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Independent Pharmacies are Closing. You Can Blame Health Insurance Companies.

More than 300 community pharmacies closed in the last year alone. It has a lot to do with big health insurance companies and their drug businesses called pharmacy benefit managers.
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Medicare Advantage is harming seniors—read the groundbreaking new report from Physicians for a National Health Program and check out our webinar featuring Sen. Elizabeth Warren.

EDITOR’S NOTE:

You all have seen my name and face in this newsletter many times, but you have not, until now, seen and heard directly from Joey Rettino. Starting today, Joey will be a regular contributor and bring a (much more) youthful voice to our work. 

Over the past several years, Joey has been behind the camera (and the keyboard), and he has and will continue to work behind the scenes to make sure this newsletter reaches you. The way it works: I write and Joey does everything else to get our content published.

Joey, who grew up in New Jersey and graduated from Cabrini University, is the longest-serving member of my team. I met him when he was a senior at Cabrini and he was working on his capstone project about wealth inequality in the U.S. A friend of mine was the university’s provost and suggested to Joey that he might want to interview me. This was not long after the publication of my second book, Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It. 

Joey’s passion for that project, and his charisma, impressed me. I asked him if he’d be interested in interning with me, and for some reason, he said yes. That was in 2016. We’ve been a team ever since.

Over the years, he has learned more about what passes for a health care system in this country – and how it contributes to wealth inequality – than just about anyone his age (he recently turned 30). I’ve been pestering him for months to move in front of the camera because he has a lot to say, especially to people who have not been on this earth as long as I have. 

He finally agreed, and you’ll be seeing and hearing from him on a regular basis about the issues all Americans need to know more about, from how big insurers have inserted themselves between us and our doctors and make us pay a fortune out of our own pockets before they’ll pay a dime; to their lies about Medicare Advantage; and how insurers suck so much money from the pharmacy supply chain.

To kick things off, Joey explains how big insurers’ pharmacy benefit managers are driving independent pharmacists out of business. Ladies and gentlemen, meet Joey Rettino. 

- Wendell Potter


Think about the town you live in. And ask yourself: “Is my town’s independent pharmacy still open? Or has a CVS or Walgreens taken its place?”

That’s the case for many towns in the United States. And it has a lot to do with big health insurance companies and their drug businesses called pharmacy benefit managers.

Health insurance companies and their drug businesses, led by UnitedHealth’s Optum, Cigna’s Express Scripts, and CVS’s Caremark, have launched a full-blown onslaught against independent pharmacies to eliminate their competition on Main Street America.

With more than 300 community pharmacies closing in the last year alone, it seems like it’s working.  

With independents withering away, health insurers are able to steer patients to their own pharmacies, mail-order operations, and big investor-owned corporations like CVS and in Cigna’s case, Walgreens. Walgreens, by the way, scooped Cigna’s Evernorth CEO Tim Wentworth to lead the company last year – teeing themselves up to be even bigger players in this market.


Medicare Advantage is harming seniors—read the groundbreaking new report from Physicians for a National Health Program and check out our webinar featuring Sen. Elizabeth Warren.

In the void left by independent pharmacies, health insurers and PBMs create vertical monopolies in many areas – making drug prices even more opaque, resulting in higher costs to ordinary Americans. And while insurers have largely gotten away with this scheme for some time, it does seem like the tides are changing.

Last year, Republican Ohio Attorney General Dave Yost filed a lawsuit against Cigna’s Express Scripts and Prime Therapeutics for their PBM practices. In the press release, Yost said:

PBMs are modern gangsters…scheming in the shadows to control drug prices on all sides of the market.

There is also growing momentum for bipartisan PBM legislation in Congress. Senate Finance Committee Chairman Ron Wyden and Ranking Member Mike Crapo’s bipartisan PBM reform package passed the Senate Finance Committee 26-0 last year. In a joint letter to their colleagues asking for better scrutiny of health insurers and their pharmacy benefit activities, they wrote: 

Despite years of public urging from policymakers and patient advocates, most PBMs continue to charge Americans high cost-sharing for drugs, often as a percentage of inflated sticker prices, even for medications with sizable rebates and other discounts. As a result, in some cases, patients may pay more out-of-pocket than their PBMs or insurers for a given prescription.

At a press conference in March 2024, Wyden said: “The time for PBM reform was actually yesterday.”

HEALTH CARE un-covered is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Down the street from Capitol Hill, PBMs have also provoked the ire of the Biden Administration. The White House and the Center for Medicare and Medicaid Services have set new rules to rein in some of the worst practices of insurance companies and their PBMs. The move has been lauded as a victory for independent pharmacists.

For more on how big health insurers and their PBMs are threatening independent pharmacy and Americans’ bank accounts, read Matthew Cunningham-Cook’s piece in HEALTH CARE un-covered from earlier this year. 

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