Chains and PBMs are thriving as Independents face diminishing profit levels caused by:

• Pricing formulas that fail to protect margins against cost changes
• Usual and Customary pricing that results in inadequate third party reimbursements on non-preferred drugs, non-formulary drugs and large numbers of generics
• DIR fees, GER adjustments and “Claw Backs”
• Delays by PBMs in updating costs for several weeks after items increase