For as long as she can remember, Carol Fuertes would get her medicine from a small independent pharmacy in the small town of Kapaʻau in North Kohala. 

She knew the names of the staff and the owner, Greg Harmon, and they knew hers. Harmon would ask how she and her husband were feeling when they ran into him in town — because he’d know they had just picked up antibiotics. 

But that drugstore, Kamehameha Pharmacy, closed its doors last week after Harmon decided to retire. It was one of the last independent pharmacies on the Big Island. And for the rural community of roughly 7,000 in North Kohala, it was the only pharmacy for miles. 

The drug store’s closure exacerbates the kind of long-term healthcare access issues already affecting rural parts of Hawaiʻi. Residents worry North Kohala’s kūpuna population will be hit the hardest as many don’t have adequate transportation. 

Harmon is transferring his customers to the next closest pharmacy, Longs Drugs in Waimea. But that’s 30 to 45 minutes away. The quickest route is a narrow windy road with no street lights that’s prone to fog and rain that significantly limit visibility. 

About 80% of the community is over the age of 60 and many need regular medication, the local senior citizen club president Sandra Cho said. For those who can’t drive, options to get to Waimea are even more limited.

Cho and the community are worried.

“We’ll need prescriptions, you know, like not tomorrow but today, and not every time we’ll have transportation,” Cho said. “So it’s going to be difficult. It’s going to be really difficult.”

‘Nobody That Wants … To Take It Over’

Across America the number of pharmacies in rural communities is shrinking. They’re often closing because pharmacists are retiring and finding it hard to find replacements, according to the Rural Policy Research Institute.

A pharmacy had existed in Kapaʻau for over 50 years. When Harmon took over 25 years ago, it had been closed for just a short time, yet residents were knocking down the door for their medication. 

“We were not even open and we did 35 prescriptions,” he said. “That was how desperately people needed prescriptions.”

As the plantation town’s population rapidly ages, the need for medication will only grow. Fuertes said she and most of her friends need recurring prescriptions. She’s already seen some of them move on to Hilo and Kona for regular medical care they can’t get in Kohala. 

Harmon didn’t want to leave the community without a pharmacist. He tried to sell the business for three years with no success.

“There’s just nobody that wants to come in and take it over,” he said. “The pharmacy business is getting really hard.”

Shrinking reimbursement from insurers is one of the major culprits, Harmon said. Insurers like HMSA have contracted out their pharmacy services to other companies. Those companies, he said, reimburse based on mainland prices without considering the added cost of shipping to Hawaiʻi. And getting through to HMSA is nearly impossible, he said. Special rates set for rural providers were the only thing keeping his business viable.   

“Your return on investment for filling your prescriptions is going down,” Harmon said. “So there’s a certain point in time when it’s really not going to work anymore.”

With no one to replace him, Harmon is worried for his community, especially the kūpuna. They’re often days late to pick up their prescription from him. Now, with their only option at least 20 miles away, he’s worried some will wait for even longer since they’ll have to rely on others for pick ups. 

For those who require regular, life-saving medicine like insulin and heart pressure pills, he noted, delaying or skipping out on medication can be fatal. 

Fuertes’ husband is diabetic and requires regular Rybelsus medication for it. She can drive but struggles with it, so she prefers to leave town only when necessary, about once or twice a month. She’s also on a fixed income, and as gas prices increase, regular trips to Waimea will cut into her limited budget. She knows she’ll probably have to ask her family for help.

“I hate to rely on the young ones,” Fuertes said. “I’m going to try and get it by myself. I still drive, but I just don’t like it.”

There are few public transportation options. The Hele-On bus stops in North Kohala just twice a day. Residents would likely have to catch the early morning ride to go south and then catch a return bus in the evening. 

The Hawaiʻi County Parks and Recreation offers transportation services for kūpuna in North Kohala. Jun Ishiminie, an employee with the county, drives a bus between there and Waimea. She has around 60 clients she regularly picks up and expects more will sign up for the service. 

But some kūpuna are housebound, Cho said, so they’ll have to ask others to pick up their prescriptions for them. 

Longs Drugs delivers some medications but not all and some insurers don’t cover prescription delivery. Harmon said he’s trying to negotiate with the company to get no-charge delivery for his customers but hasn’t gotten a solid answer. 

“There’s some signs that maybe some people will come out OK with the Longs system,” Harmon said. “But other people probably just can’t get out there.”

Losing A Lifeline

The loss of the pharmacy means more to the community than the inconvenience. For many, the pharmacy felt like family, offering a continuity of care that is rare in Kohala.

The only hospital and clinic cycles through doctors regularly, community members said. But the staff at Kamehameha Pharmacy knew their medical history and provided close, personal care. They administered flu shots, explained medications, followed up to see how they were doing — and Harmon even had the discretion to decline providing prescriptions he didn’t think were safe for his customers.

“The pharmacy has been my lifeline,” Fuertes said. “At Longs, you know, they don’t know our names.”

Trevor Blades worked at Kamehameha Pharmacy for six years. He made friends and family out of customers. He said the sense of community there is something you don’t get from corporate chains. 

“At Longs, you know, they don’t know our names.”

Carol Fuertes, Kamehameha Pharmacy customer

“Everybody was recognizable the moment they walked in the door, and we were already getting their medicine out and getting them ready,” Blades said. “That’s what I liked about being an independent pharmacy, there’s a lot of personality there.”

Blades said he is deeply concerned about what will happen to the community without the pharmacy. 

“I see all these people that I’ve helped and now I feel bad, you know? It hasn’t quite hit yet,” he said.

The community is tight knit and looked out for Harmon, Blades and the rest of the staff. Harmon said people would offer to fill potholes outside the shop and bring them fruits and vegetables from their gardens. Last week a regular customer brought in fresh eggs from his chickens. 

“They looked after (us),” Harmon said. “And these guys were really protective. They didn’t want you to go, they wanted to hold on to you.”

Civil Beat’s health access reporting is supported in part by the Atherton Family Foundation.