PBMs and Local Pharmacies

When a patient needs a medication that doesn’t come off a manufacturer’s shelf, such as a dye-free liquid for a child, a custom-strength hormone therapy, or a drug in shortage, a compounding pharmacist makes it by hand. PBMs treat that work as a cost to eliminate.

Independent pharmacies don’t set their own prices. PBMs do, through take-it-or-leave-it contracts that dictate what a pharmacy is paid for every prescription. Too often, that payment is less than what the pharmacy paid its wholesaler for the drug, before counting the cost of staff, rent, or the pharmacist’s time.

Patients should choose their pharmacy. PBMs increasingly choose it for them. The largest PBMs own mail-order and specialty pharmacies, and they design benefit plans to push patients there: lower copays at affiliated pharmacies, 90-day fills available only by mail, narrow networks that leave out the local independent, and “specialty” designations that require a drug be filled at the PBM’s own pharmacy.

Pharmacies are disappearing. Roughly one in three U.S. pharmacies closed between 2010 and 2021, and independents were more than twice as likely to close as chains. About one independent pharmacy closed every day in 2023, and nearly half of U.S. counties now have at least one pharmacy desert. Florida is not immune: it ranks among the seven states that have lost the most retail pharmacies since 2021.