Stores like Rite Aid, Walgreens, etc. primarily exist - to me at least and I think to many - to fill prescriptions. The pharmacy segment accounts for around 65-70% of Rite Aid's revenue. I think the stores are closing because the costs of prescriptions keep going up, insurance is paying less, and the people who depend on those prescriptions are going elsewhere; Amazon, Walmart, etc.
If drug costs were lower then we would see more independent pharmacies, and probably more chains, but in this economy..
I never really ever went to Rite Aid except for, as a kid, we went to go there to get Thrifty Brand Ice Cream. It's actually pretty decent, and they'd always use a giant scoop.
I was frustrated with my local Duane Reade's failures, randomly marking scripts as "call us to fill" when I tried to fill them online, only to then say "oh yeah it'll be ready in XYZ" "can you tell me why you made me call you?" "no it just does that sometimes."
So I tried a bunch of local pharmacies, which were all much worse experiences in various ways (failure to fill scripts because they couldn't source things, their online systems straight up didn't work, the lines to pick things up were very long...)
Then I tried Capsule, which was great...at first. Then one day, they completely failed to deliver a med I was about to run out of, and their "24/7 live chat" took 4+ hours to respond that they couldn't get it to me until after I would have missed a dose, and when I replied to that, got an automated message that it was closed for the day.
So now I just suck it up and deal with the Duane Reade, because there is so much further down to go.
The modern 'drug store' kinda baffles me. Compared to a grocery - worse selection of grocery items and drugs, worse laid out, at worse prices.
Then I wonder who they are trying to cater to. If it's a smaller and quicker grocery experience, they're competing with nearly every dollar store and gas station. In my experience at least, they're often severely understaffed and not at all quicker.
I guess grocery and online expanding into prescriptions, and the death of print photo were a one-two punch. What's interesting is that they've been declining for years, and at least to myself the consumer, don't appear to be trying to do anything different.
It comes down to two key forces that separate many American pharmacies from many other countries: Car-centric development and slow prescription filling.
In American suburbia, having the smallest store possible isn't an advantage at all: We are mostly talking strip malls, where it takes some time to get in or out. The energy expenditure of leaving an arterial, parking and walking us much higher than just turning inside a store from a sidewalk in a trip you were already taking. This leads to minimal demand for stores that are very small, or sell cheap items. The smallest you are going to find is the restaurant with a drive-through, which is still quite big.
The other issue is that instead of having most prescriptions in blisters, and a quick, automated dispensing system that lets you in an out of the store in seconds, American pharmacies just do way too much work to dispense medicine. Part is insurance and price variation, part regulation, and part just not having everything standardized and in blisters and bottles. So if you go to the pharmacy, you either call in advance, or you are going to sit there for a while.
Both of those things are pushing you to sell something more in the pharmacy, so you get a build in convenience store, which is as bad at pricing as any other convenience store.
The Spanish pharmacy, where you can get in and out in under a minute, and yet it's often seen as the first layer of the medical system for medical advice, is so much better, but it'd not make any sense given how the US is built, and how we regulate the pharmacy.
The entire point of a "modern drug store" is to fill prescriptions. All of those grocery items, etc. are there just to supplement the prescription business, which far and away is the bulk of revenue for that location. It's like gas stations that sell food.
This is also why the pharmacy counter is at the back of the store. They are praying that in your journey back there you find that you needed some cosmetic, a quart of half-and-half, can of Pringles, etc.
Yes, and it’s only baffling now because the “modern drug store” is no longer the only game in town when it comes to filling prescription. Grocery stores (Safeway), big box stores (Walmart), wholesalers (Costco), and online retailers (Amazon) are all in on the business.
Because usually leases aren't new custom property sizes, they're of existing spaces, and if only your kind of thing will fit in there, why would they carve up their larger space to have spots that size?
Huh. No wonder. In .de that must have been because of their opening times, many of them 24/7.
But that convenience stuff was always more expensive, and depending on your taste and preferences not especially desirable.
Mostly tabac and alcoholics, I guess.
That was pre-Covid. Post-covid full greedflation set in.
Like two to five times more expensive, than the also more expensive stuff in supermarkets.
Memories from about 1.5 years ago, for something on 'special sale' for €9,99(20 Deutsche Mark, Alder, Ey!), a 0,33L can of some whiskey-coke, which sells for about €2,50 to €3 normally.
Bag of chips, €4,99(10 Mark!1!!), single candy bar, €3,99 WTF?!
I don't see that to this level in the .us for comparable stuff.
CVS retail prices for grocery and other miscellaneous items are so high that I want to stop everyone I see shopping there and lecture them about the math of buying elsewhere.
Their membership offers a monthly store credit of $10 at a monthly cost of only $5 and it still barely feels worthwhile.
There are a lot of drug store locations though that don’t have pharmacists and others where the pharmacists work limited hours compared to the rest of the store.
In theory they should work well in food deserts. But they are always overpriced and don’t vary stock from store to store, so can’t cater to varying income levels well.
A family owned dollar store with pharma and fresh grocery would be a good replacement for many of these cookie cutter pharmacies that are disappearing.
Some states have interesting quirks, such as Kentucky, where a grocery store cannot sell wine and spirits on premise (though they may do so via an adjacent secondary storefront). Kentucky pharmacies, however, may sell wine and spirits directly, which is a vestige of prohibition.
They do have a larger selection of many medical products. Fast vaccinations.
Services like package drop off (CVS does UPS, Walgreens Fedex), bill pay, etc. While print photo isn't what it used to be, if you want a specialty photo printed like a larger size, it's pretty fast and cheap to do so (you can typically upload your photo and pick up in a couple of hours)
It’s a shame, I have had a longstanding condition that occasionally requires medication that is not readily available in some pharmacies or that pharmacists occasionally will not even want to stock. CVS is such a miserable experience I stopped going years ago, walgreen’s much the same. My rite aid, which maybe is a local quirk, for whatever reason is extra attentive to my needs, medication refills take just a few minutes, they’ll call to remind me about things and regularly contact my doctor’s office to see if they need to stock anything. It’s been great and I’ll be really sad if it closes.
Probably location dependent. We have a very well loved grocery chain in Texas called HEB who have their own pharmacy. The one down the street from me is horrifically bad at managing scripts. So I use the Walgreens down the street because even though it’s double the price they can at least reliably fill and produce medication for me and have functioning technical systems
The HEB a few minutes further down the road also is fine, so it’s often branch dependent in my experience (mismanagement?)
Be aware that Cost Plus Drug is also heavy on marketing. The few times I’ve checked it was not actually the cheapest cash-pay option.
They have cleverly, although transparently, applied the fee model to prescriptions. You see one price on their page, but when you get to checkout the total price inclusive of everything might be more expensive than your local Walmart.
Their marketing is incredibly effective, though. I can’t believe how many people think Cost Plus must be the cheapest option who are then shocked to discover the same prescription is $4 at their local Walmart.
I use Amazon Pharmacy and it’s been an amazing experience. I get my drugs auto refilled, insurance is recognized and delivery is fast.
I haven’t filled a prescription in a brick and mortar pharmacy for a long time. Only limitations of online pharmacies are no consults, no vaccinations and no controlled substances.
I still go to a Safeway pharmacy for my shots. Even with an appointment I have to wait 30 mins or mlre because the staff are slammed. Pharmacist friends tell me it’s not a great time to be a pharmacist because of the shortage of techs.
I tell folks that if they can move their prescription online, they should. Not only will it save you the hassle, it’ll take the pressure off brick and mortars and actually help them improve in-person service for those who need it.
Never, ever let CVS get hold of your cell number. They start texting and texting and texting, and to get it to stop you have to phone your local store AND the headquarters.
In the US, insurance companies and Pharmacy Benefit Managers (PBMs)[0] are the biggest threat to smaller, independent pharmacies. Even if your neighborhood has a Mom and Pop pharmacy (a rarity, as you suggest), if most insurance providers do not provide coverage for that pharmacy I doubt many folks will go there. Instead they would go further across town or use online services - driving independent pharmacies out of business.
On the side of the PBMs influence, the consumer might not see a difference in the price in order for the indie pharmacy to stay competitive, but the cost of medicine for indie pharmacy can be much higher than the corporate pharmacy - meaning they make no money on a sale and in some cases actually lose money. (I recently learned that in some cases, specifically with GoodRx, indie pharmacies can be forced to pay the PBM when a customer uses a PBM discount card at their pharmacy - so the consumer pays the PBM and the pharmacy pays the PBM)
Large corporate pharmacies have the strength and power to influence insurance providers and PBMs - and some even control them. That in my mind is the bigger issue in the US.
Just like with purchasing products made locally/sustainably, it is often a matter of convenience and lack of effort which leads people to believe that there are no other options than what is being marketed towards them.
I found them the same way I found my pharmacy-- the National Community Pharmacists Association pharmacy locator: https://ncpa.org/pharmacy-locator
> it is often a matter of convenience and lack of effort which leads people to believe that there are no other options than what is being marketed towards them.
I had this exact conversation recently. When I pointed out that we have a mom and pop drug store within walking distance of our neighborhood, the conversation shifted to imagined complaints that they wouldn’t have necessary medications in stock, they might not accept the right insurance, or that prices would be higher.
Many people’s stated preferences favor small, independent products. Often their revealed preferences favor the large company, cheapest, or most convenient option.
This conversation plays out for cheap Amazon products, too. I’ve heard so many people complain that Amazon is full of cheap foreign products, followed by them bragging about how little they paid for some cheap thing from Amazon recently.
It seems to me that the modern American way is duopoly. You have unlimited free market capitalist choice: you can choose Google or Apple, Walgreens or CVS, Lowe’s or Home Depot, Kroger or Walmart, Uber or Lyft, Cox or Centurylink, Ford or Chevy. It’s like a cosplay free market.
It feels like everywhere at all times, people are playing dirty to protect their cash flows, doing anything they can get away with to keep new entrants out of markets. They even weaponize it against other giants, too (eg JEDI, or wielding the EPA against SpaceX).
This doesn’t seem like a failure of capitalism to me, but a failure of government. Not that the government failed to regulate, no; that they were explicitly captured in such a way that results in regulation that ensures nobody except the existing, connected players can participate.
If you want to have even a tiny chance to edge in, you have to be backed by immense capital and be connected with someone who can put in a word with the right people. In tech, VCs like YC or a16z or the so-called PayPal mafia come to mind.
Innovation, but only via undocumented, preapproved channels.
It’s illegal or effectively illegal to make new pharmaceutical factories, or new retail pharmacies, or new hospitals, or new financial services and payment systems, or new banks, or new safe deposit boxes, or transit services, or ISPs, or schools, or any myriad other verticals that have been regulated to oblivion for entrants in the name of “consumer safety”. If search engines or public libraries were invented today they’d be shut down in days, perhaps hours. Even Tesla fought the biggest uphill battle to be able to sell cars direct to consumers, as it was outlawed in many states.
I really want to see orders of magnitude more new small businesses, but the American population seems to be regarded as a resource to be harvested rather than an economic talent pool to be developed.
Everyone wants more mom-and-pops, except the existing ownership class, because they aren’t on SecondMarket.
Everything you mentioned does take a lot of capital to build physical infrastructure.
There are way more than two car manufacturers and for prescriptions in particular, just near me there is CVS, Walgreens, Publix, Target and Walmart.
Cable is very much a natural monopoly because of the infrastructure and right of way issues.
None of the rest of your list is illegal or hard to do. But it takes capital to build physical stuff.
I travel a lot and my wife and I did the digital nomad thing for a year. I got my prescriptions refilled at CVS from San Juan to Las Vegas that year.
Speaking of deposit boxes, we also have a virtual mailbox whose physical location is in the back of a tax preparation office. Our important mail is sent there and when we were traveling, we could have it scanned and discarded once we viewed the image or bulk shipped to where we were. It’s dead simple to either get 1Postal or UPS franchise.
You aren’t going to have a mom and pop transit service that works globally. Again as frequent travelers, Uber and Lyft were a god send.
Banks definitely have capitalization requirements and dozens of virtual banks went out of business around 2008. I worked at a company that did bulk commercial physical and virtual mail for them - not spam, statements, notices, etc
I think you're leaving out a few obvious ones to force the duopoly narrative.
> Lowe’s or Home Depot
Harbor Freight, random local lumber yards
> Cox or Centurylink
Comcast. A few others too. Usually you only have one choice though. Dish if you're talking about TV instead of internet, various phone company offerings if you're talking about internet.
> Ford or Chevy
There's more auto companies than I can count, particularly if you include all the foreign brands sold in America, which you should because some of them are very popular and are broadly recognized to have superior vehicles.
> * Kroger or Walmart, *
Giant, Food Lion, Aldis, Target, Wholefoods, Trader Joes, more regionals than you can shake a stick at.
There’s this weird glitch in our collective psyche where an arbitrarily bloated and rapacious central committee fixing prices and wages and regulations in favor of an insular elite is somehow still called “capitalism” as long as the party insiders are called things like “CEO” or “venture capitalist”.
It’s late USSR economics with feel good nomenclature.
With e.g. Elon Musk getting heavily involved in government in sort of a vague way we’re stepping into some new stage of this. We must slash entitlements to fund corporate tax cuts comrade.
Apparently we’re kind of over it on even pretending a tiny corporate elite doesn’t just directly set policy in flagrant, naked, unapologetic self-interest.
I am lucky to have a family owned drug store near my house. The pharmacists are brother and sister and grandma runs the cash register. Grandma can't walk good or see good, but she sure can sell you some cookies or pens or sunscreen or German sausages. She makes sure you don't leave empty handed.
So much faster then going to CVS, you just give them the scrip, they put the pills in the bottle, done in 5 min. Pay cash, no insurance BS. No ID since they know all their customers. Somehow they always have what you need, even when there is a shortage of a particular medicine.
Sometimes grandma tries to give me free stuff when she rings me up and I am like, no dammit, I need you to say in business or else I am doomed deal with the megacorps again. Take my money please!
The last few times I've gone to one of these pharmacy stores (Walgreens, Rite Aid, etc) they had the same inventory as my grocery store's pharmacy section but spread out over 20x the area.
Imagine if you wanted to buy all your groceries for the week, and had to order them and pay for them one at a time from the grocery store at separate vending machines.
Now remember that, in theory at least, basically everything in the pharmacy that is not behind the counter is more or less the equivalent of the candy by the register in grocery stores, for pharmacies - something they hope you'll go "oh, yeah, I could use that" and buy.
...of course, given that most of the pharmacies I've been to have started locking 90% of their stuff behind "call an associate" barriers anyway, vending machines would probably be a better-scaling model, but that becomes a little awkward because you can't easily mix "things you must go pay at the register for" and "things you bought from the machine", and I think in the limit case you wind up with something like Amazon's experiments in checkoutless groceries to make this work, or a store that's just rows of vending machines and then the pharmacy at the back.
Of the remaining drug store chains in America, CVS Pharmacy might be the best positioned because it’s both largest in scale and vertically integrated with pharmacy benefit manager CVS Caremark.
> Meanwhile, Walgreens is also having a tough time. The pharmacy giant said in October it would close roughly 1,200 U.S. stores over the next three years, including 500 locations in fiscal 2025. In June, it said about 8,600 locations would be shuttered over the next few years.
In the Pacific Northwest RiteAid bought a local chain called Bartell Drugs. Since then they have really slumped. I am hoping they don't get snuffed out with the RiteAid brand stores.
I switched to amazon pharmacy, I get 90 days delivered in mail at 1/3rd the price, and only 1 co-pay vs 3 co-pays, and higher prices. Plus the local rite aid has had supply issues.
Does the pharmacy lobby have any role in this? Pharmacist associations have been lobbying to expand what they can do and get in on the pie, for example now able to give vaccine injections. Perhaps a solution is to automate the pharmacy process more so people can be freed up from counting pills to helping customers.
If drug costs were lower then we would see more independent pharmacies, and probably more chains, but in this economy..