Why Your Pharmacy Experience Feels Frustrating

If you’ve recently visited a pharmacy to pick up a prescription, you may have left feeling exasperated.

Both chain and independent pharmacies are facing severe staffing shortages, leading to long waits, disorganized operations, and dissatisfied customers. Shelves are often empty, and frustration is high. In fact, according to a J.D. Power study, customer satisfaction with physical pharmacies dropped by 10 points in 2024 alone.

Running these businesses is more challenging than ever. “This is undoubtedly the worst it’s ever been,” says Enrique Reynoso, a pharmacist since 1991 and owner of Beacon Wellness Pharmacy in upstate New York. To keep his business afloat, Reynoso has taken cost-saving measures like using smaller bottles for medications, encouraging customers to use Venmo to avoid hefty credit card fees, and expanding his store’s product offerings. Despite these efforts, high drug prices—such as an Adderall shortage that spiked its cost from $25 to $400 without a corresponding increase in insurance reimbursement—are pushing him to the brink, forcing him to take losses on some common medications.

Large chains aren’t immune either. Across the street from Reynoso’s store, a Rite Aid with barren shelves has customers lining up, sometimes seven deep, at the pharmacy counter. (In September, Rite Aid announced it had exited bankruptcy after closing a quarter of its stores.) CVS shut down 900 locations over the past three years, citing shifts in consumer habits, while Walgreens plans to close about 25% of its 8,600 stores due to the unsustainable nature of the current pharmacy model, according to CEO Tim Wentworth. Chains are also grappling with rampant shoplifting, which has forced them to secure products behind locked cases—a strategy that often alienates customers even further.

Changing consumer behavior is another key factor in the struggles pharmacies face. During the pandemic, more shoppers shifted online, and pharmacies saw decreased sales. While in-person shopping has returned to normal for many retail sectors, pharmacies haven’t experienced the same recovery. Retail analyst Brittain Ladd notes that even when customers visit for prescriptions, they often avoid purchasing other items in-store, opting to buy them cheaper online instead. This has led to price cuts that further erode pharmacy profits, triggering more cost-cutting measures in a vicious cycle.

In response to rising expenses, pharmacies have slashed staff numbers. A Walgreens pharmacist in Wisconsin, who wished to remain anonymous, shared that her department used to employ four pharmacists. Now, it’s often down to half that number, despite handling more prescriptions and immunizations than ever before. This pressure is pushing many pharmacists out of the industry, leading to higher turnover. “Patients are frustrated, and so are we,” she says. “They’re waiting longer in line, and they’re often served by someone brand new.”

Larretta Dickerson, who has worked for CVS, Walgreens, and Rite Aid stores in North and South Carolina, echoes these sentiments. She says all three chains face severe technician shortages. When technicians call out, pharmacists are left juggling multiple roles. “You’re filling prescriptions while phones ring non-stop,” Dickerson recalls. “You can feel the stress creeping up your neck.”

However, a deeper, more complex issue is fueling the struggles of pharmacies: the way they are reimbursed for the drugs they dispense. Most patients have insurance, and insurers rely on Pharmacy Benefit Managers (PBMs) to handle prescription benefits. PBMs act as middlemen, wielding immense power because they dictate how much pharmacies get paid for each drug. Every year, pharmacies report that PBMs are offering lower reimbursements, sometimes forcing them to sell popular medications like Ozempic at a loss.

The dominance of PBMs explains this squeeze. The top three PBMs—CVS Caremark, Express Scripts, and Optum Rx—control 80% of the market, while the six largest control 90%. The House Committee on Oversight and Accountability recently found that PBMs use their market dominance to engage in anticompetitive practices, often overcharging insurance plans and taxpayers by hundreds of millions of dollars through opaque pricing models.

In July 2024, the Federal Trade Commission released a report highlighting how industry consolidation has given PBMs sweeping control over vast parts of the healthcare sector. The report also claims that PBMs steer patients toward their own mail-order pharmacies, bypassing brick-and-mortar locations. Additionally, many PBMs are part of larger healthcare conglomerates that include insurance companies and pharmacies, raising concerns about whether they are truly negotiating for the best prices. (On Sept. 17, Express Scripts sued the FTC, challenging the report’s conclusions and defending PBMs as cost-savers for consumers and employers.)

In response to inquiries from TIME, Express Scripts cited its lawsuit, while CVS Caremark claimed its efforts help protect businesses and patients from price gouging. Other major PBMs did not respond.

Smaller, independent pharmacies like Reynoso’s are hit especially hard by PBMs. While big chains have more leverage, independents have little to no bargaining power. Reynoso says he’s often baffled by how little he’s reimbursed—sometimes less than what he paid for the drugs. “We’re trapped,” he says. “We can’t say no.”

Both independent and chain pharmacies are feeling the strain, according to Douglas Hoey, CEO of the National Community Pharmacists Association. Pharmacy contracts with PBMs are highly one-sided, Hoey explains. If a pharmacy refuses to accept a PBM’s terms, they risk losing access to patients with specific insurance plans. Despite growing scrutiny from Congress and the FTC, Hoey says PBMs have only doubled down on aggressive payment contracts and exploitative business practices.

The decline of independent pharmacies has led to the emergence of “pharmacy deserts,” where access to medications is limited. Between 2013 and 2022, about 10% of independent rural pharmacies closed. “We’re at a breaking point,” says Hoey. One study found that by 2024, 15.8 million Americans live in pharmacy deserts, many of them in communities with lower education levels and limited access to healthcare.

The impact of these shifts extends beyond rural areas. As more pharmacies shut down, the ones that remain face higher demand with fewer resources. Unfortunately for customers, the long lines and empty shelves are unlikely to disappear anytime soon.

At Mediserv Pharmacy, we understand the challenges facing pharmacies today and strive to deliver a personalized and efficient service to our Bronx community. As a locally-owned pharmacy, Mediserv Pharmacy is dedicated to providing timely prescription refills, reliable health advice, and a variety of healthcare products, all while maintaining the personal touch that large chains often lack. Despite the wider industry struggles, we remain committed to putting our customers first, ensuring that you receive the care and attention you deserve every time you visit. To experience the difference at Mediserv Pharmacy, visit us at mediservpharmacy.com or stop by our Bronx location today!