Doug White founded LTC Prescription Providers in Proctor, MN, in 1999. He says the pharmacy's service to assisted-living facilities represents 70% of his business; walk-ins alone would not be sufficient to sustain his business. He is part of a cooperative group of independents that has achieved some bargaining power, White says. "It's a really tough thing for independents to make a go of it," says Michael Swanoski, senior associate dean at the Duluth campus of the University of Minnesota College of Pharmacy, who has researched the decline of local independent pharmacies. In 2002, St. Louis County, MN, had 31 independent pharmacies and 51 chain pharmacies, but by 2017, the number of chain pharmacies declined to 41, and the number of independents fell to 12. Swanoski and White both blame PBMs, saying they have consolidated and retain a disproportionate amount of money. The National Community Pharmacists Association notes that just three PBMs control more than three-quarters of all prescription drug benefit transactions nationwide. White says he can offer his customers services they might not get from a chain store, such as providing the type of packaging they prefer. Swanoski also notes that independent pharmacies can make decisions based on local needs rather than follow a "cookie cutter" approach set at the corporate level. He adds that some rural pharmacies are opening telepharmacies to fill prescriptions in locations that otherwise would not be served.