“Independents: we take more time. We don’t have more time.” This is the core of Mike Matovich’s pharmacy practice located in Columbus, Montana. Stillwater Family Pharmacy is nestled inside Columbus IGA Plus, a local grocery store started by Mike’s grandfather in the 1960’s. An independent pharmacy practice inside a grocery store seems like it would be exempt from financial obstacles, but every pharmacy deals with the frustration of low reimbursement and PBM woes. With the freedom that owning his own store provides, Mike has found creative ways to combat low profits and keep Stillwater Family Pharmacy alive and well in his rural city of Columbus. Mike is a third-generation owner of Columbus IGA Plus. The 2,500 square foot store his grandfather originally purchased has expanded to the 30,000 square foot building it is today. The elder Matovich men ventured into unknown territory and installed a pharmacy inside IGA Plus. After prompts from his father, Mike chose to pursue pharmacy in college. However, he wanted to escape the small town of Columbus, so he became a pharmacist for Portland’s Costco. He returned to be a substitute pharmacist until his dad could find a new one. That was eleven years ago, and the replacement was never hired. Since then, Mike has settled back into his hometown of Columbus. “Over those two years, I found out how enjoyable pharmacy was when you don’t have the constraints of the chain telling you what to do,” he remembers. “You really get to start thinking outside the box and you can really shape the direction you want to take your business. Independent pharmacy hasn’t been easy for Mike since he returned to his hometown. After recounting his history with smiles and laughs, he grows somber when talk turns to industry. “We’re the only pharmacy left in our county. At one point, I believe we had about six pharmacies in our county,” he explains. “Due to reimbursement issues, everyone’s gone. We’re the only pharmacy left standing.” He calls the pharmacy an “interesting mix” because of its two different sides. The “front” depicts hardworking, trustworthy individuals who strive for better patient health. Behind the scenes, community pharmacy suffers from lost profits due to PBMs. “Everybody’s in a fight to try to control costs, and one of the first places they look to try to control that cost is in pharmacies. We succumb to the pressures of a bigger problem.” Mike, however, refuses to react to every loss of profit. Instead, he’s proactively making up for lost reimbursements and making a change in the state of Montana simultaneously. Mike found ways to take his practice beyond Stillwater Family Pharmacy. When he returned to Columbus, the local hospital needed a pharmacist. Mike keeps a part-time pharmacist in the hospital and even helped it expand from a local clinic to a $15,000,000 facility. Working alongside the hospital is an advantage to both Mike and his patients. “When we help oversee the hospital, the patients that get admitted a lot of times are our patients, so we already know them very well,” he says. “It’s been able to help us take care of patients on a much higher level than it would in a setting where you can’t see the medical records. For the patient care, it’s a huge benefit.” Because Montana is a rural state, pharmacies are not readily available on every street. The residents of Colstrip had to drive 70 miles roundtrip for their prescriptions, and in a Montana winter, prescriptions were often sacrificed for safety. In July 2015, Stillwater Family Pharmacy opened Colstrip Family Pharmacy, a telepharmacy for the Colstrip community. With the ever-evolving technology, it’s easy to be overwhelmed by the options and the change, but Mike has a different view. “I think the beauty of technology today is that it does allow us to do things with a little bit more efficiency,” he says. Mike even goes beyond technology and his store to make a difference – he approaches his colleagues. A year and a half ago, Mike banded together with fellow independent pharmacists to form Montana Family Pharmacies, a Montana-specific buying group. “A lot of buying groups focus nationally on pharmacies, and for our rural state of Montana, that’s not the best thing for us. What’s best for New York City isn’t the best for Montana,” he explains. The goal of Montana Family Pharmacies was boosting profits for the independent stores, then channeling that additional revenue into other projects. Their next step was to create a PSAO. Although they are in the early stages, Mike and his fellow Montana pharmacists aim to create partnerships with PBMs and larger corporations. “It’s really taking the best business practice and then the best of a pharmacist and trying to marry them to keep that honesty and integrity within the business world,” he says. Rather than accept profit loss and PBM pressures, Mike and other Montana pharmacists took matters into their own hands by finding their own profit solutions that really work. With that mindset, Mike has taken Stillwater Family Pharmacy beyond the expectations of a rural pharmacy. Between his strategic decision to unite Montana pharmacists under one buying group and practicing in other pharmacies, Mike’s proactive approach to business and pharmacy will see his family’s legacy and Stillwater’s health through to future generations.