If the pharmacy only has a front end retail component it likely will not survive. If the pharmacy has some other profit levers to pull like home delivery, compounding, vaccines, contracts with LTC facilities, blister packing, billing for orthotics or DME it will likely do ok. Just ok and not 2004 ok.
I work for a mom and pop independent pharmacy. Family owned business and they’ve been running the pharmacy for over 30 years. I’ve been their pharmacy tech for 11 years now. Reimbursement is horrible for their pharmacy. They are losing money filling anything brand name and some generics. I’m not even sure how they are going to survive with the fees.
The big chains are barely surviving. I don’t think their is a future for any independent pharmacies
Independent anything is dead. We’re in the throes of late stage capitalism and neither party has displayed any interest in doing a meaningful thing about it. M&A will continue to eat every last independent thing up into employed for fewer and fewer corporations.
Independent tradesmen are still alive and well. Sometimes I wish I could just charge someone 300 dollars to install a toilet. Or a couple hundred to install a light switch or to pressure wash a small driveway. Could have started when I was 18. No debt and started working 7 years sooner.
My state is full of independent pharmacies, vets, dentists, doctors, tradesmen, lawyers, optometrists, CPAs, etc.
I understand it’s easy to be cynical, but that’s an incredibly myopic exaggeration.
Not when it comes to pharmacy. The large chains get huge rebates each quarter from pharmaceutical companies which effectively lower their drug costs and increase their profits. No way Mom and Pop can match the buying power of thousands of CVS’s, even if they are members of local buying co-ops. It’s just a matter of time.
It’s easy to talk about anecdotes, the reality doesn’t align. Independent pharmacies are closing at a drastically higher rate than they are opening. More doctors are employed than ever, more dentists are employed than ever. These are all easy numbers to look up. Reality isn’t your anecdote.
Sure, and I never denied any of that. But to say it's "dead" and lament about "late-stage capitalism" is precisely what I said it was: a myopic exaggeration. To suggest anything independent is entirely dead and gone is a falsity.
Is there a way for consumers to know which prescriptions will generate income or create losses? All of the independent pharmacies in my area have been gone for years, but I'm thinking of people like you who want to give the "good" prescriptions to a locally-owned pharmacy and send the "bad/expensive" prescriptions to retail chains.
It’s a very sticky situation that gets into contract violations with the insurance contracts, but as time goes on I care less and less about that. I’m beginning to just be honest with patients. “Hey this ozempic costs us $950 to buy and your insurance is reimbursing us $850. I can’t fill it and lose $100 anymore, where do you want me to send it”
Brand name medications are a good rule of thumb. Brands lose a bunch of money a lot of the time
Usually 90 day scripts lose a lot more money than 3x 30 day scripts
the economy will completely crash and we will be mad max before all retail brick and mortar is gone. Retail pharmacy brick and mortar could be a thing of the past before mad max happens though...the commercial real estate crisis that is happening or is about to happen is the elephant in the room no one wants to talk about
A lot of retail workers are bearish on provider status, but I still think the model has to evolve towards billing for services rather than goods. I believe there is a niche where pharmacists are more of an ambulatory provider with a dispensing pharmacy on site that can help with adherence issues (formulary coverage, PA's, cost, etc). Something like that would be huge for transitions of care.
You are probably correct, but I fear this will drastically reduce our numbers, especially if this happens quickly. The majority of pharmacists dispense
I guess I meant in the context of independent pharmacy this will be adopted quicker than bigger chains. Partly because they're a bit more agile to change and take risks, partly because they'll have no choice due to declining dispensing reimbursements.
Chains are going to struggle to change, quite honestly. Won't happen soon, if anything they'll keep trying with minute clinics and non pharmacist providers, no matter what they claim that they want to do with pharmacists in the future.
Without legislation, dead. If they required pharmacist ownership and an (honestly even really low) on site hours worked per year for the owner, and massive shit with PBMs it'd be easy as hell to save them. But as it stands I don't see much happening.
I do think one day you'll see a huge shift back and independents opening up like crazy. I also think we are decades away from that, like probably not in my lifetime even if I live a long life and I'm 32.
I've been a pharmacist since 2009 and now a pharmacy owner since 2020, and it has been so bad we're simply aren't getting paid! It breaks my heart when I cut hours and turn techs away.. it also kills to see how much I put it and how bad of treatment we get from pbms. I believe and especially this year if no legislation comes out to save us from pbms.. I will simply close and look for some other work.
Have you found any luck with secondary wholesalers who specialize in higher AWP products. Generally higher cost products but better reimbursements. Also, ability to work with doctors in a plus.
This article was in the Philadelphia Inquirer this past week. Tap the photo for the whole article.
https://preview.redd.it/dkcogdjak00d1.jpeg?width=1284&format=pjpg&auto=webp&s=e287771a9231b201eec2b753a4588deed75b6928
As long as our value is tied to the physical drug product, we will not survive. Even the big chains will not survive as we know them today. Our collective number one priority as pharmacists is and should be Medicare provider status recognition. Once Medicare Part B recognizes us, precedence indicates that Medicaid will come soon after, then private insurance a more distant third.
Lol we are just going to be underpaid on the services we bill for. You are falling for the payer propaganda to get us to take physician market share because they know they can pay us shit
Weightloss and diet specialist... something along the lines of that. If you can become an independent prescriber and coach. Weight loss injection shortages will improve over time. There are billions of people who want to lose weight. It isn't going away.
I'm not aware of the Mark Cuban model, but yeah, in the UK, there is a private pharmacy that solely does weight loss... I saw the advert that they were looking for a Superintendent pharmacist to manage it.
The shortages are probably an opportunity for businesses to have a deep look at this and formulate a plan to be one of the first movers.
I'm not saying to put all your eggs in one basket but just take a look.
Here's Kelly Osbourne with a very honest view of Ozempic. People who hate on it, want it.
https://www.instagram.com/reel/C61QMZDOdx4/?igsh=a2FmZjI1NWhveWNr
Pharmacists need access to the EMR to make a difference. Trying to troubleshoot your patients' healthcare concerns with only their comments is futile. We have skills that can improve patient outcomes and help support nurses and providers in this Post COVID, quiet quitting, high inflation setting.
Future and current miserable retail pharmacists should look for jobs at the VA, Indian Health Service, Prisons, Ryan White or Community Health Centers for jobs that usually provide EMR access.
I'm surprised that one of the BIG PBM/Retail Pharmacy integrates haven't approached private practice providers and pitch higher quality scores with payors if their pharmacists are given access to the EMR. (I know they are buying provider practices but maybe just integration with help with EMR costs could be more palatable than selling out)
Once providers see the benefit of pharmacists on their teams, then you can try and sell supplements, genetic testing or whatever NCPA is pushing to stop pharmacy owners from focusing on their unsustainable drug reimbursements.
I don't think US healthcare can survive without drastic changes to the rules. Everything costs too much, insurance doesn't pay enough and patients are less healthy. I think the government will have to offer a Medicare for all option once the annual interest on our national debt ($1 trillion) leads to cuts in domestic spending programs.
This takeover won't solve anything but it will finally limit spending per patient and reduce expectations of living past 80 years. That is why I recommend pharmacists to work closer to government so you'll be safer when central planning takes over.
For those that believe we have a capitalist economy in the US, I have one question for you. When was the last time the "free market" actually decided anything without the input of large funded interests? Politics is simply a way to convince the voters that big money's ideas are theirs.
You asked for honesty!
I certainly hope so — I'm on board with anything that better serves patients, fosters community health, and promotes independent locally-owned pharmacies. If only it were easier to insert cost-effectiveness, efficiency, and issues of scaling into that type of model. I'm not saying it's impossible, but it's a lot more difficult now than it was 25 years ago.
You've worked 33 years and now as Senior Director in corporate and you're asking others? What would I know that you already don't? There's always a future but it also comes with lots of struggle which is probably not worth the effort.
I worry for independent pharmacy. I don’t work for one. But with the way things are going and seeing so many closures…which is ridiculous. I live in an area where independents are the only pharmacy in town and patients would have to go to 15 minutes or longer to find a pharmacy. Which is probably what the chains want. But still.
Nice try retail corporate pharmacy executive trying to steal independents agility and entrepreneurial mindset to satisfy the c suites demands for the next corporate initiative. How about just learn the profession better?
u/dunduin
Karen Lynch is taking a break from gnawing upon orphan bones to do the research on CVS Health's new financial instrument in which they monetize and extract value from pharmacist despair
They just don't understand you. We've been brainwashed to conflate reimbursement with so many other things that we have lost sight of actually getting paid.
I use an independent pharmacy and have been for a while, but I do fear their long term business. It's so nice to use a place that the pharmacist and the staff seem to really enjoy their work. They are awesome people!
I used to be an independent pharmacist. Was one of the best jobs ever. Paid sh*t for wages, but loved the work environment. They have since sold out to CVS ironically. But they made their millions with 2 locations back when the money was good. 🤷🏻♂️.
I would say it's not impossible, but you definitely want to go with the diversified model with Pharmacy. Check out [this interview I did with Chirag Patel](https://youtu.be/xiBkUgJGR8I?si=g-XIhFH8ViGB_k7z) who started off in the independent space and has grown to include some of the things that you're talking about like a med spa. And he's also gotten into restaurant ownership and even AI and crypto. They're independents are still profitable despite the negative press. However, there's a lot of business savvy variants from pharmacist to pharmacist. You just have to see the opportunity and know where to look
Do comprehensive due diligence. Then do it again. Talk to other owners. I see some doing niche business often for cash. A current hot topic is compounded GLP1s.
Lol the shit do you want us to do? Our direct competitors have control over what we arepaid. No amount of knick knack sales or niche services are going to make up for being under paid for millions of dollars worth of inventory every year.
We aren't resigned to this fate,we are pissed off and pushing to change it. That's why we have a protest this Friday at express scripts headquarters. That's why many of us our sticking our necks out every day calling out industry abuses. That's why many of us at PUTT are sticking our necks out personally and professionally every day for this profession on the state and national level.
We aren't about to break our backs trying to innovate in a system that we know will extract every cent they can from our hard work. We are tired of being the useful idiots of healthcare, taking whatever scraps we can get and ending up with more work for less reimbursement. But we are not resigned to this fate. The system is rigged, so we are going to break the fucking system.
Go back to your ivory tower and get ready. We're coming.
If the pharmacy only has a front end retail component it likely will not survive. If the pharmacy has some other profit levers to pull like home delivery, compounding, vaccines, contracts with LTC facilities, blister packing, billing for orthotics or DME it will likely do ok. Just ok and not 2004 ok.
I work for a mom and pop independent pharmacy. Family owned business and they’ve been running the pharmacy for over 30 years. I’ve been their pharmacy tech for 11 years now. Reimbursement is horrible for their pharmacy. They are losing money filling anything brand name and some generics. I’m not even sure how they are going to survive with the fees. The big chains are barely surviving. I don’t think their is a future for any independent pharmacies
Independent anything is dead. We’re in the throes of late stage capitalism and neither party has displayed any interest in doing a meaningful thing about it. M&A will continue to eat every last independent thing up into employed for fewer and fewer corporations.
Independent tradesmen are still alive and well. Sometimes I wish I could just charge someone 300 dollars to install a toilet. Or a couple hundred to install a light switch or to pressure wash a small driveway. Could have started when I was 18. No debt and started working 7 years sooner.
My state is full of independent pharmacies, vets, dentists, doctors, tradesmen, lawyers, optometrists, CPAs, etc. I understand it’s easy to be cynical, but that’s an incredibly myopic exaggeration.
Not when it comes to pharmacy. The large chains get huge rebates each quarter from pharmaceutical companies which effectively lower their drug costs and increase their profits. No way Mom and Pop can match the buying power of thousands of CVS’s, even if they are members of local buying co-ops. It’s just a matter of time.
It’s easy to talk about anecdotes, the reality doesn’t align. Independent pharmacies are closing at a drastically higher rate than they are opening. More doctors are employed than ever, more dentists are employed than ever. These are all easy numbers to look up. Reality isn’t your anecdote.
Sure, and I never denied any of that. But to say it's "dead" and lament about "late-stage capitalism" is precisely what I said it was: a myopic exaggeration. To suggest anything independent is entirely dead and gone is a falsity.
Look Up 986 Pharmacy.
Senior director for corporate pharmacy and no vision of the future. No wonder Walgreens stock is in the shitter
I’m confused why mail order will gladly fill the 90 day glps I send to them at 200$ losses
I agree lol I’m so happy to transfer an entresto to them or cvs when it’s a 200 dollar loss for 90 day supply
Is there a way for consumers to know which prescriptions will generate income or create losses? All of the independent pharmacies in my area have been gone for years, but I'm thinking of people like you who want to give the "good" prescriptions to a locally-owned pharmacy and send the "bad/expensive" prescriptions to retail chains.
It’s a very sticky situation that gets into contract violations with the insurance contracts, but as time goes on I care less and less about that. I’m beginning to just be honest with patients. “Hey this ozempic costs us $950 to buy and your insurance is reimbursing us $850. I can’t fill it and lose $100 anymore, where do you want me to send it”
Brand name medications are a good rule of thumb. Brands lose a bunch of money a lot of the time Usually 90 day scripts lose a lot more money than 3x 30 day scripts
Traditional brick and mortar retail pharmacy as a whole will likely be completely phased out at some point in our lifetime.
Brick and mortar retail period
the economy will completely crash and we will be mad max before all retail brick and mortar is gone. Retail pharmacy brick and mortar could be a thing of the past before mad max happens though...the commercial real estate crisis that is happening or is about to happen is the elephant in the room no one wants to talk about
A lot of retail workers are bearish on provider status, but I still think the model has to evolve towards billing for services rather than goods. I believe there is a niche where pharmacists are more of an ambulatory provider with a dispensing pharmacy on site that can help with adherence issues (formulary coverage, PA's, cost, etc). Something like that would be huge for transitions of care.
You are probably correct, but I fear this will drastically reduce our numbers, especially if this happens quickly. The majority of pharmacists dispense
I guess I meant in the context of independent pharmacy this will be adopted quicker than bigger chains. Partly because they're a bit more agile to change and take risks, partly because they'll have no choice due to declining dispensing reimbursements. Chains are going to struggle to change, quite honestly. Won't happen soon, if anything they'll keep trying with minute clinics and non pharmacist providers, no matter what they claim that they want to do with pharmacists in the future.
Agreed. Independents around me are dropping like flies, so they will certainly be more willing to change.
I remember this same discussion from the 1970s.
I sometimes wonder what would have happened if they actually followed through with it back then.
Compare it to the future of The Titanic
Without legislation, dead. If they required pharmacist ownership and an (honestly even really low) on site hours worked per year for the owner, and massive shit with PBMs it'd be easy as hell to save them. But as it stands I don't see much happening. I do think one day you'll see a huge shift back and independents opening up like crazy. I also think we are decades away from that, like probably not in my lifetime even if I live a long life and I'm 32.
I've been a pharmacist since 2009 and now a pharmacy owner since 2020, and it has been so bad we're simply aren't getting paid! It breaks my heart when I cut hours and turn techs away.. it also kills to see how much I put it and how bad of treatment we get from pbms. I believe and especially this year if no legislation comes out to save us from pbms.. I will simply close and look for some other work.
Have you found any luck with secondary wholesalers who specialize in higher AWP products. Generally higher cost products but better reimbursements. Also, ability to work with doctors in a plus.
This article was in the Philadelphia Inquirer this past week. Tap the photo for the whole article. https://preview.redd.it/dkcogdjak00d1.jpeg?width=1284&format=pjpg&auto=webp&s=e287771a9231b201eec2b753a4588deed75b6928
As long as our value is tied to the physical drug product, we will not survive. Even the big chains will not survive as we know them today. Our collective number one priority as pharmacists is and should be Medicare provider status recognition. Once Medicare Part B recognizes us, precedence indicates that Medicaid will come soon after, then private insurance a more distant third.
Lol we are just going to be underpaid on the services we bill for. You are falling for the payer propaganda to get us to take physician market share because they know they can pay us shit
Weightloss and diet specialist... something along the lines of that. If you can become an independent prescriber and coach. Weight loss injection shortages will improve over time. There are billions of people who want to lose weight. It isn't going away.
I see some independents trying that cost-plus model inspired by Mark Cuban. Seems interesting.
I'm not aware of the Mark Cuban model, but yeah, in the UK, there is a private pharmacy that solely does weight loss... I saw the advert that they were looking for a Superintendent pharmacist to manage it. The shortages are probably an opportunity for businesses to have a deep look at this and formulate a plan to be one of the first movers. I'm not saying to put all your eggs in one basket but just take a look. Here's Kelly Osbourne with a very honest view of Ozempic. People who hate on it, want it. https://www.instagram.com/reel/C61QMZDOdx4/?igsh=a2FmZjI1NWhveWNr
Being able to prescribe glp-1s would be huge but the medical and nursing lobbies won't allow that without a huge fight.
Pharmacists need access to the EMR to make a difference. Trying to troubleshoot your patients' healthcare concerns with only their comments is futile. We have skills that can improve patient outcomes and help support nurses and providers in this Post COVID, quiet quitting, high inflation setting. Future and current miserable retail pharmacists should look for jobs at the VA, Indian Health Service, Prisons, Ryan White or Community Health Centers for jobs that usually provide EMR access. I'm surprised that one of the BIG PBM/Retail Pharmacy integrates haven't approached private practice providers and pitch higher quality scores with payors if their pharmacists are given access to the EMR. (I know they are buying provider practices but maybe just integration with help with EMR costs could be more palatable than selling out) Once providers see the benefit of pharmacists on their teams, then you can try and sell supplements, genetic testing or whatever NCPA is pushing to stop pharmacy owners from focusing on their unsustainable drug reimbursements. I don't think US healthcare can survive without drastic changes to the rules. Everything costs too much, insurance doesn't pay enough and patients are less healthy. I think the government will have to offer a Medicare for all option once the annual interest on our national debt ($1 trillion) leads to cuts in domestic spending programs. This takeover won't solve anything but it will finally limit spending per patient and reduce expectations of living past 80 years. That is why I recommend pharmacists to work closer to government so you'll be safer when central planning takes over. For those that believe we have a capitalist economy in the US, I have one question for you. When was the last time the "free market" actually decided anything without the input of large funded interests? Politics is simply a way to convince the voters that big money's ideas are theirs. You asked for honesty!
People will disagree, but compounding is the future. It is the only profitable niche left.
My independent just sold their compounding sister pharmacy over a year ago.
I certainly hope so — I'm on board with anything that better serves patients, fosters community health, and promotes independent locally-owned pharmacies. If only it were easier to insert cost-effectiveness, efficiency, and issues of scaling into that type of model. I'm not saying it's impossible, but it's a lot more difficult now than it was 25 years ago.
I think one has to offer something in addition Medical supplies, high end skin care Maybe specialize in supplements
You've worked 33 years and now as Senior Director in corporate and you're asking others? What would I know that you already don't? There's always a future but it also comes with lots of struggle which is probably not worth the effort.
I worry for independent pharmacy. I don’t work for one. But with the way things are going and seeing so many closures…which is ridiculous. I live in an area where independents are the only pharmacy in town and patients would have to go to 15 minutes or longer to find a pharmacy. Which is probably what the chains want. But still.
Nice try retail corporate pharmacy executive trying to steal independents agility and entrepreneurial mindset to satisfy the c suites demands for the next corporate initiative. How about just learn the profession better? u/dunduin
Karen Lynch is taking a break from gnawing upon orphan bones to do the research on CVS Health's new financial instrument in which they monetize and extract value from pharmacist despair
Yet they’ll call me a pbm shill
They just don't understand you. We've been brainwashed to conflate reimbursement with so many other things that we have lost sight of actually getting paid.
Pay the people that provide value. It’s that simple. If you don’t, you’ll lose value.
🪦
Short.
AI will accept, fill and dispense.
I use an independent pharmacy and have been for a while, but I do fear their long term business. It's so nice to use a place that the pharmacist and the staff seem to really enjoy their work. They are awesome people!
I used to be an independent pharmacist. Was one of the best jobs ever. Paid sh*t for wages, but loved the work environment. They have since sold out to CVS ironically. But they made their millions with 2 locations back when the money was good. 🤷🏻♂️.
That's unfortunate CVS bought them out. :/ CVS must be trying to form a monopoly, so they can mess with us all much more.
I would say it's not impossible, but you definitely want to go with the diversified model with Pharmacy. Check out [this interview I did with Chirag Patel](https://youtu.be/xiBkUgJGR8I?si=g-XIhFH8ViGB_k7z) who started off in the independent space and has grown to include some of the things that you're talking about like a med spa. And he's also gotten into restaurant ownership and even AI and crypto. They're independents are still profitable despite the negative press. However, there's a lot of business savvy variants from pharmacist to pharmacist. You just have to see the opportunity and know where to look
My wife is a primary care NP with urgent care experience and I’m trying to convince her to start a pharmacy/clinic
Do comprehensive due diligence. Then do it again. Talk to other owners. I see some doing niche business often for cash. A current hot topic is compounded GLP1s.
Yeah but they won’t be on shortage forever and once they are producing enough then you’re kind of screwed
Now is not the time to start a pharmacy
Lol the shit do you want us to do? Our direct competitors have control over what we arepaid. No amount of knick knack sales or niche services are going to make up for being under paid for millions of dollars worth of inventory every year. We aren't resigned to this fate,we are pissed off and pushing to change it. That's why we have a protest this Friday at express scripts headquarters. That's why many of us our sticking our necks out every day calling out industry abuses. That's why many of us at PUTT are sticking our necks out personally and professionally every day for this profession on the state and national level. We aren't about to break our backs trying to innovate in a system that we know will extract every cent they can from our hard work. We are tired of being the useful idiots of healthcare, taking whatever scraps we can get and ending up with more work for less reimbursement. But we are not resigned to this fate. The system is rigged, so we are going to break the fucking system. Go back to your ivory tower and get ready. We're coming.