“We do a lot more than put pills in a bottle…”: Independent community pharmacists and the business of US healthcare

Abstract

Pharmacy comprises a key component of the US healthcare system, and independent community pharmacies serve as critical gap-fillers in the broader patchwork of US healthcare. Yet as small local businesses operating within the big business conglomeration of insurance and pharmaceutical corporations, their traditional revenue models no longer suffice, threatening both independent pharmacists’ livelihoods and the health of their local communities. To counter these external pressures and open new revenue streams, North Dakota’s Pharmacy Service Enhancement Project (PSEP) aims to expand billable and reimbursable pharmacy clinical services, beginning with tobacco treatment. In this article, we contextualize and examine the optimism and ambivalence among independent pharmacists at PSEP pilot sites as they look to be paid for their work while still attending to community needs and remaining accessible to patients.