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The Future of Independent Pharmacies: Innovations and Challenges

Updated: Sep 17, 2023


I have seen a lot of changes in the healthcare industry since I started in 2001. I have seen the costs of healthcare soar and actual health of patients decline. I have seen the greed of the food industry, “big pharma”, and other healthcare players taking billions from consumers with little to show for it. I have seen mergers between companies that result in a large share of the healthcare process from the ground up and everything in between in the hands of one major chain. This has given an immense amount of power to just a few. You would think it would be illegal, but somehow it has been allowed.


After the crazy demands on pharmacies during the COVID-19 pandemic, many pharmacists and technicians burned out and said, “enough is enough.” Now these large corporations who abused their workers during the pandemic are whining about a “shortage” of pharmacists and technicians. Let me be perfectly clear: there is no shortage.


I have written about some of my experiences in a couple of previous posts: Thank Your Pharmacy Staff...Please. (dramyknaperek.com) and Dark Days (dramyknaperek.com). My experiences at a large chain are not unique, and those who continue to show up are still being abused in those positions. The staffing issues were created by these big corporations because they didn't take care of the staff that they had, and the workers had enough. They left. Burned out. Found other places to go. Some even left the pharmacy industry altogether. What we are seeing at the chain retail stores are the direct consequences of decisions made by corporate executives.


So, I’m here to tell you that you can help!


But let’s take a moment to talk about some of the players.


The big chains want you to think that they are the only option available to you for your prescription medications. One chain, who also owns multiple Prescription Benefits Managers, directs patients to their pharmacies with the promise of better prices or excludes other pharmacies from their network, so they seem like the only option.


Pharmacy Benefits Managers are middleman companies that offered their services to help manage the pharmacy side of health benefits. These middlemen soon discovered that they could negotiate prices on specific medications, claw back fees from the pharmacies (called DIR fees), dictate healthcare treatment plans (formularies, prior authorizations), and offer rebates for specific medications. These middlemen made $495 BILLION in 2022. But what benefits are they really providing (other than raising prices on medications and making billions of dollars)?


I’m encouraged by states like Oklahoma that are starting to take a closer look at PBM corruption and practices that have increased the drug costs in the US. But let’s look at the intended purpose of PBMs.


PBMs create formularies, which are lists of medications that are covered, most put them on a tiered system where generics are a lower price than brand name products. Some medications can be part of the formulary but require prior authorization. Prior authorizations require the prescriber to document why they are choosing a specific therapy over a cheaper alternative. This is supposed to keep prices low and decrease over-prescribing of unnecessary medications. However, we have seen costs of healthcare and prescription medications increasing and PBMs getting a large chunk of that money. Hmm.


PBMs can alert pharmacies to potential drug-interactions with medications filled at another pharmacy (but only if they are filled under the insurance plan). For a pharmacist to properly evaluate if your prescription is appropriate, they need to know what else you are taking. There can be some life-threatening interactions between medications. If you do not fill all your medications at the same pharmacy, it can be difficult for the pharmacist to properly determine the safety of dispensing your prescription. Your doctor may also not know about the other medications that you take if you see multiple practitioners (think specialists) if you do not tell them the other medications you take.

So, if you fill all your prescriptions at the same pharmacy or bring your medication list with you, the pharmacist can review your medications for interactions. Is the PBM necessary for that? Hmm…


PBMs also offer mail-order services for prescriptions – again to “save money.” However, they will sometimes refill your prescriptions for 90-day supplies whether you need them or not. Sometimes a practitioner will stop a medication, but that message is not given to the pharmacy (mail-order or otherwise), so if it is on “auto-fill”, the medication will be filled and dispensed. Sometimes a patient is hospitalized, so their bottle of medication is not used while they are in the hospital. They would not need a refill at the predetermined time, but because it is on a schedule, it is filled anyway. Some pharmacists report seeing multiple 90-day bottles of medication (unused) sitting at a patient’s house…this is so wasteful and confusing!


Furthermore, if there is an issue with your mail-order service, it is very difficult to get the issue resolved. More and more, I see prescriptions sent to the local pharmacy to cover for a mail-order prescription that was lost, stolen, not shipped, etc. Why not get your prescriptions filled at a pharmacy where you can look the pharmacist in the eye? Hmmm…


So…that’s a look at PBMs. What about those big chains? Like I said…they want you to think they are the only game in town. They preach about their convenience when traveling (easy transfers between states) or late hours (24-hour locations). They want to be a household name…the first that you think of when you are at the corner of sick and tired. They want you to come visit soon for all your health, wellness, and convenience needs. BUT…what is the reality of retail chains right now?


Shortened or sporadic hours due to less staff. Long lines. Longer wait times. The staff that still shows up is stressed out trying to be everything for everyone. They are still providing COVID tests, COVID shots, and COVID medications. Now, some are giving flu tests (in the same place you get your flu shot). Phones are ringing off the hook with no one to answer them. Prescriptions are getting backed up by the hundreds with no one to fill them. Pharmacists and technicians are feeling overwhelmed and just try to get through the day. Is anyone critically looking at your prescriptions to make sure your new medication is appropriate? I hope so, but there is no guarantee.


So…what can you do?


Have you heard about independent pharmacies? There are over 21,000 of them in the United States. Many independent pharmacies can offer services that the bigger chains can’t. They can offer services like specialized compounding, delivery, adherence packaging, wellness services (cholesterol screening, blood pressure screening, bone density testing, diabetes screening), comprehensive medication reviews, pharmacogenomics, high-quality supplement recommendations…the list goes on and on. When was the last time you could spend 15-20 minutes talking to your pharmacist about your medications? (When was the last time you could do that with your primary care doctor?)


Here is another little secret. The cash prices for medications may be cheaper at an independent pharmacy than your copay at your large chain retail store. What?!? Yes…independent pharmacies usually have access to multiple suppliers, so they can find the best deals on a particular medication.

Here is another point. What if your independent pharmacist could help coach you with lifestyle choices, diet, exercise, etc. to reduce or eliminate your prescription medications? Many of them are specially trained to do just that! Lifestyle choices are linked to many of our chronic disease states and independent pharmacists are in a prime place to help you reverse those chronic diseases. Find pharmacists who are trained in Lifestyle Medicine, Functional Medicine, or Integrative Medicine! These specialists can help you jump off the pill treadmill!


So, help us save our independent pharmacies! Go talk to your local pharmacist about the services they provide. The large chains are NOT your only option. The large chains may not have your health and safety in mind (though I’m sure the pharmacists and technicians are trying). Work with a health coach to make lifestyle choices to reverse your chronic diseases and reduce your pill burden.


Are you ready to start your journey to a healthier, more balanced life?

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