Iowa Pharmacist Expands Test-to-Treat Services in Community Pharmacy

In Adel, Iowa, about 20 miles west of Des Moines, an independent community pharmacy is quietly redefining what patients can expect when they walk through the door. Sumter Pharmacy, owned by fourth-generation pharmacist Leslie Herron, RPh, has built a cash-pay mini clinic model that turns the traditional sequence of care on its head. Instead of heading first to urgent care and last to the pharmacy, patients can now start—and often finish—their care journey at the counter they already know and trust.

In this conversation with Erin Albert, PharmD, JD, DASPL, chief of pharmacy relations, network, and professional affairs at Cost Plus Drugs, Herron explains how the once-niche concept of test-to-treat has evolved in Iowa into a broad, pharmacist-driven clinical service. Popularized during the COVID-19 pandemic, test-to-treat initially focused on straightforward conditions like flu and strep, where rapid testing and simple treatment protocols made pharmacy-based care an obvious fit. But in Iowa, a major legislative shift has pushed the model further.

The state recently overhauled its Pharmacy Practice Act, moving from a tightly prescriptive rule set to a standard-of-care framework more in line with other medical professions. Instead of being told line by line what they can and cannot do, Iowa pharmacists now practice based on their training, experience, and professional judgment — including the ability to prescribe within that standard of care.

Herron said her technicians are trained for point-of-care testing, her staff helps with patient intake, and consultations and tests are integrated into the existing pharmacy management system as if they were prescriptions. Everything is private pay.

Against a backdrop of pharmacy closures and growing pharmacy deserts, Herron’s approach offers a glimpse of how independent pharmacies might survive—and even thrive—by leaning into clinical services and cash-pay care.

“The biggest thing I would say to somebody that wants to get started is just do it,” Herron said. “You don't have to have all of everything [or] the holy grail in place to get started. Just start small. Give yourself the permission to say, ‘I'm going to do this.’”