The Pharmacist Is.
What the brick-and-mortar collapse, pharmacy deserts, drone delivery, and Mark Cuban’s price list are all trying to tell the profession.
By Kyle Fields, Founder & CEO, Appro-Rx LLC
CVS just threatened to close 134 pharmacies in Tennessee rather than comply with a law that would require it to stop owning the very PBM that sets its own reimbursement rates. The company blanketed all six major TV markets in the state with advertising, sent mass text campaigns to patients, and had a what looks like a dark money group spend another half million dollars in TV ads to kill the legislation. A state audit had already confirmed that CVS Caremark was reimbursing its own stores up to 16,500% more for certain drugs than it paid independent pharmacies.
Look at what CVS defended. They defended the real estate and surprisingly DID NOT defend the clinical value of their pharmacists.
That distinction is the entire problem with pharmacy today, and it is the one the profession frustratingly has not yet been willing to name plainly.
The Profession of Pharmacy Has Been Mourning the Wrong Thing!
Independent pharmacies are closing because reimbursement has fallen below the cost of dispensing. Chain pharmacies are closing because the parent company owns the PBM and is restructuring around mail order and specialty. What gets left behind in both cases is a geographic void, not a clinical one. Great for the shareholder and devastating for the patients.
The pharmacist still exists. The building does not.
The profession has spent the last decade fighting to save the brick-and-mortar model when it should have been building the clinical model that survives without it. These are not the same fight, and continuing to treat them as identical is what is costing pharmacists their future.
The pharmacy as a physical structure is dying because PBMs made the economics of brick and mortar unsustainable and punitive for a pharmacist entrepreneur. The pharmacist as a clinical expert has never been more valuable or more underutilized, and I have been shouting this loudly for 14 years! The profession has confused the container for the contents.
Mark Cuban Already Showed You an Answer
The PBM and Payors partner page for Mark Cuban Cost Plus Drug Company lists more than 30 pharmacy benefit managers. Almost none of them are the Big 3. That list is not a coincidence. It is a public declaration that transparent drug pricing is structurally possible and that it requires a different kind of PBM to execute it.
The question is why pharmacists are still directing patients toward PBM arrangements that are not built around that model. Why are pharmacists not realizing that their PharmD education is the real VALUE. The answer is that most pharmacists do not know they have a choice. Most employers do not know either. That is a pharmacist education problem, not a pricing problem, and it is one the profession is positioned to solve right now if it chooses to. Employers who spend over $500,000 on Rx annually need to have a PharmD on staff. PERIOD. Companies have maintenance personnel for equipment, HR staff for employees, and IT staff for technology for obvious reasons. Why not pharmacists for Rx spend?
The Opportunity No One Is Building (Except 1 PBM): The Fractional Pharmacist
Self-funded employers now spend against a pharmacy trend that rose 11 percent in 2025 and 2026. Pharmacy now represents more than 10 percent of total employer claims spend. Most of those employers have no clinical resource in the room when they make plan design decisions. They have a broker who may or may not understand pharmacy benefit mechanics, (or frankly financially misaligned to choose a bad PBM) and a PBM whose financial incentives are also misaligned with the employer’s interests. Solution? Employers who spend over $500,000 on Rx annually need to have a PharmD on staff. PERIOD. One Pharmacist can easily manage 10 Employer Clients.
A pharmacist embedded in the employer relationship changes everything.
Prior authorization oversight.
Formulary guidance.
GLP-1 clinical protocol design.
Specialty drug strategy.
Member education at the point of decision rather than the point of crisis.
The ROI of that relationship is measurable and the competition for that position is essentially zero.
The profession has built the credential yet unfortunately has not built the commercial model.
Pharmacy Deserts Are Not Waiting for Legislation
When a pharmacy closes in a rural county, the conversation immediately turns to access. What it rarely turns to is the question of why dispensing had to be tied to geography in the first place. Drone delivery platforms are already operating in pharmacy desert markets. A pharmacist running a centralized clinical model with drone dispensing coverage can serve patients a closed Walgreens can no longer reach and do it with the kind of medication counseling and follow-up a mail-order fulfillment center will never provide. Check out DEXA (formerly Drone Express) in Dayton, Ohio and how they are innovating solution numerous spaces.
The dispensing counter was always the least important thing in the building. The pharmacist standing behind it was the asset. That asset is mobile and the profession just needs to act like it.
Four Moves for the Profession Starting Now
First: separate your identity from your location. Your value is clinical, not geographic.
Second: learn the self-funded employer ecosystem. The people paying for your patients’ prescriptions are sitting in HR offices with no pharmacy expertise and no advocate in the room. That is your market.
Third: understand what a fiduciary PBM is and why the distinction matters legally and financially under CAA 2026, and why employers who learn this distinction are looking for someone to help them act on it.
Fourth: engage with what is already built. Transparent pharmacy pricing exists. Fiduciary PBMs exist. Drone delivery is operational. The profession does not need to wait for a legislative fix that well-funded corporations will spend millions to defeat every session.
The Same Fight at a Different Scale
The Tennessee battle is the same fight at a national scale. CVS and its affiliated what looks like dark money groups spent more than $1.5 million to preserve vertical integration in a single state. They are not defending pharmacists. They are defending the architecture that profits from the confusion between who pays, who gets paid, and who gets reimbursed 16,500% more for the same drug.
The profession’s answer is not to wait for the next legislative session but to build the model that makes the old one irrelevant.
The pharmacy is not the asset and it never was. THE PHARMACIST IS. The PHARMACIST that figures that out first will not be mourning the next round of closures. It will be building the infrastructure that replaces them.
Kyle Fields is the Founder and CEO of Appro-Rx LLC, a fiduciary, transparent pharmacy benefit manager headquartered in Waynesville, Ohio, serving employer clients across all 50 states.
Related reading: Explore more coverage in our Innovation section and browse the latest analysis on Dispense Times.
