GLP-1 Reimbursement Crisis: What Independent Pharmacies Need to Know About Staying Viable

In an interview with Pharmacy Times, David Graziano, head of retail network at GoodRx, discussed how deteriorating reimbursement conditions are making it increasingly difficult for independent pharmacies to profitably dispense glucagon-like peptide-1 (GLP-1) medications for patients with diabetes, including semaglutide (Ozempic, Wegovy; Novo Nordisk), orforglipron (Foundayo; Eli Lilly and Company), and tirzepatide (Zepbound, Mounjaro; Eli Lilly and Company).

Graziano explained that unpredictable acquisition costs and opaque reimbursement structures are forcing pharmacies to question whether to stock high-cost brand therapies at all—and that without margin visibility, many are turning patients away or directing them to other pharmacies, losing the broader prescription basket in the process. He described GoodRx's Community Link program as a direct response to this challenge, providing pharmacies with transparent, manufacturer-funded reimbursement on more than 125 brand drug programs. Graziano also addressed the growing cash-pay market driven by restrictive insurance practices, the competitive threat from direct-to-consumer and telehealth models, and the broader imperative of keeping independent pharmacies financially viable as indispensable access points for patients nationwide.

Pharmacy Times: GLP-1 demand continues to rise, but many independent pharmacies report dispensing these agents at a loss. What are the primary drivers behind these negative margins?

David Graziano: Independent pharmacies are operating in an environment that's wildly complex, and the demand for high-cost therapies like GLP-1s is growing rapidly. The acquisition costs and reimbursement rates vary significantly by both payer and plan. When you have that pricing variability, benefit design changes all over the place, and reimbursement structures that create limited visibility for the pharmacy to know what they're actually going to deliver from a margins standpoint, you really do want that predictability. GoodRx stood up Community Link as a way to solve for this issue—by actually delivering for independent pharmacies and ultimately patients upwards of 125 brand drug programs that, for the first time, actually deliver a positive reimbursement on drugs like Ozempic, Wegovy, Foundayo, and Zepbound KwikPen. This is really a way that the pharmacy can clearly gain access to what they're going to get at the end. There are no games; there's no confusion as to what they're going to get from a reimbursement. The manufacturer is actually going to pay or buy down the patient price, and then we actually flow the funds back from the manufacturer directly to the pharmacy through our Community Link contract. It's a great way for solving one of the primary challenges that can frustrate an independent pharmacy owner.

Pharmacy Times: How do fluctuating acquisition costs and retrospective reimbursement adjustments impact day-to-day decision-making for independent pharmacists filling high-cost brand medications?

Graziano: In that instance, a pharmacy is actually going to make a decision: are they even going to stock a medication on their shelves? The opportunity—not really understanding if they are or what they're going to get reimbursed at the end—makes it a real challenge. Having that visibility, having the understanding of the margin that they can capture from that prescription, allows them the predictability to say, yes, I can carry that script, and I can ultimately dispense it, because I know that I'm going to be paid effectively on the back end.

Pharmacy Times: From your perspective, how is the growth of oral GLP-1 therapies and expanded indications likely to further affect pharmacy reimbursement dynamics?

Graziano: Opening up GLP-1s to an oral class, or having that ability, has really started to—we're seeing significant growth in the overall prescription volume that is running through retail settings. As that demand grows, the existing reimbursement models continue to test that overall spend. If an independent pharmacy is not able to fill that high-cost drug, they're ultimately having to farm out or ship off that patient to another pharmacy, potentially losing the entire basket of drugs that go alongside it. Again, when we stood up the Community Link program for independent pharmacy, it allowed them to keep those scripts on hand and ultimately dispense them to patients because, again, they're getting predictable revenue on the back end, and the patient is getting an accessible price to ultimately give them access to pick up and stay on that medication.

Pharmacy Times: What operational or financial strategies should independent pharmacies consider to remain viable while continuing to serve patients seeking GLP-1 therapies?

Graziano: Independent pharmacies don't have to lose money filling GLP-1s as long as they can sign up for or engage with a program that gets them access to predictable reimbursement—it should give them the ability to engage and ultimately dispense that medication to patients. Programs like Community Link actually benefit the patient too. They know what they're paying up front; the cost is visible to them, and it's what they would actually be able to achieve across the retail chain, especially at community pharmacy. There are really no last-minute surprises. It's really an alignment between affordability and sustainability—affordability for a patient and sustainability for a pharmacy.

Pharmacy Times: How are restrictive insurance practices—such as prior authorizations and high deductibles—shaping patient behavior, particularly in terms of cash-pay demand at the pharmacy level?

Graziano: That's a great question, because rising deductibles, formularies that are getting narrower, step therapy, and prior authorizations are in many cases putting barriers between the patient and ultimately picking up that prescription. It's only increasing the number of cash-pay patients that are coming in and picking up what they expected insurance to cover in the past. I would suggest independent pharmacies are well positioned to take advantage of the cash-pay market. It gives them a great opportunity—as long as it is economically viable for them—to dispense those medications. And when you sign up with an organization like GoodRx and sign up for Community Link, you actually have a foundation put underneath your dispensing mechanism. It's transparent on all generics, so you know the price the patient is going to receive and ultimately the reimbursement you'll get. Then you get access to these manufacturer-funded programs that again deliver outside value both to the patient and ultimately to the pharmacy. Our goal here is to make sure that an independent pharmacy can survive in this space as things are changing so rapidly. We want to make sure that we support the bottom line for those independent pharmacies to keep those front doors open, as they are a primary mechanism for picking up prescriptions in many of the communities across our country.

Pharmacy Times: As direct-to-consumer and telehealth prescribing models expand, what capabilities do independent pharmacies need to retain patients and remain competitive in this evolving landscape?

Graziano: Direct-to-consumer and telehealth models are expanding rapidly, and it's really changing the way that consumers are seeing the speed, convenience, and upfront pricing clarity that they're all in search of. Independent pharmacies can really remain competitive by strengthening that patient experience that they already do so well. Independent pharmacies are well known for the care and concern that they pay towards their patients, and so when we can layer on pricing transparency, when you can layer on consistency across all channels, it really does buttress the experience that patients are receiving at community pharmacies. Having the ability to offer a predictable cash-pay option really becomes increasingly more important. You're creating and delivering transparency right at the counter, and it's not a question of “Can I offer that price?”—it’s “I know that I can offer it, and I can get it to a patient really efficiently.”

Pharmacy Times: Is there anything else that you would like to add, or anything that I missed?

Graziano: I would just say that GLP-1s are a clear example of a broader structural change in the system as it relates to pharmacy reimbursement. High-cost therapies, high acquisition costs, unpredictable reimbursement—these types of challenges exist across everything from GLP-1s to autoimmune disease therapies, asthma, and mental health treatments. Independent pharmacies are structurally imperative access points that must be available for patients to gain access to these, in many cases, life-saving drugs. As we can provide value for those community pharmacies to ultimately deliver that value to patients, dispense those medications, and keep patients adherent—that’s really an important goal for us. Our aim is really always around access and affordability, whether it's to products or, ultimately, the services that make independent pharmacies indispensable inside of US health care.