Pricing Formulas Multiply, Pharmacists Translate Complexity Into Care

This September/October issue of Drug Topics is, at heart, about translation, such as how to take something complicated—whether a pricing formula, a therapeutic pipeline, or a patient's reasons for skipping a dose—and turn it into something a pharmacist can act on at the counter. That work looks different from story to story, but the through line is the same. As systems become more complex, pharmacists are the ones patients count on to make sense of them.

Our cover story tackles a term that means 2 very different things depending on where it sits in the supply chain: cost-plus pricing. As a retail model popularized by cash-pay pharmacies, it has produced savings, with published analyses finding reductions on generics like nebivolol and celecoxib alongside cases, such as certain antiseizure and pain medications, where flat fees erased the benefit entirely.

As a government price-setting formula, the same arithmetic has produced the opposite result. A 2025 benchmarking study found Iran's cost-plus system driving a median price ratio nearly 7 times international norms and an out-of-pocket burden above 52%. Meanwhile, the term is reshaping pharmacy benefit managers from the inside, with Express Scripts' Federal Trade Commission settlement and new CVS Caremark and OptumRx programs all moving toward cost-based reimbursement. For pharmacists fielding questions at the counter or the negotiating table, the lesson is the same one we keep returning to in this issue: A formula is not a guarantee, and where it's applied changes everything.

That same translation work runs through our clinical features. Mark Garofoli, PharmD, MBA, writes about the rise of pharmacist-led pain management clinics, where the pharmacist has moved from the person handing out the playbook to the coach on the field, managing opioid tapers, nonopioid optimization, and functional goals under collaborative practice agreements.

Rachel Smith, PharmD candidate, alongside Amy Ricupero, PharmD, MEd; and Jennifer Goldman, PharmD, tackles a related problem from the medication adherence side, noting that 30% to 50% of cardiometabolic medications are not taken as prescribed and offering pharmacists concrete counseling strategies that address the therapy-specific and socioeconomic barriers behind that number, from managing glucagon-like peptide-1 gastrointestinal adverse effects to simplifying pill burden.

Another feature for Total Pharmacy by Kim Rath, PharmD, offers independent pharmacy owners a framework for preparing for the wave of new therapies reaching the market, with 46 novel FDA drug approvals in 2025 alone, by auditing storage, workflow, and staff clinical knowledge before the prescription arrives rather than after. Another article by Brian Nowosielski reviews the evidence on closing vaccination gaps, finding that community-embedded partnerships outperform media-based outreach by more than 58%, a reminder that pharmacy's advantage is often less about the product and more about the relationships that make patients willing to receive it.

Take something that looks like noise, a pricing formula, a discontinuation rate, an approval pipeline, or a vaccination gap and turn it into a plan for the patient in front of them. I hope this issue gives you a few more tools for doing exactly that.

Thank you.