Redistribution of Costs Causes Barriers in Community Pharmacy | Asembia AXS26

Dee Chaudhary, principal of commercial strategy consulting life sciences and healthcare at Clarivate, discusses how recent health policy changes, particularly the $2000 out-of-pocket cap, are reshaping the realities for community pharmacies, patients, and payers. Although the cap is positioned as a win for patients by improving affordability, Chaudhary explains that it has not removed costs from the system; instead, it has redistributed financial pressure down the chain, especially onto pharmacies. Local, independent pharmacies are losing business to vertically integrated mail-order pharmacies, contributing to the emergence of pharmacy deserts where in-person access is reduced.

She also highlights how pharmacies are effectively forced to manage cash flow burdens as patient affordability is spread over time. Smaller community pharmacies are particularly vulnerable because they lack the financial cushion of large chains or integrated entities. At the same time, patients face new coverage challenges as some arrive at the pharmacy only to discover they are no longer eligible, have lost coverage, or can no longer afford their plans. Work requirements for Medicaid, varying by state, further complicate access and place additional strain on local pharmacies that must handle patient confusion and frustration face to face.

On the payer side, pharmacy benefit managers are shifting behavior, demanding higher upfront rebates, steeper net price guarantees, and moving more quickly to exclude drugs from formularies when value is not clearly demonstrated at launch. Despite these strategies, direct and indirect remuneration fees and related pressures have not disappeared—they have evolved, maintaining financial strain on pharmacies.

“It becomes more and more difficult to predict what the downstream effect is of many of these policy decisions and decisions made by people who may or may not understand the implication on community pharmacy,” Chaudhary said. “n the big picture, they think they're doing the right thing, but realistically, all different segments of health care need to be very closely aligned to what's happening in health policy.”