Operational and financial implications of GLP-1 agonist reimbursement among independent community pharmacies

Independent community pharmacies report increasing exposure to high-cost glucagon-like peptide-1 (GLP-1) receptor agonists with reimbursement that may not cover acquisition costs. How pharmacies operationally respond to these reimbursement pressures remains incompletely described.

The purpose of this study is to describe the frequency of self-reported below-acquisition-cost reimbursement for GLP-1 receptor agonists and to characterize reported operational adaptations and perceived effects on patient care, referral and retention practices among independent pharmacies.

An anonymous cross-sectional web survey was conducted from October 2024 to January 2025. Owners and managers of 39 independent community pharmacies in regional pharmacy organizations participated. The questionnaire was based on earlier research on below-cost reimbursement and pharmacy sustainability. It measured GLP-1 dispensing volume, reimbursement, finances, operations, and patient referral practices.

Thirty-nine independent community pharmacies were represented. All (100%, n = 39) experienced below-acquisition-cost reimbursement for GLP-1 agonists; 92.3% (n = 36) said this happened often or always. Revenue losses of 5% or more from GLP-1 dispensing were noted by 82.1% (n = 32). Key operational responses included limiting GLP-1 dispensing to patient-specific orders (82.1%, n = 32) and reducing high-cost medication inventory (69.2%, n = 27). Nearly all (97.4%, n = 38) referred patients elsewhere for GLP-1 prescriptions. Sixty-five point eight percent (n = 25/38) reported losing other prescription business after referrals. Common qualitative themes included cash flow strain, selective dispensing, disruption of care continuity, and threats to long-term sustainability.

Independent pharmacies reported substantial operational strain associated with below-cost reimbursement for GLP-1 receptor agonists, leading to adaptive dispensing practices and perceived risks to patient retention. Findings are based on self-reported perceptions and underscore the need for future studies using objective financial and dispensing data to evaluate downstream effects on pharmacy sustainability and patient access.