Transparent Cost-Plus Pricing Protects Pharmacies From Reimbursement Uncertainty

In Scranton, Pennsylvania, Tom DePietro, PharmD, owner and pharmacist at DePietro’s Pharmacy, remembers when every prescription processed with a discount card felt like a roll of the dice. He might be reimbursed fairly—or he might end up losing money on the transaction. That uncertainty wasn’t just frustrating; it threatened the viability of his business at a time when generics, which account for roughly 85% of prescriptions filled in the United States, already squeeze pharmacy margins with volatile acquisition costs and fluctuating reimbursements.

For years, pharmacy benefit managers (PBMs) have sat between pharmacies, manufacturers, and patients, obscuring how prices are set and who ultimately gets paid. Traditional discount cards, layered on top of this opaque system, often deepened distrust among independent owners who saw patients get savings while the pharmacy absorbed losses. One in 4 patients abandon their prescriptions due to cost, DePietro notes, raising a stark question: what good is a diagnosis if the patient can’t afford the medicine that follows?

In this interview, DePietro and David Graziano, head of retail network at GoodRx, discuss a different path forward: direct contracting that eliminates PBMs from the equation and introduces a transparent cost-plus pricing model. Under this approach, the final patient price is built from a publicly available national average drug acquisition cost benchmark, a clear dispensing fee, and an administrative fee—paid by the patient or, in the case of many brand drugs, bought down by manufacturers.

That clarity is especially critical in high-cost categories such as glucagon-like peptide-1 (GLP-1) therapies for weight management and diabetes. After years of losing money on GLP-1 claims, DePietro’s Pharmacy has now started 75 new patients on their wellness journey, many paying out of pocket with confidence about what they will owe at the counter.