Independent pharmacies were already struggling. The $69 billion CVS-Aetna deal is their newest threat.

The pending super-merger between CVS Health and Aetna has independent pharmacies worried. Insurance company ownership in pharmacies, mail order prescriptions, and the PBM business model are working together to drive consolidation. As the trend snowballs, small pharmacy businesses are getting left behind. "The bigger they get, the more powerful they are, the more leverage they have," laments Jean Keating, pharmacy manager of her family-owned and operated company in Granby, CT. "It's why you see less and less independent pharmacies. Everything is just pushing us out of the market." Data from the National Community Pharmacists Association indicate the number of prescriptions filled at these locations nationwide fell roughly 1% from 2016 to 2017. The number of independent community pharmacies also dipped during that time frame, with 132 disappearing from the landscape. "They're a dying breed," declares Gary Boehler, a consultant to pharmacies, who warns that "costs will rise" as a result of the trend. Even as the term "monopoly" is thrown at them, Aetna and CVS representatives argue that their combination will actually streamline costs, while also helping patients better manage their health and broadening their access to care. "The truth is somewhere in the middle," according to analyst Spencer Perlman at Veda Partners.

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