Meet the longtime St. Paul pharmacist who thinks the future won't be about filling prescriptions

John Hoeschen bought St. Paul Corner Drug on April 1, 1997. In all the years since, the native of central Minnesota farm country, who graduated from the University of Minnesota College of Pharmacy in 1989, has seen seismic changes in community pharmacies.

Eye On St. Paul recently visited one of the capital city's last independent drug stores — a Macalester-Groveland mainstay known for nickel cups of coffee and a full-service soda fountain — to hear how Hoeschen, 57, is navigating those changes. This interview was edited for length.

Q: You're one of only a handful of independent pharmacies remaining in St. Paul. What makes you different?

A: It's like with anything else that is independently owned and community based: You're doing just better-quality service. It's more high-touch. It's more adjusting the product to the person in front of you.

Q: How did you come to buy it?

A: I came to work for [Richard Sundberg at St. Paul Corner Drug] in 1989. Computers were just starting to come into pharmacies. I remember getting to S in the phone book and I called him. The first few words out of his mouth after I introduced myself were, "Is this God?" [Laughs] I knew how to use the computer system and I never left.

Back then, 45 orders a day was a busy day. … Now, it's between 300 and 500.

Q: COVID has had a major impact on your business. You said your front door was locked for 16 months. How did you survive that?

A: We survived on the relationships we had built over almost 30 years.

Q: Reputation means that much?

A: It does. We had people say, "What can we do to help?" We literally took photographs of our sections of over-the-counter medications and made a collage on that window right there so that people could come up and tell us what they needed.

Q: They'd call?

A: [Nods] We didn't need the checkout counter because there was nobody coming in here. We had two big banquet tables set up. People would call and say, "I've got three prescriptions I need filled. And then I want a bottle of Tylenol and Band-Aids and lotion and dah, dah, dah." And we'd pull all those things, bag it up and when they came by, we would take it out to their car. Or a lot of people lived within walking distance, and we'd just take it to a side door.

And when the vaccines came out — we started vaccinating Feb. 3, 2021 — the only people who were allowed in here were people who were getting a shot. And we just ran a shot clinic here, doing 120 to 150 a day.

Q: Which changes stayed?

A: We still do curbside. We had never done that before. For a lot of elderly people, especially in the wintertime, it's great. The [soda] fountain got shut down in October of 2020, after the riots happened. We got spared. We were boarded up for two weeks.

Q: You own the building, and you've got apartments upstairs. Where do you live?

A: About 200 yards away. We've lived there since 1992.

Q: How much longer do you see yourself doing this?

A: It all depends — if, financially, it works out. That's the biggest crux for us right now, getting over the financial hurdles. It's a mess. For retail community pharmacies right now, it's a mess. Under reimbursement, there's only so much you can do before you can't make it up. When the difference was a dollar or two, you could make it up on other stuff. When it's $20 to $70 a script, you can't make that up.

Q: That's how much more it costs you to bring a drug into the store than you get reimbursed for it?

A: We've got a gentleman on a seizure medication. It's about $4,300 for a month's supply. He's on Medicare. He's in his late 30s, but he's on Medicare disability. We're estimating he [costs us] about $360 to $380 a month.

So when the pandemic happened, and they started talking about hundreds of millions of shots, I said, "How can we do this? How can we make this a system so people can easily and efficiently come in here and get their shots?" And we never looked back. At one point, we had 65,000 people on our waiting list. We did 32,000 COVID vaccinations in the last two and a half years.

If the pandemic hadn't happened, we'd have closed probably two years ago. But we've got to figure out a different way of doing business.

Q: How?

A: I kind of pivoted to more of a functional medicine approach: nutrition, lifestyle, counseling, that kind of stuff. Working with patients on different ways to get healthy versus just handing them a different medicine. We brought in some high-end nutritional supplements. And when people try it and use it, we fit it in with their [other] supplements and their prescription stuff and maybe lifestyle changes and dietary things. Then they start feeling better.

Prescription reimbursements have been going down for years. When I got out of pharmacy school, the professional fee was about $7 to $10 a script. Today, it's zero to a quarter.

Q: So the future for you is not in …

A: Dispensing.

Q: Shifting gears, are the 5 -cent cups of coffee or the soda fountain coming back?

A: [Pauses] No. Things have changed. I need the space for other things. We have to pivot our business to more clinical management.