WASHINGTON - If House Speaker Paul Ryan comes down with the flu this winter, he and his security detail won't be screeching off toward the closest CVS for his Tamiflu.
Instead, he can just walk downstairs and pick up the pills, part of a little-known perk open to every member of Congress, from Ryan and Majority Leader Mitch McConnell down to the newest freshman Democrat.
Nearly every day for at least two decades pharmaceutical drugs have been brought by the carload to the Capitol - an arrangement so under the radar that even pharmacy lobbyists who regularly pitch Congress on their industry aren't aware of it.
The deliveries arrive at the secretive Office of the Attending Physician, an elaborate medical clinic where Navy doctors triage medical emergencies and provide basic health care for lawmakers who pay an annual fee of just over $600. Every one comes from Washington's oldest community pharmacy, Grubb's.
Mike Kim, the reserved pharmacist-turned-owner of the pharmacy, said he has gotten used to knowing the most sensitive details about some of the most famous people in Washington.
"At first it's cool, and then you realize, I'm filling some drugs that are for some pretty serious health problems as well. And these are the people that are running the country," Kim said, listing treatments for conditions like diabetes and Alzheimer's.
"It makes you kind of sit back and say, ‘Wow, they're making the highest laws of the land and they might not even remember what happened yesterday.'"
Kim's tiny pharmacy - which, at its busiest, sends as many as 100 prescriptions to members in a day - is nestled among Capitol Hill's stateliest row houses, less than four blocks from the Capitol building itself. Founded in 1867 and named for a previous owner, the pharmacy predates penicillin, the American health insurance system, and even the Lincoln Memorial.
The two-story shop, with its bay windows and wood counters, harkens back to that history, though the computer systems and supplements inside aren't far removed from your typical Walgreens counter - if all of Walgreens's inventory was shoved into the nooks and crannies of three small aisles and labeled with individual stickers. At Grubb's, staff will even scoop Hershey's ice cream into cones out of a small counter in the corner, a modern-day nod to the marble-topped soda fountain once popular with the neighborhood kids.
The pharmacy mostly serves the staffers, lobbyists, and families who make their home in the quiet, leafy neighborhood just to the east of the Capitol building, though Grubb's five drivers will deliver prescriptions across the entire city. Some 800 prescriptions leave its doors every day, filled by some three dozen pharmacists, technicians, and support staff.
The relationship between Grubb's and the Capitol has gone nearly unchanged for decades, even as congressional leaders have pushed again and again to overhaul the nation's broader health care system.
For the most part, lawmakers get the same prescription delivery service that any other customer of Grubb's does. The pharmacy still bills each lawmaker's insurance plan, whether it's Obamacare, Medicare, or a local plan back in their district. Grubb's keeps credit card information on file for copays and other purchases. There aren't any discounts, Kim said. No special treatment.
Members of Congress do, however, sometimes get to skip the lines that other Grubb's customers face - simply because of who they are.
"The Capitol kind of takes somewhat of a precedence just because of who we're servicing," Kim said, glancing toward the stately building from the front window of his shop. "The member might be calling to say, ‘Hey, I'm about to leave in five minutes, where's my drug? So [the clinicians at the Capitol] get into panic mode as well. I wouldn't say they've ever gotten frustrated with us, but it's more of a concern like, ‘Oh my gosh, the member just called us, we need to know where the drug is.'"
Those busy moments are much more prevalent in winter, when lawmakers have been in session for a while and when they might be facing more late-night vote series, Kim said. During August recess, the Capitol pharmacy business - like much of the rest of Washington's economy - slows considerably.
Most lawmakers know far more about the Office of the Attending Physician than about Grubb's or its arrangement with Congress. In a STAT survey of some two dozen House and Senate members from both parties, only one knew about the single pharmacy that delivers all their drugs: Congress's only pharmacist, Rep. Buddy Carter (R-Ga.).
"It's a great opportunity for us as pharmacists, also, to showcase what we do, because that's exactly what we do is take care of patients," Carter told STAT. "This is another example of how we go above and beyond our call of duty to help people in health care."
Others were quick to praise the Navy doctors and nurses in the Office of the Attending Physician, which counts at least one pharmacist and several technicians on its staff, too.
"If you have a vote and you can't get home to your personal physician, you need to see somebody, and I'll run over between votes and be able to keep my personal responsibilities going," said Sen. Bill Cassidy, a Louisiana Republican. "It's a convenience that definitely allows us to be more productive."
"They're good people, they're always courteous. It's a very difficult job they had, never had anything but the utmost cooperation from them - but don't tell them that! They've injured me on several occasions," Sen. John McCain (R-Ariz.) joked recently to STAT.
Lawmakers describe the Office of the Attending Physician as a modern space much like a regular doctor's office - though the $3.7 million budget it enjoyed for 2016 suggests a relatively well-furnished space. It's strictly off-limits to reporters; staff there declined repeated requests for comment, and a spokesman for the House Administration Committee that helps oversee OAP declined multiple follow-up inquiries.
That's perhaps because the office is not without controversy. Its services - and the relatively low fees that members must pay for access - were thrust into a harsh spotlight in 2009, as Congress began to debate the Affordable Care Act and as reporters began to ask how lawmakers' own care might color their perspectives on policy. The central issue is the cost: In 2016, lawmakers paid $611 for annual membership - a fee that, unlike most health care prices, has risen much slower than inflation. In 1992, the first year the office charged a fee, it was $520.
The Office of the Attending Physician itself was formed in 1928, after three members of Congress died in their offices within months of one another - more than 50 years after Grubb's first opened its doors.
But the pharmacy services at the Capitol may go back even further - a 1911 text on senatorial privileges describes an "assortment of drugs and viands, tonics and recuperatives" on hand and "readily accessible" for lawmakers. Back then, reportedly, senators took tablet after tablet and vial after vial of quinine, pepsin, and calomel, "endless supplies of cough drops," and something described as "dandruff cure."
It's not clear how long Congress has contracted with Grubb's to provide private prescriptions, but a 1992 review of the OAP - hastened after one senator threatened to make his colleagues pay market prices for the free care they got at OAP - decreed that prescription pharmaceuticals for lawmakers should be obtained through private pharmacies and paid for by the lawmakers themselves, according to a memo shared with STAT by the Senate historian.
It's not clear, either, just how many drugs the OAP keeps on hand, whether for members or emergencies. But Dr. Lee Mandel, a retired Navy physician who spent several years working for OAP in the 1980s, remembers a well-stocked pharmacy just off the main corridor under the speaker's office.
"We provided some pretty comprehensive service, to keep the members doing their jobs so they didn't have to go look for a doctor," he told STAT. "As far as all medications, I don't know - maybe the more exotic ones we didn't - but probably we did stock [most drugs] on their behalf."
Kim, 47, knows only that the OAP's relationship with Grubb's has existed since at least 1997, when he joined the staff part-time as he finished his training at Howard University.
Not much has changed since then, though enhanced security protocols after 9/11 ended the pharmacy's practice of driving each prescription to an individual member's office and collecting cash in-person. Now, the drivers - all of whom have undergone a Capitol Police background check - head straight to OAP.
After 20 years at Grubb's, Kim himself isn't nearly so starstruck by the lawmakers. Even when they stop by the shop in-person, he said they're just like any other customer.
"I still remember John Kerry - it was literally like the day after he lost [the 2004 presidential election], he came in and he was just standing in line with everybody else," Kim recalled. "I just remember seeing him standing in line and almost feeling sorry for him - one day he's a superstar, he's got his entourage and security detail, and the next day he's just by himself, he's picking up his prescription."
Though Kim himself is active in the National Community Pharmacists Association that lobbies on behalf of the industry, he said he usually doesn't push lawmakers to talk shop when they're in line as customers.
"You know, they gently push it aside and say, ‘Well, let's set up a meeting,'" he said. "Unless they're involved in one of the topics in pharmacy, they probably don't know what's going on. But they don't want to say they don't know, so they say, ‘Oh, I don't have time right now.'"
Although he isn't lobbying Congress, Kim is still working to improve his relationship with OAP. He desperately wants the office to use an electronic system to route prescriptions to the pharmacy, rather than having their physicians call them in every time.
The "back to back" calls are slowing down the rest of his business, and he thinks it's important to have a clearer record of what prescriptions are ordered than a phone call can provide.
Those frustrations aside, however, Kim is proud of the work he does for the powerful figures who dominate Washington's attention.
"It's definitely a special arrangement that no other pharmacy in the country can say that they have," he said. "In other states, [a community pharmacy] may fill prescriptions for maybe one or two members. But this location, you're getting like every member from all across the country. It's very cool."
Correction: A previous version of this article misstated the budget for the Office of the Attending Physician.