1. Paying Pharmacies Below Their Cost to Buy Medications: This is not competition — it is market destruction.
There are dozens of examples daily at most every community retail pharmacy. These are some examples to showcase the commonality of items, with specific exact dollar values and what these medications are for. EVERY insurance plan is doing this to one or more medication, to most every pharmacy, on a regular basis. No other industry sells product below their cost on a regular, daily basis and is expected to do such, while also being blamed for being the problem for an industry…
*Ozempic 2mg/3mL Pen: Pharmacy cost = $977.63 Patient CoPayment = $0.00 CareMark PBM Payment = $891.94 Pharmacy loss = $85.69 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX9844 10/3/2025, Missouri Medicare Diabetic Treatment
*Lubiprostone (generic Amitiza) 8mcg capsule: Pharmacy cost = $238.11 Patient CoPayment = $47.00 Humana Payment = $7.30 Pharmacy loss = $183.81 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX1938 3/12/2025, Missouri Medicare Plan: Chronic Drug-Induced Constipation Treatment
*Invega 234mg/1.5mL Syringe: Pharmacy cost = $3,497.77 Patient CoPayment = $0.00 Medicaid Payment = $3,441.05 Pharmacy loss = $56.72 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX8221 8/25/2025, Missouri Medicaid Plan: Long-Acting Psychosis Treatment
*Epinephrine 0.3mg/0.3mL (generic EpiPen): Pharmacy cost = $192.00 Patient CoPayment = $0.00 Anthem Payment = $165.76 Pharmacy loss = $26.24 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX2033 11/26/2025, Missouri Commercial Plan: Anaphylactic Shock Treatment
*Phenytoin Ext. 100mg capsule (generic Dilantin): Pharmacy cost = $27.19 Patient CoPayment = $0.00 Optum Payment = $7.62 Pharmacy loss = $19.57 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX3916 2/05/2025, Missouri Medicare Plan: Seizure Treatment
*Amoxicillin/Clavulanate 875mg/125mg (generic Augmentin): Pharmacy cost = $2.69 Patient CoPayment = $0.00 CareMark Payment = $2.21 Pharmacy loss = $0.48 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX4402 5/12/2025, Missouri VA Plan: Antibiotic Treatment
*Losartan 100mg tablet (generic Cozaar): Pharmacy cost = $6.04 Patient CoPayment = $0.00 Aetna Payment = $3.15 Pharmacy loss = $2.89 plus cost to dispense (payroll, electricity, insurance, software, etc.) RX5732 6/13/2025, Missouri Medicare Plan: High Blood Pressure Treatment
*Per 2025 NCPA Digest, the national average independent pharmacy experiences $15.00 average cost to dispense a single prescription. One Missouri pharmacy reviewed the 2025 dispensing data, and found that only 1 in 5 prescriptions truly paid at this level, showing nearly 80% of all dispensed medications were sold cheaper than it cost to dispense them to the patient. Another confounding factor beyond this is that not always do patients pay charge accounts that independent pharmacies often allow copayments to be placed into, in an effort to assist patients with costs…