Dared and Renee Price are husband-and-wife pharmacists in south-central Kansas, and have spent tens of thousands of dollars and several months getting their six independent outlets in five small towns ready to deliver the two-dose Pfizer and Moderna vaccines. They’ve had to buy freezers, temperature monitors and a mobile refrigerator.

They’d like to break even. At first, they received just 100 doses through the federal retail pharmacy program, though they’ve since gotten more. It’s unlikely to be a big money-maker — in Kansas, they’ll be reimbursed about $24 for fully vaccinating someone with two doses — yet they see it as part of the service they provide to customers who live far from big hospitals and mass immunization sites.

“We were just begging for vaccine,” said Dared Price. “Because we’ve done all this preparation, we had all the processes in place. Our waiting list was thousands of people long.”

Independent pharmacy owners in the U.S. like the Prices are often the sole providers of the COVID-19 vaccine in rural or exurban communities. Over the past month, they’ve started receiving doses to fill gaps in the nation’s vaccination campaign, making appointments in their stores and setting up clinics in churches, factories and schools, and even making house calls to homebound patients. The Prices partnered with a local meatpacking plant, Creekstone Farms, to give shots to workers.

But a majority of independent owners are still waiting for supply. And those who have received doses must navigate the challenges of billing and the intense reporting requirements that big chain pharmacies often have entire departments to handle.

Independent pharmacies are ready to provide much more vaccine, said Cody Clifton, project leader for COVID-19 vaccines at CPESN USA, a network of community-based pharmacies in 45 states that includes the Prices’ pharmacies. About 2,000 members signed up for the program, and of those, about 1,800 don’t yet have vaccines.

“It’s just a matter of allocation, right?” Clifton said. “That’s what we’re all waiting for.”

The nation has about 21,000 independent community pharmacies, and 77% are in areas with 50,000 or fewer residents, according to a report by the National Community Pharmacists Association. About 20% of U.S. Zip codes that have a pharmacy have only an independent outlet, and most are in rural or medically underserved areas, according to the group’s research.

The U.S. campaign for vaccination has accelerated, especially with authorization of the one-dose Johnson & Johnson shot, but has favored people with access to technology, transportation and time to find appointments.

That makes allocation of doses to independent pharmacies crucial, Clifton said. In the federal program, the independents receive vaccines through network administrators or group purchasing organizations that support procurement and help with reporting. The U.S. Centers for Disease Control and Prevention made recommendations for allocations to independents through the program.

Helping Heal

Alessandra Ochoa and her father Joe Ochoa run two pharmacy outlets in the Rio Grande Valley in Texas, which Joe opened about 40 years ago. The coronavirus outbreak has been devastating for their Hispanic community and demand for the vaccine is high, said Alessandra Ochoa.

With an initial 100 doses per store through their partner AmerisourceBergen, the Ochoas have vaccinated the elderly members of their community, especially those in walkers and wheelchairs who cannot stand in long lines at mass vaccination sites.

The doses are the start of an “immense opportunity to help our community heal,” she said.

Some independent pharmacy owners awaiting vaccines are spending time fielding questions from customers, especially those who need information in languages other than English. In the Baltimore suburb of Glen Burnie, Thuy Cao, owner of Soleil Pharmacy, has signed up to receive vaccines from the state and the federal program but so far has no doses.

“Our pharmacy is special because we’re also serving ethnic groups,” Cao said. “Patients come to us because of the language barrier.”

Such barriers underscore emerging data that richer, predominantly White areas are getting more than their share of inoculations. The U.S. vaccine rollout is still highly inequitable, according to the Bloomberg Vaccine Demographics Tracker.

Among Cao’s staff, there are speakers of Vietnamese, Korean and Spanish, and the pharmacy’s vaccine consent forms have been translated. Whether someone can get the vaccine without insurance coverage comes up regularly.

In January, a Vietnamese speaker told Cao she had gotten the COVID-19 vaccine. When Cao investigated further, she learned her customer was mistaken — it was a flu shot.

A new vaccine can be confusing for anyone, but with a language barrier, Cao said “it’s mind-blowing sometimes the situations we’re facing and seeing every day.”

‘Surgical’ Process

In Sioux City, Iowa, Drilling Pharmacy is a success story: They’ve gotten in-store vaccinations down to a 20-minute process with timers, private immunization rooms and appointments scheduled from 9 a.m. to 7 p.m. Within the normal work flow, they’re handling 192 appointments a day, said staff pharmacist Elizabeth Webb.

The only other providers in the area are the local health departments as well as Hy-Vee, the grocery store chain, she said. Drilling has had no trouble getting allotments and has worked through their waiting list. They’re now reaching out to local churches, non-profit groups and long-term care facilities.

Drilling is a 15-minute drive from two other states, Nebraska and South Dakota, so the pharmacists have juggled three sets of state guidelines for vaccination.

“In the state of Iowa, we’ve moved on to school staff, but South Dakota hasn’t,” Webb said. “There was confusion up front of who we can give it to. Now, it’s where do we find those people that haven’t had access to make appointments.”

As more doses come on board, independent pharmacies will need to focus on strategic outreach to meet public health needs, said Nancy Lyons, chief pharmacist at Health Mart, a network partner in the federal program.

Amid the recent authorization of the J&J one-dose shot, the U.S. vaccine supply is expected to surge in coming weeks. The U.S. has already reached a seven-day average peak of 2 million doses administered a day, according to the Bloomberg Vaccine Tracker. Those independent pharmacies waiting are ready and hopeful that more doses will be on the way soon.

“We’re not CVS, we’re not Walgreens,” Lyons said. “There’s definitely a need for them to continue, but we’re trying to be more surgical and strategic.”