Rite Aid is Quietly Cutting Off GLP-1 Patients. Why Other Pharmacies May Follow

Over the past couple weeks, we’ve heard from more and more people: “Rite Aid says they don’t carry Zepbound anymore.” Or Mounjaro. Or Wegovy.

Not out of stock. Not delayed.

They’ve just… stopped.

And while there’s been no formal press release, the reports are coming in from across the country: Massachusetts, New Hampshire, New York, California. It does not seem to be every Rite Aid at this point. But it’s enough to make it clear this isn’t random. And it’s not a manufacturing shortage.

It’s a financial decision.

Rite Aid is has faced well-documented financial woes. Hundreds of stores are closing. And somewhere in the process, many of them have stopped filling GLP-1 prescriptions. Why? GLP-1 medications have it a fever pitch, wouldn’t this cause Rite Aid’s business to boom? No. Why? Because they’re likely losing money every time they fill a GLP-1.

Let’s break that all down.

Pharmacies don’t decide how much they’ll be reimbursed for filling your prescription. That decision comes from the Pharmacy Benefit Managers, or PBMs. These are the powerful middlemen who sit between your pharmacy, your insurance company, and the drug manufacturer. And right now, for many GLP-1s, the amount PBMs reimburse is actually less than what the pharmacy paid to stock the medication in the first place.

It’s like buying something for 950 dollars and getting paid back 875. Over and over. That math doesn’t work out for too long.

But here’s the deeper problem. Pharmacies have to contract with PBMs to stay in business. They don’t really have a choice. In most cities and towns, a few big insurance plans cover most of the population, plans tied to the largest local employers. If you don’t contract with the PBMs that run those plans, you lose access to almost every patient in the area. It’s like opening a gas station but being told you can’t accept Visa or Mastercard. Sure, you’ll have the same fuel as everyone else. But no one will have the ability to pay for it.

And if you think a pharmacy could just raise the price to make up the difference? They can’t.

PBM contracts explicitly prevent pharmacies from charging more than the negotiated price. The pharmacy is stuck accepting the rate it’s given, even if it means losing money. And what’s worse, most of these contracts include gag clauses. These clauses make it impossible for the pharmacist to tell the patient that they could get the drug for less if they paid out of pocket, without putting their relationship with the payers (PBMs) in jeopardy. That’s right. Sometimes the cash price is cheaper, but the pharmacist isn’t even allowed to say it out loud.

So when a patient walks in with a GLP-1 prescription and their insurance card, the pharmacy is forced to process it at the PBM’s price, even if it’s a losing deal. And they’re bound to silence about any better options.

Now, both major GLP-1 manufacturers have started offering direct to consumer options that bypass this whole mess. Lilly Direct and NovoCare both allow patients to access their respective GLP-1 obesity medications without going through insurance. These programs don’t rely on PBMs. They offer a straight cash pay price. And for many people, this has been a lifeline, especially for those whose insurance plans won’t cover the medication at all.

But these programs aren’t without their own frustrations and limitations, because after all, they have to keep to PBMs happy to stay on their formularies. The limitations of these programs can often be traced back to some of pharma’s own agreements with the PBMs, the deals that keep their drugs on PBM formularies. Case-in-point would be the deal we saw Novo Nordisk cut last week with CVS Caremark, a deal which will force thousands of patients off Lilly’s Zepbound, and onto CVS’s new preferred obesity drug, Novo Nordisk’s Wegovy.

Another element to consider, is when the drug manufacturer cuts a deal directly with the patient, the local pharmacy is often completely left out. With Lilly Direct in particular, you can’t even fill your prescription at your corner pharmacy. It has to go through their mail order partners. That might be more convenient for some patients, but it further squeezes out independent pharmacies already struggling to stay afloat. It also sets a dangerous precedent. When manufacturers and PBMs are both bypassing the pharmacy, what’s left for the people behind the counter who are supposed to be part of your care team?

Now, compounding pharmacies operate outside of that structure too. But in a different way. They don’t bill insurance. They don’t deal with PBMs. They set their own prices and serve patients directly. And while not every compound is made equally or with the same oversight, the reason these GLP-1 options have become so important is simple: they fill a gap that others are increasingly unable or unwilling to fill.

This doesn’t seem to be happening yet at other major chains. CVS, Walgreens, Walmart, and Costco are still filling GLP-1 prescriptions, at least in most locations. But we’ve definitely heard from patients who say their local independent pharmacies are pulling back too. Quietly. No big sign. Just a polite “we don’t carry that anymore.”

You’ve heard of GLP-1 shortages. But this isn’t that. This is what it looks like when the system is so broken that the math just stops working. When it doesn’t even make sense for a pharmacy to help the patient in front of them. Access seems to be getting harder from every direction.

So what can you do?

Call around. Try other pharmacies. Ask your doctor’s office to help. Look into Amazon Pharmacy. And if nothing else works, perhaps explore reputable compounding options. Because when the system can’t meet the moment, patients have to find the gaps. And they often have to fill them themselves.

If this has happened to you, I want to hear your story. Comment below or email me what your pharmacy said. Tell me where you’re located and what med you were prescribed. We need real time data. Not for clicks, but for clarity. These stories matter.

We will continue to tell the story, boldly and with clarity.

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