Ken Bertini, pet medication compounding specialist at Sear’s Pharmacy in Oak Park just outside Chicago, has worked in retail pharmacy since 1965. He spent most of his career at Segreti Pharmacy, also in Oak Park, but moved to Sears after Segreti closed this January due to rising rents.
When he was starting out, Bertini wrote labels on a typewriter. Now, he not only uses a computer for that work but also took up new skills to stay strong in the evolving industry, including compounding, or making tailored medications for patients and pets.
“There’s not too many pharmacists around as long as I’ve been around,” Bertini said. “I remember way back when—when things were profitable, things were fun in the pharmacy—but now it’s very stressful. You don’t turn out numbers, you’re not going to survive.”
The pharmacy industry has grown significantly in recent years, up from about $317.2 billion in 2000 to nearly $1.7 trillion in 2024. But a study last year showed 1 in 3 retail pharmacies closed between 2010 and 2021, suggesting there’s increasing pressure to compete with the big names like CVS, Walmart, and Walgreens.
Healthcare Brew spoke with Bertini and Jim Schniepp, clinical pharmacy specialist at Rush University Medical Center in Chicago and pharmacist for 40 years, about how the industry has changed.
Tech changes
Both pharmacists began their careers before digital tools like electronic health records existed.
While retail pharmacists focus more on dispensing medications to patients in settings where they can also buy household items like toilet paper or over-the-counter meds, hospital pharmacists provide treatments for patients in hospitals.
Bertini said “technology is probably the biggest change for pharmacists” and computerization made it easier to store data, track a patient’s medication usage, and remind them of refills. When someone orders potassium, for example, Schniepp said he can pull up a patient’s labs and look for more information about the order.
Tech is everywhere in pharmacy settings (like all of healthcare) these days. Between 2003 and 2016, the amount of hospitals with computer prescriber systems grew from 2.5% to 95.6%, according to a 2018 study. And tools like barcode scanners that can digitally verify the safety and accuracy of a drug have grown in use from 5.7% in 2002 to 61.7% by 2017.
“You know in real time more of what’s going on,” Schniepp said.
Sear’s Pharmacy
Rush also uses Pyxis machines that automatically dispense medications now, he added, compared to having to use floor stock and medication carts before.
Schniepp said the problem is if technology fails—like not responding during a cardiac arrest—because pharmacies are extremely reliant upon it. (Though one could argue that’s the case for just about every industry.)
Education, clinical work
Technology, Bertini said, also changed the roles of pharmacists, who went from putting pills in bottles to receiving doctoral-level education (PharmDs, or doctors of pharmacy), which takes roughly four to six years to complete. However, the industry is still facing staffing shortages, and only 13,323 new pharmacists graduated in 2022, down from 14,223 the year prior, according to the American Association of Colleges of Pharmacy.
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When Schniepp was fresh out of school, he said his job was mostly distributive and much less clinical. But in the last 20 years, he said the staff has grown “exponentially” and pharmacists are now assigned to different departments like ICU, pediatrics, and surgery.
“The skill level of the pharmacist has increased. Almost all of our pharmacists have done residencies,” he said.
Now, compared to when he first started, pharmacists also approve all medications, compared to that being solely a doctor’s purview in 2000. He and other hospital pharmacists speak with providers about what patients should take and which meds need to be changed to better their care.
“It’s not like I’m in the basement filling drugs,” Schniepp said. “In fact, I don’t see drugs very often, which people are surprised to hear.”
PBMs
One of the downsides of technology, Bertini said, is it has increased the control of payers and pharmacy benefit managers (PBMs) in the industry. The three biggest PBMs control around 80% of the drug market.
Payers and PBMs now have control over “what we could dispense, how much we could dispense, to whom we could dispense, how much they were going to reimburse us for it,” he said. Before PBMs’ rise in influence, there were more direct relationships between drug manufacturers and pharmacies, and pharmacies made more money this way.
Though competition with corporations like CVS and Walgreens has grown over the years—CVS went from operating 5,471 stores in 2005 to 9,135 stores in 2024, for instance—the big competition, he said, is not with other pharmacy chains. It’s with the PBMs.
“We actually are losing money,” Bertini said, due to low reimbursement rates for medications, which make up a significant portion of pharmacies’ revenues. “How can you survive? You can’t.”
On top of that, corporate pharmacy jobs have become “very stressful,” he said.
“[Pharmacists are] not getting enough time, enough information, and…it’s not the pharmacists’ fault. The corporates don’t put the pharmacists that they hire in a position to do [vaccinations and additional tasks]. They have quotas,” he said.
In the early days of his career, Bertini said there was an independent pharmacy on every corner. What were once competitive relationships with other independent pharmacies has turned into collaborative ones. Now, there are only a few left.
But at the end of the day, Bertini said, the “personal contact” provided by independent stores remains important and strong.
“If you read the reviews about this store, people just love it—they don’t want to go anywhere else. There are chains all over the place,” he said, “but when you give people personal service, that’s really what they need and that’s what they like.”
This is one of the stories of our Quarter Century Project, which highlights the various ways industry has changed over the last 25 years. Check back each month for new pieces in this series and explore our timeline featuring the ongoing series.
