Current Issues Facing Independent Pharmacies

            Community pharmacy has long been the backbone of pharmacy practice and has been what the average person thinks of when they are asked the question “What is a pharmacist?”. Over the years the practice has undergone quite a few changes but one of the many consistencies are the local, independently owned pharmacies. However, that is beginning to change. According to the NCPA digest, in 2011 there were 23,106 independent pharmacies while in 2017 21,909 which is a relatively significant decrease. This begs the question of why the amount of independent pharmacies is decreasing instead of increasing, or at least staying relatively level. I believe there are a few big reasons for this decline. 

            First, in general the reimbursement rates for pharmacies, even chains, have decreased over time. This mainly stems from the fact that there are three (CVS Health, OptumRx and Express Scripts) main Pharmacy Benefit Managers (PBM’s) that manage and pay for the vast majority of claims. These three companies have overwhelming control on how much pharmacies get reimbursed, what copays will be for patients and even in some cases, where and how a patient’s prescriptions are filled. For instance, a patient with insurance through CVS Caremark who is a longstanding patient with one particular pharmacy may have to transfer to a CVS location solely due to the fact that they have CVS insurance. This does not seem like a fair practice to me. I understand that it is a cost saving measure on the part of CVS, but it seems that practices like these will not only hurt competing pharmacies but could also hurt the patient by potentially ruining longstanding pharmacist-patient relationships. 

            Additionally, many PBM’s have instituted policies such as DIR fees and clawbacks that have had a substantially negative effect on the bottom line of many independent pharmacies. How this works is a pharmacy will submit a claim and the copay will come out to be significantly inflated, often close to or quite higher than what the cash price, and the acquisition cost for the pharmacy, would be for the medication. The PBM will then take a large portion of the profit made on that prescription for themselves and leave the pharmacy with a very small amount that can often be lower than their acquisition cost for the drug. Furthermore, pharmacists can also be under gag clauses from the PBM’s that prohibit them from informing the patient that their copay is inflated and that there are cheaper methods of obtaining the medication. This causes problems on two fronts, first, it causes patients to pay more money and potentially lose access to needed medications. Second, it can cause many of the smaller independent pharmacies to lose money and patients due to high costs. 

            Independent pharmacies can provide excellent patient care due to the ability of the patient pharmacist relationship to develop much more closely. Having worked in multiple retail settings, I can comfortably say that the patients at the independent I worked at seemed to have a significantly higher satisfaction level with the service we were able to give compared to that of the chains. Many were, and still are, very appreciative that their pharmacist is looking out for them and paying close attention to any issues that may arise with their medications. I am sure that independent pharmacies will still be viable for years to come. However, it is getting continually harder for these pharmacies to be sustainable and carry out the high level of service that their patients have become accustomed to.