Some Indie Pharmacy Upshots That Surprised Me—and I Thought I Was Pretty in the Know, With Benjamin Jolley, PharmD. EP422

What would you do if you owned an independent pharmacy and discovered that nearly all of your profit came from just 10% of the prescriptions you fill — and that you'd actually make more money by firing most of your staff and refusing to fill the other 90%? That's the math Benjamin Jolley, PharmD, a third-generation independent pharmacy operator and consultant, lays out for Stacey Richter in this episode, a natural companion to the recent conversations with Mark Cuban and Ferrin Williams (EP418) and Ge Bai (EP420). And here's the kicker: the 10% of drugs that actually make an indie pharmacy money are, unsurprisingly, the exact same drugs that PBM-owned mail-order pharmacies mandate get filled through them instead. WHAT YOU'LL LEARN ✅ Why roughly 10% of prescriptions generate nearly all of an independent pharmacy's profit — and why that 10% happens to be the same drugs PBM-owned mail-order pharmacies steer away from independents ✅ The two ways an indie pharmacy actually loses money on a prescription: when the PBM-mandated reimbursement is less than the drug's acquisition cost, and when the dispensing overhead (like the pill bottle itself) exceeds the profit on an ultra-cheap generic, even at a 100% margin ✅ Why what a patient pays at the counter has no real relationship to what the pharmacy is actually paid or to what the employer plan spends — because the PBM sitting in the middle controls all three independently ✅ Why, per Ge Bai's research (EP420), $41 of every $100 spent on generic drugs goes to the PBM — and why patients paying cash out of pocket often come out ahead of patients using their own insurance ✅ What Benjamin Jolley thinks independent pharmacies and employers can actually do to make the PBM less relevant to a transaction it has no legitimate role in WHY THIS MATTERS The core absurdity here is structural: a third party that never touches the drug, the patient, or the pharmacy's costs still controls what everyone pays and gets paid — and does so in a way that specifically starves independent pharmacies of the 10% of prescriptions that keep them financially viable. Benjamin Jolley's math isn't a complaint about margins; it's a demonstration that the PBM's role in routine generic drug transactions has become disconnected from any value it actually adds. For employers and patients alike, that disconnect is exactly where the money is quietly disappearing. MENTIONED IN THIS EPISODE EP379 with AJ Loiacono: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 04:47 Benjamin Jolley's recent revelation. 06:14 What are the 10% of drugs that provide all the profit for pharmacies? 09:21 What's happening with the other 90% of drugs that pharmacies are filling? 11:05 What is the breakdown of costs when fulfilling prescriptions and running a pharmacy? 18:50 EP379 with AJ Loiacono. 21:42 What is the "cost savings" within the "insane system" of PBMs not sharing profit with independent pharmacies? 23:00 What is one of the things that PBMs and pharmacies don't often talk about? 26:39 What can employers do so that patients aren't getting overcharged by PBMs? 27:51 "How do I make the PBMs irrelevant?" 33:30 What's the difference between an independent pharmacy delivery service and a service like Express Scripts? 34:36 What's the other potential solution in solving the problems independent pharmacies face, and why does Benjamin Jolley feel that it's not the best solution to pursue?