James Sheets and his partners decided to create a business that focused on home
immune globulin therapy, they didn’t really know what to call it. The
traditional dispensing pharmacy they already operated had a name: North Heights
Pharmacy. But they felt this local focus would limit this new venture, which
they expected to expand beyond their current Texas/Arkansas/Louisiana area.
I was presented with the challenge of coming up with a name, I didn’t really
have any ideas,” James says.
the time in late 2013, specialty pharmacies were just starting to emerge from
other fields of pharmacy, so James decided “specialty” would be part of the
name. He also wanted the word “clinical” to be in there, because with a team of
outstanding pharmacists with decades of infusion experience, he and his
business partner Barry Buls felt it was their commitment to providing
comprehensive clinical services that set this new business apart.
one night in the middle of the night James woke up from a dead sleep with a
picture of the whole plan.
sat up in bed and said, ‘Wait a minute. We’re going to call this thing Clinical
Specialty Infusions, and we’ll use the name CSI Pharmacy,’” he says. “People
will remember it, because they will think of the TV show Crime Scene
logo would be a thumbprint overlaid with a magnifying glass, also tying in the
idea of the detective. And the motto would be “Individualized therapies
designed to be as unique as you,” because, like one’s fingerprint, CSI
Pharmacy’s treatments are designed for the specific needs of each patient.
Pharmacy is now licensed in 39 states and the District of Columbia with plans
to acquire licenses in all 50 states. North Heights Pharmacy is still part of
the business, filling retail prescriptions in Texarkana, Arkansas. The headquarters, which includes an infusion center,
are based at a second physical location in Wake Village, Texas. Soon CSI plans
to expand their individualized care by acquiring new bricks-and-mortar
locations in at least two additional states.
are truly focused on making a difference in people’s lives,” James says. “And
I’ve always said if we take care of patients, if we are there for the prescribers,
and if we take good care of our employees, the rest will take care of itself.”
When Michelle Vogel joined CSI
Pharmacy as Vice President for Advocacy and Provider Relations in 2016, one of
the first things she did was take owner James Sheets to a support group for
From the very beginning, CSI had
been committed to caring for patients, not just filling prescriptions. But
until this point, the only interactions the pharmacists, nurses, and staff had
with patients was when they provided their infusions.
“He didn’t really know about working with patient communities, so I took him to participate in The Myositis Association support group in Houston,” Michelle says. “That’s when James became dedicated to helping patient communities.”
“I went there to talk about IVIG ,” James says. “I went in there thinking this will be great. I can really help this community learn a lot. But when I heard some of what patients were experiencing, I realized I had so much more to learn. That’s really where my passion for building relationships with the rare disease community came from.”
James and Michelle and some other
staff started making a habit of attending support group meetings, not just for
myositis, but for myasthenia gravis and other rare diseases that are part of
CSI’s patient community.
These support groups are a place where
people who live with a rare disease can get together with others who have the
same disease. At the meetings, patients and caregivers share their experiences
of dealing with the challenges of things like symptoms, treatments, and living
with chronic or disabling conditions. When they participate in these
gatherings, the CSI staff gain valuable insight into what their patients deal
with on a daily basis. It makes a difference in how the pharmacy works with
Knowing more about myositis as a
disease, for example, and the sorts of challenges patients face in dealing with
it gives CSI much more ammunition in helping them access treatments, most of which
are used “off label” and can be very expensive.
“When we’re working to get approvals from insurance
companies,” Michelle says, “we’re able to ensure that the patient meets the
diagnostic criteria of their individual health insurance plan. There is no
reason why these lifesaving therapies should be denied when we can submit it to
Having an advocacy program also supports
the physicians who prescribe treatments like immune globulin therapy, infused
and injected immune suppressants, and cutting-edge biologic treatments.
In addition to advocating for
patient access with insurance providers, Michelle can also help people find
copay assistance programs to help cover the expenses insurance doesn’t. There
are also some financial assistance programs that can help patients with extraordinary
medical expenses. And if a person’s insurance is too restrictive, she can help
them choose a plan that works more to their advantage.
And then there are the times when
CSI just needs to bend over backwards to get the patient their treatments. Michelle
tells a story, for example, of an uninsured patient who had been diagnosed with
myasthenia gravis. She had applied for social security disability and was
waiting for approval, so she would be eligible for Medicare, but it would be
three or four months before her hearing with a judge. Meanwhile, she needed
IVIG treatment to live.
Michelle was sure the judge would
approve the patient for social security disability, making her eligible for Medicare.
She also knew Medicare would cover the treatment retroactively. So, CSI agreed
to provide all the patient’s medications while she awaited approval. Michelle
even contacted the patient’s physicians to ask if they would waive their fees
during that waiting period. (They could always bill Medicare later.) Three
months later, the patient was approved, and the physicians and the pharmacy all
“We had to pay for everything in advance, but in the end it
all worked out,” Michelle says. “I don’t know of any other specialty pharmacy
that would do that. There’s that trust, that extra step for patients. That’s
really what you need, because if you do things right, it all comes back tenfold.”
“I’d always had a dream of owning a little mom-and-pop pharmacy,” says James
Sheets, CEO of CSI Pharmacy. He’d had a number of jobs working in both big box
pharmacies and smaller shops in and around his hometown of Texarkana, Texas,
and he preferred a small, local business where he and his staff could get to
know their customers.
In 2013, James’s dream came true when he and two other pharmacist friends,
Barry Buls and Mark McMurry, had the opportunity to partner up and purchase
North Heights Pharmacy, a shop that had been in business in Texarkana since
North Heights was doing some retail sales, but they also provided
medications for some local hospice services. They also did compounding, mixing
up specialized medications for individualized patient needs. The plan, when
James took over as chief pharmacist, was to build on these services, with
outstanding customer service as their main goal.
In a previous job, however, James had started a successful home infusion
program. The service provided treatments such as intravenous antibiotics,
cardiac medications, and intravenous nutrition. It was a way for patients to receive
these intensive treatments at home, rather than having to go to the hospital or
stay in a nursing home.
He wasn’t really trying to get back into home infusion services at North
Heights, but one day James got a call from a local neurologist who had several
patients who were desperate for someone to provide intravenous immune globulin
(IVIG) therapy in the home. These were people with chronic inflammatory
demyelinating polyneuropathy (CIDP) who had been cut off from this service
because the big national pharmacy chain that once provided it had decided it
wasn’t getting paid enough by the patients’ health insurance.
“These were patients who were stable on IVIG, who had been doing well for
years, yet they were losing their home infusion services,” James says.
“Naturally we wanted to take care of them. Some of these patients we knew from our
previous experience, so we already had a personal relationship with them.”
So James and his partners decided to go all in with home infusions,
especially IVIG. They made some infrastructure changes to add the necessary
facilities at North Heights, and they hired Tracy Knox, a nurse who specializes
in infusion therapies, to work just with these patients. They also hired
several other staff members who were experienced with the processes necessary
to administer infusions, including pharmacy technician Natalie Edwards, IV
technician Jet Richardson, intake coordinator Vanessa Noble, and Abe Cardenas,
who serves as warehouse manager.
The pharmacy also needed a new name, one that more accurately reflected this
new focus. Clinical Specialty Infusions
was born and immediately became CSI Pharmacy.
“What really sets us apart is that we’ve developed clinical programs around
the different types of patients we serve,” James says.
In addition to people with CIDP, CSI also has patient communities for those
with myositis and myasthenia gravis, both rare, autoimmune neuromuscular
diseases. A new patient community is also developing with people who live with pemphigus
and pemphigoid, which are rare autoimmune diseases that affect the skin and/or
In caring for these patients, James and his team don’t just take an order
from a physician and give the customer the medication. CSI hires or contracts
with infusion nurses who know how best to administer immune globulin and how to
monitor the patient during and after the treatment. More than that, though, they
work with the whole CSI team, including physicians, pharmacists, patient
advocates, and insurance staff to be sure the patient receives the individualized
care they need.
More importantly, because staff spend so much time with patients, both
administering the medications and working to get insurance coverage for these
expensive treatments, they get to know them as friends not just patients. Staff
and patients exchange personal stories, check in with each other, and share the
success when the patient’s condition improves.
Infusion nurse Tracy Knox, for example, has been working with James since
the beginning. “I can see the difference I’ve made in people’s lives, and I
like that,” she says. “I’ve been doing infusions for this one patient for many
years now. She used to have to use a wheelchair, but now I see her in Walmart
and she’ll say, ‘Look! I can walk with a cane now!’”
Over the past few years, CSI has grown from a small, hometown pharmacy into
a thriving nationwide specialty pharmacy with two physical locations and plans
for more and a mission to make sure every patient receives the care she or he
needs regardless of how much they get paid for it.