Does Pharmacy Have an Identity Crisis?

What is Pharmacy anyway?

Is 'pharmacy' community pharmacy? Is it chain pharmacy? Is it independent pharmacy? Is it grocery-store pharmacy? Is it mail order? Is it specialty? Is it clinical care? Is it retail?

The honest answer is: pharmacy has become all of these things, and that is exactly why the profession is struggling with an identity crisis.

By that definition, a pharmacy that sells prescriptions, over-the-counter products, immunizations, consultations, testing, supplements, durable medical equipment, and health services to patients is participating in retail. But pharmacy is not "retail".

That is the tension. The transaction may be retail, but the pharmacist is not a retailer first. The pharmacist is a medication expert, a clinical advisor, a public health access point, and often the most reachable healthcare professional in the community.

One of pharmacy's disruptors, the godfather of "Deprescribing in Senior Care" as I like to think of him, Dr. Delon Canterbury, PharmD, BCGP, wrote an article on LinkedIn, read it below:

Delon wrote how he's tired of "7 specific lies in pharmacy", with one being ""Retail is a dead end." --which is what spawned this blog post. I got stuck on the word "RETAIL" and have always had a problem with the phrase "Retail Pharmacy" -- because it's a commodity word.

The word “retail” means selling goods or services directly to the end consumer for personal use. Merriam-Webster defines retail as selling in small quantities directly to the ultimate consumer, while Britannica describes retailing as selling goods and services to consumer end users.

(Merriam-Webster)

The problem is that the business model of pharmacy has often defined the professional identity of pharmacy more than the pharmacist has. There are massive differences between chain pharmacy, independent pharmacy, grocery-store pharmacy, big-box pharmacy, long-term care pharmacy, specialty pharmacy, health-system outpatient pharmacy, and community-based clinical practice. They may all dispense medications, but they do not all operate with the same staffing model, ownership structure, patient relationship, payer leverage, workflow pressure, clinical autonomy, or community accountability.

Treating all of them and terming them as “retail pharmacy” flattens the profession into a checkout counter with a prescription department attached.

Historically, pharmacy carried a stronger professional identity because the pharmacist prepared, compounded, interpreted, and advised. The pharmacist was not simply handing out a finished product. The American Institute of the History of Pharmacy notes that American pharmacy practice gained much of its stature through the manufacturing and compounding of drugs, even as the rise of manufactured medicines created tension between preparation and distribution. (aihp.org) By the 1950s and 1960s, modern drug manufacturing sharply reduced the need for routine compounding, and the pharmacist’s role increasingly shifted from preparing individualized medications to dispensing manufactured dosage forms. (Compoundia Pharmacy)

That was the first wave of commoditization: the end of compounding as the dominant public-facing identity of pharmacy. The pharmacist moved from maker to dispenser. Mass manufacturing brought enormous benefits, including standardization, scale, safety controls, and therapeutic advancement. But it also changed the public perception of the pharmacist. Instead of being seen primarily as a therapeutic advisor and preparer of medicine, the pharmacist became associated with the distribution of pre-packaged products.

The second wave came through corporate consolidation. As chain pharmacies, big-box retailers, supermarkets, and national brands expanded, pharmacy became increasingly embedded inside high-volume retail environments. The profession’s identity became tied to convenience, hours of operation, front-end sales, drive-through windows, coupons, and prescription count. Scale became the strategy. Price and volume became the language. The pharmacist became more accessible to the public, but also more trapped inside a production system.

The third wave came from PBMs, payer control, and digital disruption. The Medicare Modernization Act of 2003 created Medicare Part D, which further expanded the role of private plans and pharmacy benefit managers in the prescription drug benefit. Research on Medicare coverage strategy notes that PBMs became central intermediaries in managing Part D formularies and drug access. (PMC) Over time, PBMs gained enormous influence over reimbursement, network access, preferred pharmacy status, formularies, rebates, and patient steering. The Federal Trade Commission has reported that PBM contracts often include reimbursement and post-sale adjustment provisions that determine what pharmacies are ultimately paid, and the FTC has warned that PBMs affect both medication affordability and the ability of independent pharmacies to remain viable. (Federal Trade Commission)

This is where pharmacy’s identity crisis becomes an economic crisis.

When the system pays for product movement instead of clinical judgment, the profession gets measured by speed, volume, adherence scores, refill capture, inventory turns, and claim adjudication. The pharmacist’s value is reduced to whether the prescription was filled, whether the patient waited too long, whether the claim paid, and whether the pharmacy survived the reimbursement. That is not a clinical identity. That is a distribution identity.

Independent community pharmacies feel this most intensely.

They are often the most locally accountable pharmacy model, especially in rural, older, and lower-income communities. A Health Affairs Scholar study found that about 15.1 million people in the United States rely on independent pharmacies for optimal access, and those patients are more likely to live in rural areas, be older adults, or belong to low-income households. (OUP Academic) In other words, independents are not simply “small retailers.” In many communities, they are healthcare infrastructure.

Chain pharmacies face a different version of the crisis.

They have national scale, payer contracts, brand recognition, technology, and convenience. But their pharmacists often carry the burden of volume metrics, corporate staffing models, immunization surges, phone calls, inventory pressure, patient frustration, and administrative demands. Grocery-store pharmacies may offer convenience and local shopping integration, but they also risk being viewed as one department inside a broader retail food operation. Specialty pharmacies bring clinical sophistication and complex therapy management, but many are shaped by payer ownership, limited distribution drugs, PBM relationships, and narrow access channels.

These are not minor differences. They are huge differences.

So when someone says “retail pharmacy,” the profession should ask: which one? A rural independent pharmacy that delivers medications, supports local physicians, offers immunizations, manages adherence packaging, and helps patients navigate insurance is not the same environment as a high-volume national chain store inside a metropolitan market. A grocery-store pharmacy is not the same as a closed-door long-term care pharmacy. A specialty pharmacy managing complex biologics is not the same as a mass-market prescription counter. Yet policymakers, payers, media, and even some healthcare leaders often collapse them all into one category.

That collapse hurts the profession.

It also confuses the public. Patients see a pharmacist behind a counter, surrounded by shelves of consumer goods, and assume the pharmacist’s job is to “get the prescription ready.” But pharmacists are trained to evaluate medication therapy, identify drug interactions, support adherence, administer vaccines, educate patients, monitor therapy, manage medication-related problems, and contribute to outcomes. Medication Therapy Management, as described by pharmacy organizations, is explicitly different from merely dispensing medication and includes patient-centered activities such as medication reviews, therapy monitoring, education, adherence support, and coordination with other healthcare providers. (Med Therapy Management)

This is why the “Pharmacy First” movement matters.

NHS England launched Pharmacy First on January 31, 2024, allowing community pharmacies to complete episodes of care for seven common conditions through defined clinical pathways. (NHS England) Community Pharmacy England describes the service as part of a broader investment to support community pharmacy services and absorb elements of the prior Community Pharmacist Consultation Service. (Community Pharmacy England) Whether the U.S. adopts its own version at scale or not, the philosophical direction is important: pharmacy must be recognized as a clinical access point, not merely a medication pickup site.

The identity crisis in pharmacy is not that pharmacists lack value.

The crisis is that the marketplace has defined that value too narrowly. PBMs define pharmacy as a reimbursable claim. Corporations may define pharmacy as a traffic-driving department. Manufacturers may define pharmacy as a distribution endpoint. Payers may define pharmacy as a cost center. Patients may define pharmacy as a place to pick up prescriptions. But the profession must define pharmacy as a healthcare access point built around medication expertise, patient trust, clinical intervention, and public health.

Pharmacy must reclaim language.

“Retail pharmacy” may describe a transaction, but it should never be allowed to define the profession. “Community pharmacy” should mean more than a storefront. It should mean a healthcare destination embedded in the daily life of the patient. “Independent pharmacy” should not be framed as a nostalgic small business category; it should be recognized as a flexible, locally responsive clinical care model. “Chain pharmacy” should not be dismissed as corporate retail; it should be challenged and supported to create practice environments where pharmacists can deliver care at the top of their license. “Grocery-store pharmacy” should not be treated as an afterthought; it can be a powerful preventive health access point if the model supports clinical care.

The future of pharmacy depends on whether the profession accepts commoditization or fights for clinical definition. If pharmacy continues to be measured mainly by prescription volume and reimbursement mechanics, pharmacists will remain trapped in a system that underuses them. If pharmacy moves toward value-based care, provider recognition, clinical documentation, public health integration, and patient outcome measurement, the profession can reassert what it has always been at its best: the bridge between medicine and the patient.

Pharmacy does have an identity crisis.

But maybe the crisis is also the opportunity. The profession is being forced to decide whether it is a product channel or a care model. Whether it is a retail department or a healthcare profession. Whether it is defined by the payer, the corporation, the manufacturer, the PBM, the patient, or the pharmacist.

Who Defines Pharmacy & what the value actually is?