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Writer's pictureRxConnexion

The State of Pharmacy: A Profession in Crisis

The pharmacy profession stands at a crossroads, facing a slow and painful decline that affects independent and chain pharmacies and the core of our professional identity. The question is not whether the crisis is real, but how long we can endure it before reaching a breaking point. Pharmacies are being squeezed from all directions, from the stranglehold of Pharmacy Benefit Managers (PBMs) to the monopolistic practices of wholesalers, health plans, and suppliers. The ripple effects of these pressures are pushing pharmacies to the brink of closure, while pharmacists' wages stagnate or even fall behind inflation, leaving many professionals struggling to stay afloat.


PBMs, once middlemen who provided a valuable service, have now evolved into gatekeepers that dictate the terms of pharmacy reimbursement. Their opaque pricing practices and clawbacks are a cancer in our industry. Reimbursements are so low that some pharmacies lose money on prescriptions. Simultaneously, PBMs negotiate rebates with drug manufacturers that are not passed on to pharmacies or patients, while demanding compliance with their formularies and mail-order services. They’re driving independent pharmacies out of business and limiting patient choice. For years, we've sounded the alarm, yet the problem only worsens.


Wholesalers also play a role in this decline. They, too, have consolidated power in a market with few options, dictating pricing and availability. Health plans exacerbate the problem by steering patients toward their own pharmacies or those aligned with PBMs, further marginalizing the independent pharmacy model. Meanwhile, suppliers contribute to fluctuating drug prices, creating a volatile and uncertain environment for pharmacists trying to manage inventory.


The crisis is not only economic but also professional. As pharmacists, we’re being devalued. The labor strikes of dock workers and retail employees demanding upwards of 70% raises reflect a growing awareness in other industries that workers deserve fair wages. Yet, pharmacists, with years of specialized education, are seeing their effective earnings erode year after year, falling behind by single or negative digits. Many are working longer hours with higher stress levels for less reward, watching their colleagues close their doors forever.


Whether this is part of a grand scheme or simply the result of systemic neglect, one thing is clear: change is needed, and it’s needed now. The apathy from lawmakers, who only respond when a crisis impacts them directly, is a huge barrier. But can we imagine a world where there are no pharmacies or pharmacists, where patients can’t fill a prescription for a sick child or get advice on managing their medications? It’s not far-fetched. When that day comes, will lawmakers finally realize the magnitude of their inaction? Not only affects patient's health but the overall healthcare economy and pharmaceutical industry.


The time for pharmacists to come together is now. We must advocate for transparency in PBM practices, fair reimbursements, and policy changes that protect our profession and ensure patients can access the care they need. The future of pharmacy depends on our ability to push back against a system that is failing us—and ultimately, the patients we serve.

Let’s make lawmakers notice before it’s too late. Is it worse not going to work for 3 weeks or not even making any money to just feed your family the basics forever? Think!

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