Pharmacy students from across Pennsylvania came to Harrisburg today, on a mission to advocate for community pharmacies.

“For me, pharmacy was the intersection of healthcare and patient advocacy,” Christopher Ober said, a 1st year student at LECOM in Erie. Ober was one of dozens of pharmacy students who met with their legislators and set up informational presentations in the East Wing Rotunda.

Workforce demands for pharmacists are strong— from 2011 to 2021, the number of people applying to pharmacy schools decreased by 35%, leaving a shortage across the nation. However, the overall pharmacy business climate is bleak.

In Pennsylvania, over 190 pharmacies shut down since January of 2024, according to the Pennsylvania Pharmacists Association.

“We’re discovering we’ve got some pharmacy deserts,” Victoria Elliott said, CEO of the Pennsylvania Pharmacists Association. She also says there are an additional 213 pharmacies that if they close, it will create a pharmacy desert. These are being described as ‘Keystone Pharmacies’.

It’s not just mom and pop shops shutting down; Walgreen's has announced nationwide closures of its stores. There is word of a second round of bankruptcies from Rite Aid.

“These folks, you know, are losing access to care. Whether it's vaccines, monthly medications, the chance to ask for advice,” Elliott said.

Pennsylvania Pharmacists Association says pharmacy benefit manager contracts are the root cause for many closures.

The Pennsylvania General Assembly passed Act 77 in 2024, which required more transparency from PBMs and added regulation for how these companies negotiate contracts between insurance companies and pharmacies.

“Wonderful support from our legislators. We really appreciate it,” Elliott said. “Just, didn't get us far enough. The issue is reimbursement.”

For example, a pharmacy might pay $13 for a drug prescription that they sell to a patient… but only get reimbursed $5 by an insurance company, based on their PBM contract.

“If we can't afford to keep the medications on the shelf, [if] we don't get paid for our time—  It's unsustainable,” Elliott said. "These pharmacies can't remain open.”

The association is pushing for more change in Pennsylvania. With legislation passed last year, advocates are hoping to keep momentum up on the topic. Because many PBMs operate over state lines though, state law is limited in impact. Similar conversations have been happening in Washington D.C. over the past few years.

While legislative advocacy continues… some pharmacies are creating new ways to work.

“Just last year, I opened my own independent pharmacy in New Brighton, [called] Forward RX. The only difference is we are not contracted with any PBM,” Brandon Antinopoulos said, the pharmacists and owner of Forward RX.

Antinopoulos grew up working in his family’s pharmacy, and watched it close in 2019 because of financial losses from PBM contracts. His new pharmacy doesn’t accept insurance, but operates on a subscription level and prioritizes transparent pricing.

“We don't artificially inflate the price of medications,” Antinopoulos said. "We post all of our prices online, and so we actually save a lot of people money.”

He showed a picture graph of some pharmaceutical drugs and how much they cost with insurance, at wholesale, and at his store price. With one of the drugs, insurance companies were pricing the drug at around $5,000. The cost of the drug at wholesale was around $90.

Forward RX was selling the prescription drug for around $120.