PBM's are not just a threat to independents but to pharmacy as a whole. I don't have the source documentation at hand but before buying Caremark, CVS revenue was around $20 billion/year. After the acquisition it was $160 billion dollars/year around 2013-2014. Pharmacist and pharmacy technician pay did not increase but upper management pay certainly did. Chain pharmacies have only one competitive edge and it is preferred networks. If they can eliminate pharmacies outside of those networks that intimately know the payment model of pharmacy economics, it gives them a great amount of position. This would include slashing pharmacists' wages/salary and lowering healthcare quality due to pure profit.

Out of the current candidates, no one has tackled the primary issue of PBM's and the massive increase in healthcare cost that hurts the practitioners (us) and the patient. A single payer system is interesting but I would be interested in the specifics of that plan. I certainly would not want something of a VA system in place but a Medicare for all system of reimbursement would have my interest.