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When stay-at-home orders began to spread across the country, Shantelle Brown, owner of Hope Pharmacy in Richmond’s Church Hill neighborhood, saw a rush. People stocked up on their medications as they prepared to wait out the coronavirus pandemic. By the beginning of April, though, business had dried up.

One of the greatest ironies of the pandemic is that fewer people are visiting health care professionals—and that has impacted many pharmacies across the country. An August study from the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF) shows the total number of filled prescriptions, as of late April, was down compared with January and February, but there are some signs of recent rebounding.

That initial gap was especially hard on small independent drugstores, including Brown’s.

Initially, Hope Pharmacy shifted by making hand sanitizer. The business distributed it to first responders for no charge and sold it to customers. The company vastly expanded its delivery business, as well. But as elective procedures were canceled, and apprehension grew about visiting the emergency room in that community, Brown knew she had to look for new ways to increase revenue.

One of the most successful initiatives has been adding pets to the patient list.

Before opening her own pharmacy, Brown worked at Sam’s Club, which included pet meds among its offerings while she was there. As she met with a strategic planning group in the early days of the pandemic, the idea popped into her head.

Getting access to the meds wasn’t hard. Many pets take the same medicines humans do for things like blood pressure and heart conditions. The trick was letting people know they had an option other than buying directly from their vet.

Brown’s not much for social media. She says she prefers a more “old-fashioned” way of attracting business, so she and her husband made up signs that people could put in their yards and flyers that accompanied deliveries. Before long, business picked up.

Hope Pharmacy, which opened at the end of April 2018, currently serves “800-something” people in the community, but since it began selling pet meds, it has been adding an average of two new patients per day. And while those aren’t numbers that would ping the radar at CVS, they’re huge for a small independent pharmacy.

“We had a couple of people advise us that we should partner with a vet,” says Brown. “I tried, but…I didn’t realize at the time how much vets were making off of pet meds. Our prices are so much cheaper, and we’re able to save patients quite a bit of money.”

COVID-19 hit as independent pharmacies were already facing challenges. Between 2009 and 2015, 9,654 pharmacies shut down—and independent pharmacies were three times as likely to close as chain pharmacies, according to U.S. News.

There was a fear that customers would rely more on mail-order pharmacies as the pandemic has continued, but Antonio Ciaccia, senior adviser for disruptive innovation and practice transformation at the American Pharmacists Association, says business has now largely returned to normal for many pharmacies.

People are still avoiding doctor’s offices, though, and the pharmacy industry is hoping to persuade regulators to let them integrate more clinical services into their practices, serving as a partner of sorts with physicians—another pandemic pivot that would bolster small practices.

“We’ve had conversations about getting pharmacists paid for things like pain management,” says Ciaccia. “We don’t want to replace primary care visits, but we’re interested in what opportunities exist where you can have the second most educated health care professional to engage the patient…Pharmacists certainly have the expertise and training. It just makes sense, given the accessibility they have to the patient.”

The goal with this, as with the carrying of pet meds or other products that aren’t traditional pharmacy staples, is the same, though: build a closer relationship with the patient-customer to earn his or her loyalty. In the event that another substantial wave of COVID hits the country—or some other pandemic forces people back into their homes—those customers will be more apt to return quickly.

“In the pharmacy business, it takes a while to build a clientele because people are used to going where they go,” says Brown. “Our hope and goal is not to just get the animal—we want the whole family.”