purpose. You know the anger of watching patients struggle while the system profits from their confusion.
You are not imagining it. The system is working exactly as designed. Just not for you, and not for your patients.
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But this story refuses to end in grief.
In 2011, before the pharmacy closed, Kyle Fields saw the storm forming. Instead of walking away, he walked into a Pancake House in Centerville, Ohio, met with an attorney he paid with money he didn’t have, and started building.
He founded Appro-Rx. Not in a boardroom, but out of pharmacy back offices and patient conversations. A transparent, fiduciary mindset PBM where every financial and clinical decision is made in the best interest of employers and patients. No spread pricing. No hidden rebates. No opaque economics that crush pharmacies and rob employers. Full data access. Enforceable audit rights. Pharmacist-led clinical programs. Incentives aligned so that when costs come down and outcomes improve, everyone benefits including the pharmacy.
What began as one pharmacy owner’s refusal to accept the system grew into a national platform that is now serving hundreds of clients and hundreds of thousands of lives across all 50 states.
| Appro-Rx may not have saved Waynesville Pharmacy. But Appro-Rx is saving pharmacy. |
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Here is the hard truth.
Legislation is not going to save you in time. By the time a bill is debated, amended, lobbied against, and watered down, more pharmacies will be gone. The PBM lobby will delay, dilute, and outlast every reform effort because the current system is worth billions to them.
But the real answer is simpler, faster, and already working.
Every employer in your town has a pharmacy benefit. Most have no idea how it works, who profits from it, or that it is actively harming the pharmacy down the street where their own employees fill prescriptions. They are not the enemy. They are uninformed and when they learn the truth, many of them want to fix it.
The fastest way to fix pharmacy: get your local employers to stop using bad PBMs and start using good ones.
No legislation required. No waiting for Washington. One employer at a time, one conversation at a time. The solution exists today. It is working today.
Stop waiting for someone to save you. Start the conversation with the employers in your community. Show them what their PBM is doing. Give them a better option. That is how we save pharmacy. Not from the top down, but from the counter out.
Waynesville Pharmacy • 1878 – 2024 • What we lost should be the last.
Kyle Fields
CEO
Appro-Rx, LLC
