McKesson ideaShare 2026: What Does It Take to Sustain a Rural Independent Pharmacy? Sandie Kueker, RPh, Explains

In an interview with Pharmacy Times, Sandie Kueker, RPh, pharmacist and owner of Hesston Pharmacy and Harvey Drug, and president of the Kansas Pharmacists Association, discussed at McKesson ideaShare 2026 how PBM reform has been KPhA's top legislative priority this year as part of broader efforts to keep independent and rural community pharmacies open and educate the public on pharmacists' expanded role. She explained that sustaining an independent pharmacy long-term requires diversifying services based on each community's specific needs, citing diabetes education and medication packaging programs as examples from her own rural Kansas pharmacies. Kueker detailed how her pharmacies build all clinical services around a strong medication synchronization (MedSync) model, which creates predictable monthly patient visits and allows technicians to practice at the top of their license while pharmacists focus on judgment-driven, one-on-one patient care. For pharmacists looking to expand into clinical services, she advised starting with a robust, patient-friendly med sync program—often marketed simply as a "Refill Reminder"—as the foundation for building everything else into the pharmacy workflow.

Pharmacy Times: Can you please introduce yourself?

Sandie Kueker, RPh: Hi, I'm Sandie Kueker, and I'm a pharmacist and owner of two independent pharmacies in Kansas, and I'm currently serving as the president of the Kansas Pharmacists Association.

Pharmacy Times: The Kansas Pharmacists Association, founded in 1880, is one of the oldest statewide pharmacy organizations in the country and is active on advocacy, clinical services, government affairs, and PBM reform. As president, what have been your top priorities, and what advocacy wins has KPhA achieved this year?

Kueker: Our board's top priority this year was PBM reform, and we knew that that was something that we needed in order to keep our independent and our rural community pharmacies open in our state. If the pharmacies aren't open based on their dispensing activities, then it's hard to add everything else in. But for me personally, my pharmacies have provided a lot of clinical services, and I've really seen the impact that that has on patients and our community, and so I wanted to see us get as many members involved as possible and educate our state so that they understand that pharmacists do a lot more than just put pills in a bottle.

Pharmacy Times: You own two independent community pharmacies in central Kansas, serving rural communities where the pharmacy is often the closest — or only — health care provider. What has that experience taught you about what it really takes to sustain an independent pharmacy long-term?

Kueker: Well, you have to diversify, and you have to pay attention to what your community needs. So, even though our pharmacies are located at smaller communities, what is needed in Heston, Kansas, or Abilene, Kansas, is not necessarily the same thing that's needed out in Tribune, Kansas, for a table. And so you have to pay attention, and so for us, our community really needed more diabetes education options, and so we found that bringing patients in core could be the classes that we have providers referring them to. We also discovered that our medication packaging programs are so important to patients and their families, but at the end of the day, every time we get ready to add a new service, we ask ourselves a couple of questions. We ask, how would I want my own family cared for, and will this be doing that, and will we approach it in a way that's how we want our own families cared for? And then the second question we asked, because there are so many things that we could do, and it's so exciting to be a pharmacist, but you can't do everything.” And so we stop, and we think, well, what we do, will it have an impact on the greatest number of patients? Which of these options will have the greatest impact? And that's what we go forward with.

Pharmacy Times: You've been recognized as a pioneer in integrating clinical services into community retail pharmacies, earning the NASPA Excellence in Innovation Award and the Kansas Pharmacist of the Year honor. What does that integration look like in practice, and what has had the biggest impact on your patients?

Kueker: For our pharmacy, what we do is a building block approach, and so at the base of everything that we do is MedSync, and if we go back in time, it's really always been that way. Our pharmacy is a combo pharmacy, and so when we do long-term care services, we really start with a MedSync model—that’s what MedSync is. And so we've applied that to the retail side too, and by doing that, we're lining up the patient's medications, and so that gives us an opportunity that we know where the patient's going to come in each month, so if we do want to provide an immunization for them, check their blood pressure, or visit with them about their medications, we know there's going to be the opportunity. And so everything that we do, the heart of it's MedSync, and then we build from there. The other piece is utilizing our technicians. We have the most amazing staff. I'm sorry for everyone else that they don't have our technicians, because they're just phenomenal, and we have a team approach to everything we do. Each of us practices at the top of our license, and so that includes all of our pharmacy technicians, and they literally run our workflow and run our point-of-care services, and our pharmacists have time in for the functions that require judgment and the one-on-one with the patients. So at the end of the day we make sure we're extremely efficient, and things that, well, everything that we do matters, but we, the things that aren't patient-facing, we're very efficient behind the scenes, and that way when our patient walks in the door, they feel like we have all the time in the world for them, and we really feel like we have time to provide the care that they want.

Pharmacy Times: For community pharmacists attending McKesson ideaShare who are considering expanding into clinical services but aren't sure where to start, what is your most practical piece of advice?

Kueker: Start with a good, strong, robust med sync program because if you can do that, then you can build everything else into workflow. And if you don't have that, then ask why, because there are a lot of different ways to do it, and don't be scared, and your patients watch and love it too. We call our program Refill Reminder so that our patients—they don't know what the word “med sync” means—but when we say, "Hey, would you like us to call you once a month and just remind you it's time to get everything? And you could tell us if you don't, if there's anything you don't why,” and they're like, "Oh, you guys are amazing."