Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3.

In 22 instances that day, the reimbursement was less than the cost of the medication. And that’s just among the prescriptions that were actually filled. Managing pharmacist Brad Tabaac said he has to turn away some patients because their prescriptions will cause too much of a loss for his business.

One recent patient, for instance, came in hoping to transfer his inhaler prescription to Friendly after his local Rite Aid closed. Filling the medication would have cost Friendly $22 more than the insurance reimbursement.

“I just can’t afford to serve him,” Tabaac said.

And now he can no longer afford to serve anyone.

Tabaac plans to close his doors on May 31 after 26 years in business. As a second-generation pharmacist, he said, he’s been working in drug stores since he was 11 years old. Making money on medicine wasn’t a question back then, but now it’s a string of “exhausting” calculations on a daily basis.

“Years ago, you would just fill prescriptions, and you would concentrate on patient care,” Tabaac said. “Now you have to look at each and every prescription you fill and say, ‘Am I losing money?’”

Why pharmacy benefit managers are challenging small pharmacies

Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance.

The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies. In other words, NCPA has said, “what community pharmacies charge patients and are reimbursed is often determined by a competitor.”

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