Good article Ben. As a new independent pharmacy owner as of January 1, 2024 of a pharmacy that's been in business since 1886. I can tell you that I feel the pressure every day of keeping the doors open. Follow me on tiktok and twitter where I post videos about fighting PBMs!
Incredible work Ben. I don't have the answers but I do know this will get worse before it gets better. I am a positive person, I know that the aggressive, business savvy, well funded independent pharmacy owners out there will 'do well' growing their businesses through acquisition of troubled pharmacy businesses, I hope we have a lot more taking over other pharmacies instead of shutting down. With According to the U.S. Census Bureau, the population of the United States on September 16, 2024 was 337,116,365. By 2027 it's estimated the population to be 341.69 million. We're not going to have enough pharmacies.
1) unfortunately, a large fraction of the acquisitions are to the usual suspects, the big chains, including a surprising number of acquisitions by the literally-just-exited-bankruptcy Rite Aid, if you read the news stories.
2) The US already has much lower pharmacy access than the majority of comparable OECD countries. The OECD average is 28 pharmacies/100,000 population, vs. the US was at ~20 pharmacies/100,000 population in 2021. https://www.oecd-ilibrary.org/docserver/1ce785db-en.pdf
Physician here, 40 years in practice. Really elegant piece of work, and very clearly presented. Even stupid politicians should be able to understand your message, and smart ones (there are a few) will get it right away. As in many other sectors, independent pharmacy practice is crumbling before our eyes and our policy-makers are doing nothing about it. Love the term “payvidors” btw.
I understand you in a personal way! I will tell my story to educate readers who don't know of the ongoing demise of Independent Retail Pharmacy. I owned and operated a retail community pharmacy from 1985 to 2015 in Medford, Oregon. In the early days, the first PBM's (Pharmacy Benefit Managers) were only being started, with the first one being PAID(soon became Merck/Medco). I resisted joining for a couple of years, but was soon forced to begin accepting 3rd party reimbursements in order to have more customers (patients). In 1992 I joined Medicine Shoppe International(MSI) to have access to many PBM's (a good decision at that time). Wholesaler costs were not very relevant then and there was little competition to me at that time.
EVERYONE was happy😊
But around 2003 to 2005, the profits were starting to decline. Soon it was big time declines.
Joining MSI was good for awhile, it was the beginning of the end. Although drug cost was above Average Wholesale Price (AWP), there was and probably still are 2 to 6 different drug costs!! ( true cost vs cost plus/minus a % vs rebates that may vary..etc), the drug cost being extremely variable (based on pharmacy type,patients being served, location) etc. The number of variables were huge and caused great difficulty for a small pharmacy.
And the PBM's were relentless! (huge corporation against at best 800-1000 retail pharmacies in the network). Also the major wholesalers teamed with drug manufacturers to screw more from pharmacies. The PBM's and wholesalers and drug manufacturers were and still are multi-billion dollar companies with thousands of pricing options and hundred's of programs.
The complexity of this business was and still is unbelievable.
AWP+ (plus) soon became soon became AWP- (minus) (a percentage from AWP). Yes, I had access to the PBM's , but the cost to my business was lower and lower reimbursements .
After 14-15 years with MSI, I was able to buy out my contract (with help of large lawsuit) and I was again an independent pharmacy until my retirement in 2015.
I was lucky enough to sell to Safeway!
THE POINT of this story is that in 2015 my cost of drugs was AWP-18%(at that point I
knew that it was impossible to continue in the business of retail pharmacy. BTW, I had been
compounding for 7 years, which really kept me in the game for the last 3 to 5 years.
Specializing in multiple areas is the only way to stay alive (Compounding, diabetes care,
foot care products, etc).
I FEEL AND KNOW YOUR PAIN.
I would love some method for independent pharmacies to remain alive financially, but I am
not sure that this will occur.
I wish the very best to you and your fellow independent pharmacy owners.
Marlow Medicine, LLC closed September 2022 after serving its customers for over 14 years. It’s so hard to keep the company afloat when you are losing money on nearly every prescription filled.
Nature just had an article pharma isnt interested in furthering investment into the nazi governments euthanasia program. Mental illness isnt a provable science.
No evidence of any kind its all behaviors. Also, the contamination in this country from your WMD and waste has become deadly limits. Only 12% of service aged men are healthy enough for service. You are all sick, dead and about to bloat. All the while listening to the very people responsible for your deaths and so much suffering.
Great information. It would be of some help for you to define the acronyms for us non-medical types. This is extremely informative and useful information for the educated and soon to be educated consumer. I feel for you and any privateer pharmacist/ businessman that is stuck with the complete and total failure of congress to reasonably regulate this industry. In no small way, this and the utterly useless oversight of pharmacological -clinical issues, is yet again the result of good old fashioned graft, greed, influence peddling and outright corruption. Res Ipsa Loquitur.
Gosh let me make you a better map! (I'm a geographer and geospatial analyst) so csv's are my thing, and I can use the kml's, but the Google My Maps KML's are clunky and difficult to change and analyze fyi.
https://www.youtube.com/watch?v=96Hym73GDBQ&t=421s&pp=2AGlA5ACAQ%3D%3D
Good article Ben. As a new independent pharmacy owner as of January 1, 2024 of a pharmacy that's been in business since 1886. I can tell you that I feel the pressure every day of keeping the doors open. Follow me on tiktok and twitter where I post videos about fighting PBMs!
Good luck!
Incredible work Ben. I don't have the answers but I do know this will get worse before it gets better. I am a positive person, I know that the aggressive, business savvy, well funded independent pharmacy owners out there will 'do well' growing their businesses through acquisition of troubled pharmacy businesses, I hope we have a lot more taking over other pharmacies instead of shutting down. With According to the U.S. Census Bureau, the population of the United States on September 16, 2024 was 337,116,365. By 2027 it's estimated the population to be 341.69 million. We're not going to have enough pharmacies.
1) unfortunately, a large fraction of the acquisitions are to the usual suspects, the big chains, including a surprising number of acquisitions by the literally-just-exited-bankruptcy Rite Aid, if you read the news stories.
2) The US already has much lower pharmacy access than the majority of comparable OECD countries. The OECD average is 28 pharmacies/100,000 population, vs. the US was at ~20 pharmacies/100,000 population in 2021. https://www.oecd-ilibrary.org/docserver/1ce785db-en.pdf
Agree
Physician here, 40 years in practice. Really elegant piece of work, and very clearly presented. Even stupid politicians should be able to understand your message, and smart ones (there are a few) will get it right away. As in many other sectors, independent pharmacy practice is crumbling before our eyes and our policy-makers are doing nothing about it. Love the term “payvidors” btw.
Thanks for the comment, you’re very kind!
PBM's are COLD, HEARTLESS BASTARDS!
I understand you in a personal way! I will tell my story to educate readers who don't know of the ongoing demise of Independent Retail Pharmacy. I owned and operated a retail community pharmacy from 1985 to 2015 in Medford, Oregon. In the early days, the first PBM's (Pharmacy Benefit Managers) were only being started, with the first one being PAID(soon became Merck/Medco). I resisted joining for a couple of years, but was soon forced to begin accepting 3rd party reimbursements in order to have more customers (patients). In 1992 I joined Medicine Shoppe International(MSI) to have access to many PBM's (a good decision at that time). Wholesaler costs were not very relevant then and there was little competition to me at that time.
EVERYONE was happy😊
But around 2003 to 2005, the profits were starting to decline. Soon it was big time declines.
Joining MSI was good for awhile, it was the beginning of the end. Although drug cost was above Average Wholesale Price (AWP), there was and probably still are 2 to 6 different drug costs!! ( true cost vs cost plus/minus a % vs rebates that may vary..etc), the drug cost being extremely variable (based on pharmacy type,patients being served, location) etc. The number of variables were huge and caused great difficulty for a small pharmacy.
And the PBM's were relentless! (huge corporation against at best 800-1000 retail pharmacies in the network). Also the major wholesalers teamed with drug manufacturers to screw more from pharmacies. The PBM's and wholesalers and drug manufacturers were and still are multi-billion dollar companies with thousands of pricing options and hundred's of programs.
The complexity of this business was and still is unbelievable.
AWP+ (plus) soon became soon became AWP- (minus) (a percentage from AWP). Yes, I had access to the PBM's , but the cost to my business was lower and lower reimbursements .
After 14-15 years with MSI, I was able to buy out my contract (with help of large lawsuit) and I was again an independent pharmacy until my retirement in 2015.
I was lucky enough to sell to Safeway!
THE POINT of this story is that in 2015 my cost of drugs was AWP-18%(at that point I
knew that it was impossible to continue in the business of retail pharmacy. BTW, I had been
compounding for 7 years, which really kept me in the game for the last 3 to 5 years.
Specializing in multiple areas is the only way to stay alive (Compounding, diabetes care,
foot care products, etc).
I FEEL AND KNOW YOUR PAIN.
I would love some method for independent pharmacies to remain alive financially, but I am
not sure that this will occur.
I wish the very best to you and your fellow independent pharmacy owners.
I wrote this into my book as a tiny subtext.
Our medical system is totally broken. Thank you
Good article. I appreciate the data you collected. I shared this on LinkedIn.
thanks for sharing!
Good job on the data cleaning, analysis, and visualization!
Marlow Medicine, LLC closed September 2022 after serving its customers for over 14 years. It’s so hard to keep the company afloat when you are losing money on nearly every prescription filled.
So very sorry! My pharmacy may be next...
Nature just had an article pharma isnt interested in furthering investment into the nazi governments euthanasia program. Mental illness isnt a provable science.
No evidence of any kind its all behaviors. Also, the contamination in this country from your WMD and waste has become deadly limits. Only 12% of service aged men are healthy enough for service. You are all sick, dead and about to bloat. All the while listening to the very people responsible for your deaths and so much suffering.
Great information. It would be of some help for you to define the acronyms for us non-medical types. This is extremely informative and useful information for the educated and soon to be educated consumer. I feel for you and any privateer pharmacist/ businessman that is stuck with the complete and total failure of congress to reasonably regulate this industry. In no small way, this and the utterly useless oversight of pharmacological -clinical issues, is yet again the result of good old fashioned graft, greed, influence peddling and outright corruption. Res Ipsa Loquitur.
Very thorough research. Much appreciated for yourself and volunteers
It would be interesting to know the number of new pharmacies in that period. Im sure there are some.
867 opened in the same period. I mentioned it in the article.
Gosh let me make you a better map! (I'm a geographer and geospatial analyst) so csv's are my thing, and I can use the kml's, but the Google My Maps KML's are clunky and difficult to change and analyze fyi.
be my guest the raw data is here: https://docs.google.com/spreadsheets/d/1u9SFsXwzAboBoTRFG8Cg5eY4lpOYEA75pZDhwVF5_DQ/edit?gid=1767472805#gid=1767472805
That Frankenstein industry is shutting down and we'll be going back to more natural remedies and such.
Big Pharma is OVER along with their toxic drug pushing ways.
Join the New Earth!