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Pharmacists across Florida are facing tough times. The reasons are complex

Prescription pill bottle spilling onto money image to illustrate the business of pharmaceuticals

Independent pharmacists say they're losing money on many prescriptions they fill. “It’s just a lot of different elements in the system all at once," says a pharmacy assistant professor at FAMU.

Pharmacists across Florida are facing tough times, whether due to lower profits on the drugs they dispense or more patients ordering prescriptions online. Independent pharmacists are worried about staying in business.

Harsh Patel owns Care Rx Pharmacy in Tallahassee. He used to manage a pharmacy for a big chain but says he loves his freedom.

“This is my seventh year running,” he says, “and I’m proud to take care of my patients and try to do anything and everything to take care of them.”

But Patel says he loses money on many of the prescriptions he fills — less on generics than on name-brand drugs. And that loss has increased within the past year.

“I don’t know why because nothing has changed. It’s the same pharmacy, same patient population,” he says. “I used to fill a prescription for Fycompa, and Fycompa I used to lose $20, $30. Now I lose $70, $80 on a Fycompa prescription. And it just does not go well in my brain.”

Fycompa is a brand-name for perampanel, an anti-epileptic medication.

Patel says it has even affected the big chains. He says that’s evident when pharmacies across the board are cutting back hours.

“Every single chain is noticing this reimbursement cutting back, so they are cutting back the number of hours they are open,” he says. “Who is going to suffer? The patient who is needing their crucial medication.”

According to Fortune magazine, in 2023 there were 4,550 fewer pharmacies than a decade earlier. And the National Community Pharmacists Association said in February that several thousand more local pharmacies, up to a third of its members, could close this year.

The costs of running a pharmacy are complex, according to Ancil Carruthers, the director of Pharmacy Services and an assistant professor at Florida A&M University’s College of Pharmacy and Pharmaceutical Sciences.

“Just like most patients think we order the drug, it costs money and it comes in,” Carruthers says. “But that process, as simple as it may sound, has a lot of different elements to it that affects the retail space a lot.”

Instead, Carruthers says, the insurance company might only give the pharmacist a reimbursement that’s less than the drug cost. The pharmacy could lose, say, $1,200 a year on that one prescription – and there could be dozens of patients with the same issue, costing the pharmacy a substantial sum over the course of a year.

“And so, that patient is none the wiser. They went to the doctor today, got a new prescription, got a new diagnosis, trying a new therapy,” he says. “And they’re thinking, ‘My pharmacy is going to get the insurance money and get reimbursed and everything’s the same.’ But that pharmacist or that pharmacy manager has to realize, ‘Oh, this patient who has been with me for a while, someone I know their name, I know their family, I know their kids – they’re going to cost me 100 bucks a month.”

Health care experts say pharmacy benefit managers, the negotiating entities between drug companies, insurers and pharmacies are part of the problems. There is a lot of scrutiny over whether these "middlemen" should be able to keep rebates they receive from drug manufacturers that generally aren’t made public.

Last year, the Legislature passed a bill aimed at boosting transparency for pharmacy benefit managers, but Carruthers says other elements could be at play when pharmacists don’t get reimbursed adequately.

“It could be the PBMs. It could be the wholesalers and the price they’re giving us. So, those numbers are variable, too,” he says. “It’s just a lot of different elements in the system all at once, coming together to make it tough and challenging.”

He says the question of whether the pharmacy industry is tough is always relative.

“It is a new and challenging way to go about it. You have to think on your feet, see where the reimbursements are and just learn and evolve with the tough times. So, it’s not that it’s impossible,” he says. “It’s not that it’s one element over the other. It’s just, it’s a lot of things that come together that makes it tough.”

Margie Menzel