According to the Centers for Disease Control and Prevention (CDC), diabetes is about 17% more prevalent in rural areas than urban ones.

With rural communities often facing barriers to accessing healthcare, including limited specialists and transportation.

But what if there was a way to increase rural patient access to specialists? In this episode of The Bottom Line Pharmacy Podcast, Scotty Sykes, CPA, CFP® and Bonnie Bond, CPA talk with Leanna Schwend, PharmD, owner of Yellowstone Pharmacy in Montana and founder of SugarBEAT for a powerful conversation on turning personal adversity into clinical innovation.

After being diagnosed with type 1 diabetes just before graduating pharmacy school, Leanna’s career trajectory transformed leading her to create one of the only certified diabetes education programs in a Montana retail pharmacy. Now, she’s helping patients and other pharmacy owners bridge gaps in diabetes care, education, and revenue generation.

This episode explores:

• The story behind Leanna’s diagnosis and how it changed her mission
• Building and sustaining a certified diabetes education program
• Creating a digital support platform for patients, caregivers, and pre-diagnosis education
• Revenue options: cash-based models vs. accredited services
• And more!

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Podcast – Driving Independent Pharmacy Profitability in 2025

If you prefer to read this content, the video transcript is below:

Bonnie E. Bond, CPA, MBA: Welcome everybody to another episode of the Sykes the Bottom Line Pharmacy Podcast. We are super excited to have Leanna Schwend today from Montana Yellowstone Pharmacy. She is a great client of ours who we wanted to talk to her today about some of the different revenue options that she has at her pharmacy to serve her patients. Scotty, as we know, it’s very important with reimbursements the way they are these days. We’ve talked a lot about it, diversifying our revenue streams, anything we can do service related, clinical related, cash revenue is always gonna help the bottom line. Obviously with patient care being first, paramount and foremost. I want to say that right out of the gate. But we also know this is a business and so these things are important for our top line revenue. 

Scotty Sykes, CPA, CFP: Yeah, this fits the theme of what we’ve been saying for quite some time now, diversified revenue. So, yeah, I mean, definitely an appropriate topic. So let’s get into it, Bonnie. 

Bonnie E. Bond, CPA, MBA: So, Leanna, I’m gonna let you just kind of start. I know one of the things we wanted to really dive into today is I know that you’re offering some services and different programs and education options there at your store for diabetes. And I know you have a personal story with that as well. So if you would just jump in and tell us kind of how you got started and why you decided to do that in your store, that would be great. 

Leanna Schwend, PharmD, DCES: Yeah, thank you guys for having me. Super excited to talk about this topic, that I am extremely passionate about. So yeah, I at the age of 25, just about to graduate from pharmacy school, was diagnosed with type 1 diabetes. So, I had all those classic symptoms, you know, increased urination, and some sudden weight loss. But I really just chalked it up to I’m stressed; I’m doing these clinical rotations. It’s all the doctor’s fault for calling on me and asking me these hard questions, right? But then I was actually doing a rotation in my hometown pharmacy, which I now own, and decided I’m just gonna check my own blood sugar. Also, not how you diagnose yourself, but you know, I was smart, so I was gonna try it out. And my blood sugar was 311, and I know, “yeah, just that spot check.” So, I called my hometown doc and was like, gosh, think I have diabetes.  I need to be seen right away. And of course, they’re like, we’ll get to you in a couple of weeks. And hung up and was like, no, I think I have diabetes. And called back and thank goodness the doc was like, ok, if you’re really worried, I’ll get you in on my lunch break. And so went in and sure enough, A1C of 10%, landed in that diagnosis. So that really changed my mindset from someone who was going to care for people with diabetes to becoming the person living with diabetes. You know as pharmacists, we know a lot, right? We know the pathophysiology; we know medications and everything. But we don’t really always know how to appropriately talk to and educate people with diabetes at the level of education and support. And so, I was actually referred to a certified diabetes educator, but the wait time was a couple of months. They’re just, especially in Montana, there few and far between. There’s not enough to go around. We have access issues. But once I finally was able to get in, I was given so much information and knowledge that, you know, we’re not defined by our diagnosis and really had to take all these tools and use them to help us truly thrive with diabetes. And so that really sparked my interest in becoming an educator myself. And so, I’m the only one that I know of still retail pharmacy in Montana that has a certified program. So back in 2017 or 18, I finally got the accreditation. It was a grueling experience. I think I have PTSD from trying to get that status. It’s hard to keep the program going as well, especially when you’re kind of a lone soldier. I’m very fortunate in Montana, we actually have a state umbrella program now where the state kind of handles the management and the paperwork part of it and the accreditation piece of it, so I can just do the education. But also, fast forwarding to the real issue here is reimbursement piece of what we want to talk about. So it is wonderful to be able to use our knowledge and whatnot and have the accreditation to be able to provide the service and get paid for it. However, since we are not recognized as providers, the payer part is also very, very difficult. Right now, Medicare is really my only success in being able to receive reimbursement. Montana Medicaid does not recognize me as a provider, so I can’t help my Medicaid patients. And private insurance is hit or miss. And so, you know, that really just is a big bummer for pharmacies who want to provide these other services. But just know that that is out there, that Medicare has been a successful platform for me. And then now, as so many independent pharmacies are struggling with health. I kind of fell in this spot where I don’t have a lot of help in my pharmacy with other pharmacists. And so, I really had to pull back on some of these things, but I’m still kind of that go-to person for diabetes education and support. And so that led me down the path to create a digital solution.  It’s an app-based website. So now people can have that in their pocket whenever they need it. So yeah, that’s kind of my background story and how we got where I am now. 

Bonnie E. Bond, CPA, MBA: Wow, that’s awesome. And how interesting, I mean, that is a great thing. Number one, it would be great for any pharmacy to have, but to have you understand it is the next level to be able to offer that. know I’ve had someone years ago, a friend of mine, that’s son got diagnosed, you know, as a six-year-old.  And it was just so stressful. And the doctors and nurses can only help you, but so much. And so, she got a lot of assistance from our local pharmacy or pharmacist but it wasn’t in a program. It was just kind of like, let me help you as much as I can. And then this has happened again to another family in our area recently, and they’ve used that mother, that same one that I mentioned first, is kind of, that’s their person, because it’s the closest they have to someone that truly understands it. And they’re not obviously a doctor or a nurse or a pharmacist, but they’re just doing the best they can to help. So how great to have something from someone who truly understands it to be available. I know if I was going through that, that would be awesome to be able to come to you in a program like that. 

Scotty Sykes, CPA, CFP: So, what is the program, Leanna? What service are you offering? 

Leanna Schwend, PharmD, DCES: Yeah, so what we have going on right now is diabetes education and support tool. So, members are able to think about the whole scenario. If you go in for your annual, and all of a sudden, you’re getting all the blood work done, and the doctor comes in and says, guess what? You have diabetes. And in that moment, the person’s thinking, oh great, well now what? And the doctor’s thinking, okay, I have to write a prescription for a meter for test strips, metformin coming at you. By the way, you need to change your diet, exercise, lifestyle. And I don’t have time to give you all this education. I’ll make a referral, but by the way, you’re gonna wait. And that’s where we come in. We really help fill that gap. And at any point on someone’s journey living with diabetes. So, we fulfill the diabetes core content or the American Diabetes Care and Education Specialist, so we meet those criteria. We talk about nutrition, exercise, problem solving,  monitoring, reducing risk of complications, and healthy coping, which is so huge. Then Bonnie, you mentioned that peer support is another piece of the puzzle. And so, we’re able to now provide a safe community space for people to share their success stories, share their recipes. You know, just get the support that they need, not medical advice. Obviously, we don’t replace the face to face with the providers by any means, but were there to support and fill that gap with material that has been developed by certified educators, pharmacists, as well as registered dietitians. So there’s so many people out there right now. There are just rooms scrolling on TikTok or Facebook and just getting this advice that’s not correct. And so again, partnering with businesses, so pharmacies, direct primary care providers, non-profit, now we’re able to really reach the masses and those people are able to offer really great service to their patients as well. And like I said, you get a little bit of advice, right? You go to the pharmacy to counter, you pick up a meter or you get started on medication, that person goes home completely overwhelmed and they have more questions. And so now we can be there as a trusted source to help those people as well. 

Scotty Sykes, CPA, CFP: So, I’m just curious anybody out there thinking of getting into this. Is it like a weekly class that you’re doing or one-on-one coaching?  Just curious, you know, what that looks like. 

Leanna Schwend, PharmD, DCES: Yeah, so it’s really great because this is actually all on your time on your timetable. So, our classroom portion is filled with different modules that I mentioned, and we utilize micro learning. And so, I think post COVID our brains are just not capable of retaining a lot of information. Unless anybody here is education and classroom, and they’re like, yep, not doing it. But our material and content is retainable because we’re giving it to you bite sized pieces in the middle first that you can participate in while you’re waiting for your morning coffee, while you’re in line at the grocery store, you can double check about how to read a label.  Just those simple things that fit into everyday life.  We have text, we have videos, we have infographics, just all different sorts of learning that fits everybody’s style. We do have webinars up there as well. So, if people want to take 15 minutes, they can go through a whole three micro units at once. They’re able to do that. We bring in experts as well so that we can kind of pick their brains and get their golden nuggets. And so, we’re always looking for people in that space as well that want to contribute to the content and make real impact. 

Bonnie E. Bond, CPA, MBA: Yeah, and like you said, what you guys are offering is a kind of high-quality education, correct education. There’s a lot of great things on the internet. You can look up a YouTube video about anything, but is it correct? Is it safe? So, it’s good to know that you have, you know, that is available to people as well.  Fantastic. 

Leanna Schwend, PharmD, DCES: Yep, exactly. 

Bonnie E. Bond, CPA, MBA: So how would some, and I think I read as well, that you guys actually offer this education option too, to people who aren’t necessarily diagnosed yet. Maybe they just are prone to be or are worried that they could be and want to make changes or maybe it’s hereditary. But so, you offer education before the facts in some cases. 

Leanna Schwend, PharmD, DCES: Yeah, yes, our support tool is specifically designed for people diagnosed with diabetes at risk or those that support someone or the caregiver of someone with diabetes because to better understand and reduce the risk to pull the disease progression or to help the loved one, you need the education and support as well. And so that’s the other really cool thing about our tool is we’re always able to learn about our community and what they need. And so, the newest module going up that should hopefully be done in the next couple of weeks is specifically for the support person. How do you not become diabetes police? You know, how do you cook meals for the whole family when you’re the mom but the husband has diabetes and you’re raising kids with busy support schedules? And so we’re really able to kind of tackle all spectrums there as well. 

Bonnie E. Bond, CPA, MBA: Yeah, I love the…I would have never even considered it, but I love the idea with the caregiver piece. Again, I had a child spend the night with my daughter once that, you know, the mom dropped her off. She said, by the way, you know, because they were just used to it. She has diabetes. You just need to do this, this and that before she goes to bed and make sure this is ok. And I was like, “what? What has happened? I was panicking. So, I could see for grandparents and people like that that would have no clue that it would make, you know, it’d be a great learning tool for someone like that, that, you know, take care of the children at some different times that they can have education on it as well. So, I think that’s awesome. 

Leanna Schwend, PharmD, DCES: Yeah, and that’s, we’re finding really that those are actually the most motivated people to learn. For some reason, it is really hard to convince people to look into these things when they are diagnosed with diabetes, but the child taking care of the mom or the granddaughter taking care of the grandma, man, those people are motivated and they want to learn everything. And so it is really great to have a space where, you know, they can kind of become the educator in their home themselves and know that they are getting support and the right content to help care for people. 

Scotty Sykes, CPA, CFP: I guess this would apply, and this is me just being ignorant. Is this like type one and type two diabetes type service education? It doesn’t matter?  

Leanna Schwend, PharmD, DCES: It’s yeah, so it is. I will say that it is more geared towards people with type 2 diabetes. People with type 1 usually do need even more specific guidance. The principles are usually pretty much the same, but right now it is a little bit more specific to those individuals with type 2 or others with type 2. 

Scotty Sykes, CPA, CFP: And obviously diabetes is all over. It’s in every community and widespread in a lot of communities. And so, this seems like a really good opportunity for pharmacies to maybe find a little niche here and dip their toe in it and see if it’s something that can work for their market. 

Leanna Schwend, PharmD, DCES: Yeah, absolutely. 

Bonnie E. Bond, CPA, MBA: Yeah, and it’s like we’ve said, it’s really about pharmacies, independent pharmacies are really becoming health care centers if you’re doing it correctly and taking care of the whole patient like we’ve mentioned before too, just being that one stop shop for all of these things. And I think this is just another example of that is, you’re not just, again, not feeling just the script and passing it, you’re taking care of the patient. 

Leanna Schwend, PharmD, DCES: Yeah, exactly. And we were able to run a 90-day pilot with our program. And it’s true that independent pharmacists can make such a huge impact in this space, specifically with diabetes. I mean, right now, I think it’s something like 1 in 6 people are probably living with diabetes and if trends continue by 2050 or 2030, like 1 in 3. And so that is huge. And we’re still working to perfect our delivery method, and we know where we need to go with it because we were able to pilot what we want to have happen. And in that independent pharmacy setting, we were seeing a 90% opt-in rate and an 80% engagement rate with our content. And so when you look at what’s out there now for a traditional model for diabetes education support, it’s something like 7% to 10% that are eligible to receive it and are participating in it. And so, you know, we have a true space here where we can really dig in and improve the trajectory of diabetes as well as just help people with where they’re presently at on their journey. And so we’re constantly building, we’re constantly tweaking. And if any pharmacies are ever interested in being able to offer this to their patients, we have a lot of different models set up with it. It can be a service, it can be a revenue stream for them. And so yeah, we just, would love to talk to people who are passionate about clinical type services and, you know, helping their communities that really doesn’t take a lot of the pharmacist’s time at all. So. 

Scotty Sykes, CPA, CFP: So, it’s a pretty turnkey solution to get up and running. Is that fair to say? 

Leanna Schwend, PharmD, DCES: Yep, we are ready to go. Super turnkey. And yeah, the biggest effort on the pharmacist part is educating their patients on what it is and getting them enrolled. So, we take it from there. 

Bonnie E. Bond, CPA, MBA: So, what would be the first step for someone who, a pharmacy, that pharmacist that is looking to get into this, Leanna, what would you say? I mean, you said that accreditation was a little difficult. I’m assuming that’s the first step. 

Leanna Schwend, PharmD, DCES: So yeah, if someone did want to be able to bill for this, they would have to go through the accreditation process.  My team and I are happy to share our experiences and how to do that. We don’t have the manpower to help with that piece, but we know people who can help with the accreditation piece. If anybody wants to do the app and web-based program and this more turnkey solution, I can definitely get you guys my calendar link, but I’m also on LinkedIn. They can just send me a message as well. But we’ll just. 

Scotty Sykes, CPA, CFP: And this could also be a cash-based service, I’m guessing, if you don’t want to go through the accreditation process. Yeah. If you have that market. 

Leanna Schwend, PharmD, DCES: Yes. Yeah, that’s exactly it. That’s what our app is targeting is cash, the cash-based program. And it’s cheaper than a McDonald’s meals. It’s not expensive on the consumer’s part. If the pharmacy doesn’t even want to pass that on to their patients, it’s not expensive for the pharmacy. I’m an independent pharmacy owner, so I would never make or do something that I wouldn’t do myself. 

Bonnie E. Bond, CPA, CFP: Right. Yep, that makes sense. Well, this is a great example. Thank you for taking the time, Leanna, today to dive into this a little bit, to give our viewers and listeners, you know, spark some interest somewhere.  We always have clients that are, you know, asking things like, what else can I do? What else can I do? This is a perfect example. How to help the patient, number one, then also help those numbers. 

Leanna Schwend, PharmD, DCES: Awesome. Thank you guys for having me on today. 

Scotty Sykes, CPA, CFP: I appreciate having you. Thanks everyone for listening.