Will Independent Pharmacies Survive?
By Dr. Robert Seik, PharmD, FMNM
Integrative Therapeutics Board of the The Wellness Company
The days of corner drug stores with soda fountains and a pharmacy owner the entire community knows are all but over. The replacement has come in the form of mega corporations, the chain drug stores. While these large companies are nearly ubiquitous in America, independent drug stores still make up approximately half of all pharmacies.
Unfortunately, this number is declining rapidly as many independent pharmacies are struggling. Should people care? In my opinion, it’s a matter of choice. What kind of country, what kind of world will Americans choose to live in? If it is a world dominated by two or three corporate choices, the landscape of patient care, from the pharmacy perspective, could change dramatically. This time, what's at stake is the choice of the practitioner and patient regarding what treatments are made available or denied.
Reflecting on the behavior of the large chains during Covid-19 taught us that the corporations will fulfill their primary duty, fiduciary responsibility to the shareholders to maximize profits, without regard to patient care.
In today’s pharmacy marketplace, collusion between pharmaceutical manufacturers and chain drug stores is driving limitations to patient care in several ways, denying prescriptions for Hydroxychloroquine and Ivermectin, and promoting immensely profitable vaccines, for example.
Furthermore, the chain drugs stores now own or have a strong voting interest in prescription insurance providers known as pharmacy benefits managers (PBMs). CVS owns Caremark, the biggest PBM. Large shareholders in the Walgreens Boots Alliance company have ownership in Express Scripts and OptumRx. Wal-Mart owns Humana.
These four PBMs control nearly 80% of all prescription claims, and the reimbursements for independent pharmacies are structured so that we lose money on nearly 70% of all prescriptions filled using these insurance plans. This is the main reason independent pharmacies are under threat of extinction. It is by design.
Is this a public health concern? You decide.
When chain drug stores were pushing Covid-19 vaccines, and denying effective early treatment options such as Hydroxychloroquine and Ivermectin, independent pharmacies were there to answer the call from patients and their practitioners based on the abundance of published evidence supporting their use for Covid-19.
No pharmacist or corporation should deny a practitioner’s prescribed treatment unless there is a clear contraindication for the patient or a dangerous drug interaction. Even then, a clarification call by the pharmacist to the practitioner could result in a medication change or instructions for the pharmacist to proceed because the practitioner decided that the benefits outweigh the risks.
My pharmacy is focused on patient health first and foremost. Like many independent pharmacies, we offer compounded medications for unique needs such as hormone replacement therapy. We also advocate a healthy lifestyle and the use of high-quality nutritional supplements. Good supplements have tremendous value and I have seen them reduce the need for prescription drugs in many patients.
That’s right, a pharmacist just stated that healthier patients need fewer drugs or none at all. Targeted nutritional support is crucial for treating Covid-19, Long Haulers, and the vaccine injured. The pharmacist has a duty to understand the treatments available and offer consultative advice to both the patient and the practitioner.
It’s not how many prescriptions are filled or how many vitamins are purchased that keeps an independent pharmacy in business, it’s the focus on patient care with knowledge that provides value. It is not easy or inexpensive to acquire this knowledge either. I and another pharmacist of mine are fellowship trained in metabolic and nutritional medicine and my main clinical pharmacist is a Doctor of Natural Medicine.
We still fill prescriptions but integrating the compounded prescriptions with functional medicine products and supplements is what keeps the business open. I am often asked why my pharmacy doesn’t take insurance. Now you know, losing money on ~70% of all claims while the PBMs reimburse the chain drug stores that own them very profitably is not a good business model for my company. Besides, PBM audits are frequent and an independent pharmacy’s funds are held until the audit is complete. MBA 101: a business needs cash flow and when the PBMs withhold the money, businesses close, and many have.
The main thing I want people to consider is the value of having independent pharmacies on Main Street versus chain drugs stores exclusively which primarily benefits Wall Street. Patient care is at stake and saving independent pharmacies is important. We can’t match $5 generics or GoodRx coupons but we can provide knowledge, products, and care exactly as the practitioner ordered. Patient choice is freedom and the freedom to get the treatments you need, without objection, is worth preserving.
As a pharmacy owner, I am particularly proud to be an affiliate of The Wellness Company. Our philosophies are the same - patient care is always first. Our approach is also identical, integrating the best choices for patients using the right medications, nutritional supplements, and healthy lifestyle choices.
Supporting independent pharmacies supports the families of everyone we employ. We occupy a space in steadfast dedication to our customers’ health under ominous specter of corporate dominance favoring only the most profitable treatments. It is our honor to share such a mission with The Wellness Company and you, our customers.
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About the Author:
Dr. Robert Seik, PharmD, FMNM, is a pharmacist and owner/founder of Partell Pharmacy based in Las Vegas Nevada. He is one of the founders of the Integrative Therapeutics Board of The Wellness Company, and a global leader in reinitializing continuum of care processes between pharmacists, patients, and their doctors.