Changing prescriptions: pharmacists compound a new formula to keep fit a business that's been in the family four generations.

• Author: Martin, Edward
• Position: FEATURE

The past seems to cling to Mount Pleasant, change treading lightly on this 160-year-old town of about 1,400, with its quiet, shady streets and antebellum homes. The most prominent structure is still Mount Pleasant Collegiate Institute's main building, erected in 1855-56 and now a museum, its 30 rooms and three floors crammed with Cabarrus County history. Down East Franklin Street, the mill built in 1899 of brick made at the site is still spinning yarn. On a corner under the town's only stoplight stands an exception.

Not that the drugstore Archibald Walter Moose founded in 1882 looks much different than when it reopened after a fire in 1927. Like the Tuscarora Yarns mill, the building is brick. Inside, along a wall above shelves of remedies and sundries, sit red, blue and green apothecary jugs labeled vinum portense, pulvis scilla, acidum citricum. The ingredients once treated rheumatism, finicky digestion and various other miseries.

It's the way Moose Drug Co. does business that has changed, radically in some ways. "When Mrs. Jones comes to us today, she's not just getting a bottle of pills," says Joe Moose, 43, who with his older brother owns the company. "She's getting time with Whit and time with me. She's getting help in order to get the most from her prescriptions. We're selling health care."

It's a formula that's working. The Moose brothers and their father have opened two more drugstores in nearby communities and keep adding lines of business, such as Moose Pharmacy-branded dietary supplements. Their pharmacists--eight among 28 employees--train for niches in what's called disease-state management. Whit Jr., 46, is an expert in osteoporosis and fibromyalgia. Whit Sr., 69, focuses on diabetes. Joe concentrates on pharmacoeconomics--cost-benefit analyses of drugs or drug therapies--for customers and compounding--making--many of the remedies himself. "I came in early today," he says. "I had to start mixing one that included 13 ingredients."

The bottom line: "We're solidly in the black." Getting there isn't easy, and many community pharmacies find it hard to stay in what health-care experts describe as the most competitive segment of modern medicine. Pummeled by giant drugstore, supermarket and discount chains, parsimonious managed-care plans, shrinking government reimbursements and rising wholesale drug costs, independent pharmacies face a choice: change or die. Nationwide, about 1,300 went out of business last year; it's unclear how many did in North Carolina. In 2000, the N.C. Board of Pharmacy tallied 942 chain pharmacies and 539 independents operating in the state. Last September, there were 1,131 chain stores and 593 independents.

Nationwide, according to IMS Health, a Norwalk, Conn.-based pharmaceutical and health-care research company, independent pharmacies accounted for about $35.5 billion of the nearly $275 billion of prescription drugs sold in 2006. Chain stores, including drugstores and such mass-market retailers as Wal-Mart and Target, sold $96.1 billion, while mail-order...