Owning a Community Pharmacy

09/24/2025

Another Opioid Phone Call
Last week I received a call asking if the pharmacy could accept her prescriptions. I politely asked the patient. "Which Medications are being prescribed?" They were Tizanidine, Motrin, and Oxycodone 30mg. I politely told the patient that we could not fill those prescriptions. I told her that I was sorry, but we could not honor them.
Every community pharmacy is being monitored by their wholesaler, they have a mandate to review each C2 controlled drug dispensed. If the pharmacy refuses to follow the guidelines, the wholesaler will deny any purchase of C2 or any controlled drug from their wholesaler.
The end result is closure, once a wholesaler makes this decision, the remaining wholesalers will also deny purchasing.

09/15/2025

The High Copay Dilemma
Here we go, living under the insurance overlords.
I recently filled a prescription for #90 Levothyroxine 175mcg.
The patients copay was $60.00 Wow! The acquisition cost was $1.17 Yeah. It only cost the store One dollar and seventeen cents for a 90 count.
That's a huge profit margin, but does the store get to keep the copay or is it "clawed back" by the insurance company.
I cannot answer this question directly. I do not have the permission to review the reconciliation reports. BUT! I've spoken to other pharmacy owners and they claim that the high copay is deducted from the actual reimbursement balances.
So, here's my question. Does anyone know if the pharmacy keeps the 60 dollars or are we just collecting the money for the insurance company to keep?
Leave a response if you know the outcome.
(I am assuming that you are allowed to post on the this page.)
JJC

09/01/2025

To discount or not to discount, that is the question.
I am a huge proponent of discounting prescription prices.
You may say that you need at least $15.00 profit from each RX that you fill. That would be nice. However, we are filling prescriptions every day that we literally make pennies on and even loose 25% off branded products with insurance reimbursement.
I've watched pharmacies try to make up their lost profit by overcharging patients who pay cash for their medications.
Here's a real life loss of a customer from the past 10 days.
A potential new customer handed me a slip of paper with a blood pressure RX, strength, quantity of 90, and requested a cash price.
She was losing her insurance coverage and was looking for the best price on this and 5 other medications. I looked up the big box price of $25.00. I calculated our acquisition cost of $2.64
I recommend to the "BOSS" that we should charge $12.00 to crush the Big Box pricing. "No." The boss said make it $27.00.
The customer left and never came back into the store.
So, how much money did we make?....ZIP! NADA! Strike Out!
We could have had a game winning home run in the last inning.
A satisfied new customer will tell 20 other people about our great pharmacy. On the other hand, 20 other people are going to hear the opposite. That we are no better than any other independent pharmacy in town. Essentially, that we suck!

We can now know in advance what the big box stores are going to charge for any product. AND! The pharmacists that work there cannot meet a competitive price and have no idea what any drug actually costs.

Here are a few examples of
BigBox price and ACQ (Our acquisition price) all 30 count

DRUG BigBoxPrice ACQ

Metoprolol 25mg $9.15 $4.67
Amlodipine 10mg $19.22 $0.35
Atorvastatin 40mg $16.70 $0.90
Rosuvastatin 10mg $15.26 $0.95
Clopidogrel 75mg $10.05 $1.29
Furosemide 40mg $9.74 $0.70
Omeprazole 40mg $17. 05 $1.53
Sildenafil 50mg $25.00 $2.19
Tadalafil 10mg $21.21 $2.24
Gabapentin 300mg $15.30 $1.26
Lisinopril 20mg $13.28 $0.75

As you can see, the BigBox makes a substantial profit over ACQ.
Selling at their discount prices.
We can meet or beat them at their own game or we can sit on a stool and watch videos on your computer.

08/30/2025

An old success story with advertising.
I opened my first pharmacy in 1984.
Last storefront in a shopping center plaza with an A+P supermarket at the far end. Not the best location, but I got what I got.
After 3 months, my store was barely making any money. The future did not look good.
I received a phone call or perhaps a mailer from a company called "Promotions Unlimited". They specialized in proving advertising flyers and OTC products at super discount pricing.
I was desperate. I called and got on board with their program.
I arranged to put the flyers in the local Sunday newspaper. That covered all the homes in the area.
I helped unload the truck, stickered all of the merchandise a week before the sale.
Monday arrived and BINGO! There was a line of people waiting for me to open. We sold out all the door busters.
I meet hundreds of people who became customers.
That was the turn around, from worrying about my future to looking forward to the next door buster sale.
Promotions Unlimited is no longer in business.
Their primary customer segment was retail pharmacy and most of us could not survive the "Managed Care" format that the insurance companies imposed upon us all. In the 2 years of 1999 and 2001,
750 New Jersey pharmacies closed or were bought out by CVS for their expansion initiative.

08/30/2025

Cheap and Effective Advertising:
Assuming that there are 28,000 citizens living within your trading area, how many of them have any knowledge of your pharmacy?
I would estimate that maybe 2,000 people know that your pharmacy exists.
This is purely a guess on my part, but when I meet people and they ask me where I work, their response is, "Oh, where is the pharmacy?" When I shop for food at any grocery store, I rarely see anyone that is a customer. That encompasses 2 Publix Supermarkets and one Walmart. I never shop in a Walgreens or CVS. There is no need to.
So what can you do? Radio? Newspapers? Flyers? Group advertising mailers?
I say "NO" to all of this media. Let's advertise for free and then we may experiment with printed media.
The internet provides wide and permanent exposure for your business, especially FaceBook!
FB: Search out groups that are in your territory. A pretty easy task.
Search FB for your local town groups. OK, look for the groups with the higher membership count.
Most groups do not allow direct advertising. However, they will welcome public health advisories. Here's a good one "Athlete's Foot". Boring, right? How many people in your community have experienced the smelly, itchy symptoms? Nearly, everyone. Myself Included.
Next question, how can I compose or get the correct info for this condition? Its at your fingertips, all of the info for 50 or more conditions are free on the CDC website. I'll attach the smelly foot one. Post the public health advisory and add your contact info at the end of the post. Make sure that you carry the OTC products on your shelves, or you'll be wasting your time.
Next add topic will be post cards! Not free, but the most effective direct mail campaign.

Athlete’s Foot (tinea pedis)
Athlete’s foot, or tinea pedis, is an infection of the skin and feet that can be caused by a variety of different fungi. Although tinea pedis can affect any portion of the foot, the infection most often affects the space between the toes. Athlete’s foot is typically characterized by skin fissures or scales that can be red and itchy.
Tinea pedis is spread through contact with infected skin scales or contact with fungi in damp areas (for example, showers, locker rooms, swimming pools)
1. Tinea pedis can be a chronic infection that recurs frequently
2. Treatment may include topical creams (applied to the surface of the skin) or oral medications
3. Appropriate hygiene techniques may help to prevent or control tinea pedis. The following hygiene techniques should be followed:
Prevention of athlete’s foot:
Nails should be clipped short and kept clean. Nails can house and spread the infection.
Avoid walking barefoot in locker rooms or public showers (wear sandals).
For control of athlete’s foot infection, persons with active tinea pedis infection should:
Keep feet clean, dry, and cool.
Avoid using swimming pools, public showers, or foot baths.
Wear sandals when possible or air shoes out by alternating them every 2-3 days.
Avoid wearing closed shoes and wearing socks made from fabric that doesn’t dry easily (for example, nylon).
Treat the infection with recommended medication.

Your GOOD HEALTH is OUR BUSINESS!
Please visit for the lowest prescription prices and our
personal care and advice.

08/23/2025

Secondary Generic Wholesale Suppliers
The disparity of generic drug pricing is dramatic.
A generic drug's pricing could be 5 to 20 times cheaper from a secondary generic "house".
Sounds good? Right, well there is a catch. The purchase contract.
These purchase guarantees require minimum per order purchases, and minimum monthly purchase.
These are reasonable assurances of your continued business.
Per order buys can range from $150.00 to $200.00.
Monthly business purchases from $1,000.00 to $2,000.00 are also reasonable.
There is a trap to avoid. Keep the number of generic supplier contracts to a minimum. WHY? Saving money on cost of goods is a great idea. YES! It is. BUT! Increasing shelf inventory just to meet a purchase guarantee reduces your cash flow. You will be struggling to buy unnecessary inventory just to meet your monthly minimum.
Actual example. The Pharmacy that I am working in has 3 contracts with generic suppliers. At the end of each month, we are purchasing extra inventory to meet the cumulative $6,000.00 monthly volume. There is not enough room on a shelf for three 1000 count bottles of metformin 1000mg. "Oh, but I'm saving money and, making more money on a insurance prescription!

Sounds good.. But, expand that concept to the entire inventory and you will have $60,000.00 worth of generic inventory rather than $40,000.00. Imagine two hundred "100 dollar bills" sitting on the shelf. I'd rather have them in my pocket.

When you open or purchase a new pharmacy...Buy what you need not what you have to.
Ok! How many pills do I need?
If you opened a new store, it will take a year or so to determine how many bottles of drug X to have on the shelf.
If you are dispensing 120 units a month, then you need two bottles of 100 each, not a bottle of 500 or 1000. You'll eventually be able to calculate one month's usage plus a backup quantity.
You will be tempted to buy an extra bottle of a 1000 for a lower acquisition price. That's the trap.
When opening a new store, your inventory should follow the "hand to mouth" inventory concept.
Inventory usage is easy to determine. Your computer has all the info you need. If you are selling 300 units a month then you will survive keeping two 100 count bottles on the shelf.

If you have purchased an established Pharmacy, you will know exactly need from month to month.
No guessing.

01/05/2025

Location! Location! Location!
This is the most important decision to make when opening a new Pharmacy, or any retail store.
In brief, we need street exposure, parking for 6 cars, an illuminated sign, a location that is close to the majority of the population.
A Pharmacy must be conveniently located to ensure that patients can see the store, enter the parking area close to the front door.
Do not rent the first available storefront. If you see a good location that is already occupied, call the landlord. That tenant may ne looking to get out. It happens. Its OK if you need to wait a year to get in. Don't fear the big drugstores. They anger their customers every day. "OOPS! Closed for lunch, pick up your child's medicine in an hour or so." or "Oh No! I cannot fill your prescription today, you have to wait three more days! I'll lose my license!"
As an Independent pharmacist, we have the discretion to always act in the best interest and health of our customers.
Read the Federal Laws. Read the State laws. Read every word about dispensing and refilling controlled substances. You will be surprised. There are written exceptions that allow pharmacists to accommodate a patient's needs when their health or well being is at risk.
Just document what and why, you decided on the script.
Here are some real life examples.
A patient was having an asthma attack when he came into my store. He said I left my inhaler home and I can't catch my breath.
I immediately gave him an albuterol inhaler. After he recovered, I called his doctor, I informed the MD what happened. I got the script and a new lifelong customer.
Another patient lost her diazepam bottle and was reacting poorly.
I gave her one dose and called the MD, I explained the situation and received a script. Another lifelong patient.
Did I behave illegally? NOPE! I acted to benefit the health and wellbeing of my patient.
Another customer just cut her hand. I cleaned bandaged the wound and recommended her to see her doctor.
We're here to help people, not to judge them.

12/29/2024

Advertising your Pharmacy
Yes! Advertising is important!
I work in a town of 28,000 people in Florida. How many of the population know that the pharmacy exists? I'm guessing that less than 3,000 people have heard of this store. Its not a large area, yet we don't advertise nor do we promote the store. (It ain't my store. I just work here. I have to keep reminding myself, over and over again).
Social media offers businesses access to free advertising. There about 5 FaceBook groups covering our town.
Just posting an ad may have some effect. Its far better to provide health content to reach potential customers.
What kind of content?
I've been in community pharmacy since 1978. I took some time to remember what were the common ailments that customers had questions about. Here are some of the situations: Head Lice, diarrhea, constipation, poison Ivy, insect stings, fleas, cough, cold, local pain, athlete's foot, acne, ear aches. The list is longer with some more personal situations and others that needed immediate medical care.
Now I needed to find content that would inform and educate people to promote the pharmacy as a source for health info.
I found what I needed on the CDC websites. The near perfect health info only needed some editing on my part. I will ad one of these ready to go health check ads as an example.
How to stand out in the neighborhood compared to the chains!
I had two new customers come in this past week. I welcomed them graciously. Both had left two different chain stores, because they were "gated out". Each patient was refused service due to a lunch break in 5 minutes and the other told to come back tomorrow due to planned store closure. One of them had just left the emergency room. I LOVE THOSE REFUSALS!
Check out the attached pdf. You can copy and edit the content to enhance your pharmacies value to your customers.

Other topics to come:
Beat GoodRX, SingleCare, and Amazon and promote private pay prescriptions. AND still make money up front.

Location / Location / Location
For prospective owners before signing that lease.

Apparently, I cannot add a file to my post.
So I'll copy and paste the content below.

Athlete’s Foot (tinea pedis)
Athlete’s foot, or tinea pedis, is an infection of the skin and feet that can be caused by a variety of different fungi. Although tinea pedis can affect any portion of the foot, the infection most often affects the space between the toes. Athlete’s foot is typically characterized by skin fissures or scales that can be red and itchy.
Tinea pedis is spread through contact with infected skin scales or contact with fungi in damp areas (for example, showers, locker rooms, swimming pools)
1. Tinea pedis can be a chronic infection that recurs frequently
2. Treatment may include topical creams (applied to the surface of the skin) or oral medications
3. Appropriate hygiene techniques may help to prevent or control tinea pedis. The following hygiene techniques should be followed:
Prevention of athlete’s foot:
Nails should be clipped short and kept clean. Nails can house and spread the infection.
Avoid walking barefoot in locker rooms or public showers (wear sandals).
For control of athlete’s foot infection, persons with active tinea pedis infection should:
Keep feet clean, dry, and cool.
Avoid using swimming pools, public showers, or foot baths.
Wear sandals when possible or air shoes out by alternating them every 2-3 days.
Avoid wearing closed shoes and wearing socks made from fabric that doesn’t dry easily (for example, nylon).
Treat the infection with recommended medication.

Your GOOD HEALTH is OUR BUSINESS!
Please visit for the lowest prescription prices and our
personal care and advice.

12/26/2024

The Phone Call
When calling a doctor's office to clarify a prescription, we want to make a good impression. We need to speak politely and graciously to the staff member that answers the call.
Here's an example of a recent call that I made. The quotation marks will be made for the office response:
"This is Louise at Dr Cutsalot's office."
Good morning, this is John the pharmacist at ABC Pharmacy. We have a mutual patient that has a prescription that I would like to verify.
"What's the Name and Date of Birth?"
Its Joe Pipinyats, date of birth 05/10/1959. "Yes I have his file, what's your question?"
Joe has two prescriptions for the same drug, Losartan, with 2 different strengths, one for 25mg and the other for 75mg.
I want to be sure that we are giving him the correct strength.
"Hmmmm, Yes I see here that the 25mg has been discontinued and he now takes Losartan 75 daily."
Thanks for your help. I really appreciate it. "Thank You."

Many times, I'll add a little more levity to the conversation.
For instance: Wow 1959 that was a great year for the Yankees.
Tell the doc to let you off early today.
These seem stupid and unprofessional, perhaps.
I know plenty of stern and oppositional pharmacists.
I'd rather present myself as a happy and concerned pharmacist.
Politely as for their help, and they be glad to do so.

12/20/2024

First Steps: LOCATION – LOCATION - LOCATION
Where do you want to live and work?
This is an important starting point. Every community has a profile, defined by population statistics: density, income, age, school system, cultural, transportation, and crime. Each of these characteristics must be considered, even if you are planning to open in your own home town.
Starting Point: It is important to live in or near the community of the drugstore.
This allows you to become a real neighbor and to provide the emergency services that the competition does not.
YOUR NEIGHBORHOOD PHARMACY IS IN YOUR NEIGHBORHOOD!

You become a valued addition to the neighborhood.
Pick a place that you would like to live in and let’s look at the numbers.
Population vs Competition
Look up the population statistics http://www.city-data.com
Total population and change of population trends
Check crime data
Total mean family income (over$ 60,000 / year for a middle income home)
Varies by locality, Living on Long Island NY has a much higher income level to ne middle class.
Home Values and Locations – Zillow
Town Geography - Bing or Google Maps

RX Volume by Population
calculating the total expected RX volume for the total population:
The average number of RX’s per person, for independent pharmacies,
is currently at #12 prescriptions per year.
(These averages are calculated annually https://www.drugchannels.net/2019/01/independent-pharmacy-economics-keep.html)
Calculate the number of pharmacies, both chain and independent, serving the entire area. Then we do the math!
Note! (An independent pharmacy can easily compete against the chains and supermarkets. It’s much harder to compete against another independent)
Let’s say we have 25,000 people in the town.
25,000 x 12 (Rxs per year) = 300,000 Rxs per year.
NOW! WE divide that 300,000 by the number of pharmacies in the area.
This will give you the average RX volume, equally divided among each pharmacy.
Let’s say that there are two towns of 25,000 people.
One has 15 drugstores and the other has only 2.
Town 1 (15 drugstores) annual average RXs per store = 20,000
Town 2 (3 drugstores) annual average RXs per store = 100,000
(These are real towns in New Jersey. Many prescriptions are lost to mail order. They do a large volume of RXs per year, Dollar volume stats are available at
https://www.kff.org/health-costs/state-indicator/mail-order-sales-of-prescriptions-drugs-by-payer/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
This is a no brainer…Right? You bet.
However, some small towns will have 15 pharmacies and others only have 3. If you open and compete against 15 other stores, you are in for a futile struggle and a long and tedious road to bankruptcy.
I am watching this happen in Union City, New Jersey.
The Pharmacy,that I worked in, opened a year ago and is still only filling an average 3 prescriptions a day, on the day that I left.
Another pharmacy recently opened one block away.
These new owners did not analyze the potential script volume. They will fail.
CASH FLOW So…How many RX’s do we need to pay our bills?
Prescription sales account for 90% of your gross sales.
Without establishing the breakeven analysis and just looking for a ball park number, we need 100 scripts a day to be profitable. That’s the goal.
Annually that is 36,500 filled prescriptions.
How much profit is that? The average gross profit, for independent pharmacies, is $10.80 per prescription. Once you reach the RX goal of 100 scripts a day, the pharmacy should realize $394,000 gross annual RX profit.
It should take 3 years to hit the 100 a day goal.
(I did it in one year at my first pharmacy)

BREAK EVEN ANALYSIS:
This is an easy calculation. No need for an accountant.
List and total all of the stores FIXED EXPENSES!
(These are the same expenses from month to month} Figure out what you need to pay each month if you sat around and watched YouTube videos all day.
It’s OK to ignore variable expenses now. (These are expenses that would increase as you store does more business)
Once you are filling over 200 Rxs daily, then we look at variable expenses.
The Calculation!
Divide the total monthly expenses by $10.80, the average gross profit per RX.
That will provide the number of scripts that need to be filled each month to break even.
Here’s an example: These are estimated costs for demonstration only.

Fixed Expenses: Monthly
Rent $2,000.00
Utilities $300.00
Phone $250.00
Computer $450.00
Internet $150.00
no TV
Insurance $250.00
Accountant $300.00
Clerk Salaries $3,000.00
200H x 15.00
Owner Draw $5,000.00
Finance $1,500.00
Total Expenses $13,200.00
Divide by $10.80 = 1,222 RXs per month!
That’s only 47 RXS per day (26 day month, closed on Sundays)

(You will need an accountant once you are up and running.
Paying your sales taxes and filling your financial reports with the state and federal authorities promptly and accurately is important!
If you are audited for sales tax returns, they will find a way to have you pay more money.
No matter what evidence you show, they will still levy a payment or fine.)

Location specifics:
Lots of tough decisions to make here:
Storefront, rent, lease, square footage needed, parking, and signage.
LEARN THE NEIGHBORHOOD!
Family average annual income: We are basically setting 3 Income neighborhoods:
$5,000 to $20,000
Low Income = More Medicaid Business some expendable cash.

Middle to Upper Income
$25,000 to $150,000
Commercial Insurance and higher levels of expendable
cash. BEST BET! The Middle Income neighborhood is most
likely to respond to your special services and personal care.

High Income = Over $200,000 The store must appeal to a discriminating clientele.
If you don’t have an intimate knowledge of the community, get down there and visit the local businesses, visit the chamber of commerce, identify all of the medical provider’s locations, review the traffic patterns, and note any barriers to trade (rivers, bridges, and highways).

Visit the planning board to determine if construction projects are planned that will impede customer access.
Imagine a sewer project on the street in front of your store. Yep! It Happens.

SHOP THE COMPETITION!
Visit each drugstore as an OTC customer. Evaluate their customer service, layout, inventory, check local ads and newspapers. Evaluate their weaknesses and strengths.
Weaknesses: Lack of customer care, poor lighting, old merchandise, high retail pricing.
Ask yourself, “Would I want to shop here?” Do they even care if I’m here?
Print out a map and mark up the business and residential layout.
Identify retail space availability.
Once you feel that you can beat the competition, it’s time to start serious location hunting.

KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

12/20/2024

Motivation:
You want to be your own boss! You enjoy helping people.
You want to open your own pharmacy.
The outcome could be great or tragic. It’s up to you.
You will be investing a considerable sum of money of your own and you will need additional financed capital.
More importantly, you will be working 60 hours a week without any significant income from your store, for at least one year.
If you are married, both of you must be in agreement.
Working together is a good start.
Your labor is cheap. Everyone else get paid for their time, before you!
Once you have decided, it’s time to roll up your sleeves and start the process.
Competitive Advantage
You are selling something that no other store has. YOU!
You will personally counsel your customers on all of their health care needs.
You will answer the phone promptly without using call center.
You will fill prescriptions for sick children ahead of everyone else.
You will provide your personal phone number to your customers in need.
You will make emergency deliveries or open the store after hours to aide a sick patient.
You will earn their trust and confidence. That’s what you are selling.

NOBODY ELSE OFFERS YOUR CARE AND PATIENT SERVICES!
You will never need to post negative comments on
“The Angry Pharmacist”. All customers are valued friends.

02/10/2024

Yes! There is a reason why so many young people are diagnosed with asthma and autism. I discuss both conditions briefly.
In the early 1980's, I noticed that many of my young customer's parents were given asthma medications from one on the NYC Union's Clinic. One such patient's child, only a few months old, developed an upper respiratory infection with fever, coughing and yellowish phlegm. She brought her child to this clinic. The child was diagnosed with asthma and had received prescriptions to treat the symptoms of asthma.
As a Pharmacist, I urged the mother to seek another physician. She did not heed my advice. After one week, that child died of pneumonia.
Over the remaining years, many other patients were told their children had asthma. The Asthma diagnosis became a prevalent opinion in medical practice.
Autism: In 40 years of community pharmacy practice, I only had know of one child with "true" autism. I only had two young patients that had true hyperactivity disorder, now known as ADHD.
Near the later 1980's, the medical community expanded the term autism to include about 30 other childhood physical or developmental disorders under the "AUTISM SPECTRUM" disorders. Attention deficit disorder (ADD) becoming the most popular. (If I were a child, I certainly would have been diagnosed with ADD. I was a non conforming pest from kindergarten through High School.)
What was the solution for ADD, amphetamine based stimulants given to unruly or non performing students. Many of these drugs had trade names that inspired the positive effect on ADD, but failed to reveal that their children would become physically and emotionally dependent into early adulthood and middle age.
So! That in my opinion is IT! Asthma and Autism diagnosis's became a popular trend, not due to increased cases but rather the trend to make it popular.