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> We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writi

> We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready". This is such a great graph. Your company feels successful because your customer is happy yet the rest of the world would be just happy if your company died in a fire. This seems to also be just fine for companies like yours.

jonathan-adly 2mo ago
[flagged]
- jimberlage 2mo ago
  Why were pharmacies viable before? Presumably they didn't lose money for their whole history.
  - 43920 2mo ago
    Most pharmacies are having financial issues basically due to being stuck in the middle of the battle between insurers, drug manufacturers, and PBMs over reimbursement rates, and having the weakest negotiating position of all of the parties. AI probably will save the pharmacies some money, but IMO this will probably cause reimbursement rates to decline further, leaving the pharmacies in the same position as before.
    - taurath 2mo ago
      Weakest negotiating position other than the customers. The funny part is probably a majority of pharmacies are owned by CVS or Walgreens each of which are insurance companies in their own right, and often people with company health insurance will ONLY allow reimbursements through their company pharmacy.
    - Scoundreller 2mo ago
      Tbh, this is most industries. Very few have much of a moat and have some wedge/pressure from their suppliers (land/labor/capital), their clients and competition. Insurance companies and PBMs would probably say the same they have competitors (ie:replaceable) and can’t just pay more for this or that, or reject any cost saving measure available.
  - jonathan-adly 2mo ago
    https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.00192 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.0... Of the 88,930 retail pharmacies operating during 2010–20, 29.4 percent had closed by 2021.
    - nickphx 2mo ago
      and that was not due to answering phones .. adding a nondeterministic black box of bullshit will change nothing.
  - milkshakes 2mo ago
    see: https://en.wikipedia.org/wiki/Pharmacy_benefit_management https://en.wikipedia.org/wiki/Pharmacy_benefit_management
  - quickthrowman 2mo ago
    PBMs gained control of drug pricing and squeezed out the small pharmacies that don’t offer additional services like compounding. CVS And Walgreens both own and operate PBMs. And UHG (Optum), 19 Blue Cross plans collectively own Prime Therapeutics, Kaiser owns one, the DVA has one, Express Scripts is owned by Cigna. There’s likely more I am unfamiliar with too.
- dylan604 2mo ago
  Clueless? You sound tone deaf. If you came here thinking everyone would love your product becase AI, well, sorry about that. Just because you think it is an amazing product does not mean the rest of us will agree with you. It's right up there with "I've never had a problem with it so anyone claiming to have a problem is wrong" mentality. It was your comment acknowledging the public does not like your product or products like yours. You just think your product is better than others. That may be true but it again does not mean it is so good that the public enjoys interacting with your product.
- swatcoder 2mo ago
  First, most tech companies of comparable size to your customers have negative margins and survive on investment cycles, and the tech companies that are bigger haven't offered human support to anyone in decades. (And indeed, everyone already resents this practice and those tech companies. Generally, sentiment is abyssmal.) I know you're just trying to illustrate the real plight of your customers, but it's a bad illustration that confuses the discussion. Second, out of sincere curiosity: what was the future of the industry -- and these particular pharmacies -- if AI hadn't arrived to offer salvation? The role they fill in society is non-optional, so how the market restructuring around these infeasibly narrow margins before?
  - dcrazy 2mo ago
    Microsoft offers human chat support for consumers, once you try their self-help tools: https://support.microsoft.com/en-us/contactus?ContactUsExperienceEntryPointAssetId=S.HP.SMC-HOME https://support.microsoft.com/en-us/contactus?ContactUsExper... Apple offers online, telephone, and of course in-person support for hardware and software: https://support.apple.com/?cid=mc-ols-general-homepage-marcom-06042025 https://support.apple.com/?cid=mc-ols-general-homepage-marco... Amazon offers online and telephone customer support on your “my orders” page. Netflix offers phone and chat support: https://help.netflix.com/en/contactus https://help.netflix.com/en/contactus
    - watwut 2mo ago
      NONE of those is comparable size.
      - dcrazy 2mo ago
        I was replying to this: > the tech companies that are bigger haven't offered human support to anyone in decades.
    - Dotnaught 2mo ago
      >Apple offers online, telephone, and of course in-person support for hardware and software The last time I waited on hold for Apple developer support, I got to enjoy two whole hours of free hold music. So they offer human support, just not very enthusiastically.
- therein 2mo ago
  > We are their lifeline. Yeaaaah, I don't think that's true at all but I am glad it makes you feel virtuous and helpful.
- toomuchtodo 2mo ago
  PBMs, private equity, and health insurance companies are what are crushing pharmacy margins. AI voice assistants will not last as a solution imho. https://nashp.org/state-tracker/state-pharmacy-benefit-manager-legislation/ https://nashp.org/state-tracker/state-pharmacy-benefit-manag... https://www.thebignewsletter.com/p/boom-the-break-up-of-big-medicine https://www.thebignewsletter.com/p/boom-the-break-up-of-big-... https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing https://www.thebignewsletter.com/p/inside-the-mafia-of-pharm... https://www.thebignewsletter.com/p/the-real-reason-walgreens-collapsed https://www.thebignewsletter.com/p/the-real-reason-walgreens... > But the real reason Walgreens, and the pharmacy business in general, is dying, is because of a failure to enforce antitrust laws against unfair business methods and illegal mergers. Elson touched on it when he mentioned lower reimbursement rates, but I don’t think people appreciate the full scope of what happened to Walgreens, and to the full pharmacy business in general. This is not a case of bad management, it’s a case of desperate management.
- gamblor956 2mo ago
  Retail pharmacies in the US are dying dozens a day. I have a lot of pharmacist relatives. This is news to them.
  - Scoundreller 2mo ago
    Store count seems to have peaked in 2018. Yes that data goes to 2021 but I doubt it got better after that. https://schaeffer.usc.edu/research/pharmacy-closures-united-states-health-affairs/ https://schaeffer.usc.edu/research/pharmacy-closures-united-... The bigger thing is consolidation and independents being replaced by bigger fish because their leverage is very very low.
    - gamblor956 2mo ago
      If you read the data you would have observed that a large chunk of those store closures were by the big retail pharmacy chains, which blows your central thesis out of the water.
      - Scoundreller 2mo ago
        Maybe in absolute numbers but the situation for the ma and pa operations is worse: “Independent pharmacies, often excluded from networks by pharmacy benefit managers, were more than twice as likely to face closure compared to chain pharmacies.”
- wolvoleo 2mo ago
  I wonder why? My pharmacy in Spain is owned by this older lady who's had this shop for life. Not too many customers but she manages and even has a few part time staff. It pays enough to make a living. And she always knows what I need and pings me on WhatsApp if something is ready for pickup. And there's 4 such neighborhood pharmacies within 200 metre walk. No kidding. All are viable. I wonder, what changed in America? Why is the mom and pop pharmacy not viable anymore? This sounds like a much bigger problem than having to answer a couple of calls, really. I don't really understand how everything turns into a mega corp with shareholders in the US. Sure we have some of those here too but why are small businesses not viable?
  - Scoundreller 2mo ago
    > I wonder, what changed in America? Why is the mom and pop pharmacy not viable anymore Deregulation at every level = small/low leverage players get squeeeeezed. Most likely in Spain (and much of the world), you have controlled pricing of drugs and fixed markups/fees at pharmacies. Quite possibly it’s illegal there for a non-pharmacist to own a pharmacy and they can’t own a bunch as a silent/relatively inactive partner either.
    - wolvoleo 2mo ago
      True all those yes. In fact the govt pays for the meds, I just pay an issuance fee of 2€ or so. You can get private health insurance but I didn't bother, the state one is fine. And yes you need to be a licensed pharmacist obviously. I think the pharmacists mainly make their money on value add stuff and non prescription drugs. People here mainly pick their pharmacy by familiarity and service not price. They're all the same anyway. I've never been to the other ones close to my house :) It's kinda weird there's so many but it works so why not. And it's nice that she knows my name and what I'm on in case of issues. I live only 5 doors down the street. I really like that about here.
    - mindslight 2mo ago
      > Deregulation at every level = small/low leverage players get squeeeeezed. I love how stating a simple truth gets you downvoted. Deregulation doesn't mean "less regulation". Maybe in the abstract, but in practice after it passes through the political machine it means increasing regulation that entrenches a handful of large "private" businesses, while removing regulations that would constrain those businesses commensurate with their market power. It's a plain fact - the players in the health care industry are closer to de facto governments rather than productive businesses in a competitive market. But yet they're allowed to squeeze pharmacy owners, patients, and anyone they can due to lack of effective regulation. That is why our small pharmacies are going away. Note that I personally favor more market based reforms (eg the sheer majority of visits/procedures/medication should have up-front prices, and those prices should be uniform no matter who might be paying). But we've currently got the worst of both worlds and I would basically support any angle of reform as long as it actually reforms rather than resulting in more regulatory capture.

jonathan-adly 2mo ago

[flagged]

jimberlage 2mo ago
Why were pharmacies viable before? Presumably they didn't lose money for their whole history.
- 43920 2mo ago
  Most pharmacies are having financial issues basically due to being stuck in the middle of the battle between insurers, drug manufacturers, and PBMs over reimbursement rates, and having the weakest negotiating position of all of the parties. AI probably will save the pharmacies some money, but IMO this will probably cause reimbursement rates to decline further, leaving the pharmacies in the same position as before.
  - taurath 2mo ago
    Weakest negotiating position other than the customers. The funny part is probably a majority of pharmacies are owned by CVS or Walgreens each of which are insurance companies in their own right, and often people with company health insurance will ONLY allow reimbursements through their company pharmacy.
  - Scoundreller 2mo ago
    Tbh, this is most industries. Very few have much of a moat and have some wedge/pressure from their suppliers (land/labor/capital), their clients and competition. Insurance companies and PBMs would probably say the same they have competitors (ie:replaceable) and can’t just pay more for this or that, or reject any cost saving measure available.
- jonathan-adly 2mo ago
  https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.00192 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.0... Of the 88,930 retail pharmacies operating during 2010–20, 29.4 percent had closed by 2021.
  - nickphx 2mo ago
    and that was not due to answering phones .. adding a nondeterministic black box of bullshit will change nothing.
- milkshakes 2mo ago
  see: https://en.wikipedia.org/wiki/Pharmacy_benefit_management https://en.wikipedia.org/wiki/Pharmacy_benefit_management
- quickthrowman 2mo ago
  PBMs gained control of drug pricing and squeezed out the small pharmacies that don’t offer additional services like compounding. CVS And Walgreens both own and operate PBMs. And UHG (Optum), 19 Blue Cross plans collectively own Prime Therapeutics, Kaiser owns one, the DVA has one, Express Scripts is owned by Cigna. There’s likely more I am unfamiliar with too.
dylan604 2mo ago
Clueless? You sound tone deaf. If you came here thinking everyone would love your product becase AI, well, sorry about that. Just because you think it is an amazing product does not mean the rest of us will agree with you. It's right up there with "I've never had a problem with it so anyone claiming to have a problem is wrong" mentality. It was your comment acknowledging the public does not like your product or products like yours. You just think your product is better than others. That may be true but it again does not mean it is so good that the public enjoys interacting with your product.
swatcoder 2mo ago
First, most tech companies of comparable size to your customers have negative margins and survive on investment cycles, and the tech companies that are bigger haven't offered human support to anyone in decades. (And indeed, everyone already resents this practice and those tech companies. Generally, sentiment is abyssmal.) I know you're just trying to illustrate the real plight of your customers, but it's a bad illustration that confuses the discussion. Second, out of sincere curiosity: what was the future of the industry -- and these particular pharmacies -- if AI hadn't arrived to offer salvation? The role they fill in society is non-optional, so how the market restructuring around these infeasibly narrow margins before?
- dcrazy 2mo ago
  Microsoft offers human chat support for consumers, once you try their self-help tools: https://support.microsoft.com/en-us/contactus?ContactUsExperienceEntryPointAssetId=S.HP.SMC-HOME https://support.microsoft.com/en-us/contactus?ContactUsExper... Apple offers online, telephone, and of course in-person support for hardware and software: https://support.apple.com/?cid=mc-ols-general-homepage-marcom-06042025 https://support.apple.com/?cid=mc-ols-general-homepage-marco... Amazon offers online and telephone customer support on your “my orders” page. Netflix offers phone and chat support: https://help.netflix.com/en/contactus https://help.netflix.com/en/contactus
  - watwut 2mo ago
    NONE of those is comparable size.
    - dcrazy 2mo ago
      I was replying to this: > the tech companies that are bigger haven't offered human support to anyone in decades.
  - Dotnaught 2mo ago
    >Apple offers online, telephone, and of course in-person support for hardware and software The last time I waited on hold for Apple developer support, I got to enjoy two whole hours of free hold music. So they offer human support, just not very enthusiastically.
therein 2mo ago
> We are their lifeline. Yeaaaah, I don't think that's true at all but I am glad it makes you feel virtuous and helpful.
toomuchtodo 2mo ago
PBMs, private equity, and health insurance companies are what are crushing pharmacy margins. AI voice assistants will not last as a solution imho. https://nashp.org/state-tracker/state-pharmacy-benefit-manager-legislation/ https://nashp.org/state-tracker/state-pharmacy-benefit-manag... https://www.thebignewsletter.com/p/boom-the-break-up-of-big-medicine https://www.thebignewsletter.com/p/boom-the-break-up-of-big-... https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing https://www.thebignewsletter.com/p/inside-the-mafia-of-pharm... https://www.thebignewsletter.com/p/the-real-reason-walgreens-collapsed https://www.thebignewsletter.com/p/the-real-reason-walgreens... > But the real reason Walgreens, and the pharmacy business in general, is dying, is because of a failure to enforce antitrust laws against unfair business methods and illegal mergers. Elson touched on it when he mentioned lower reimbursement rates, but I don’t think people appreciate the full scope of what happened to Walgreens, and to the full pharmacy business in general. This is not a case of bad management, it’s a case of desperate management.
gamblor956 2mo ago
Retail pharmacies in the US are dying dozens a day. I have a lot of pharmacist relatives. This is news to them.
- Scoundreller 2mo ago
  Store count seems to have peaked in 2018. Yes that data goes to 2021 but I doubt it got better after that. https://schaeffer.usc.edu/research/pharmacy-closures-united-states-health-affairs/ https://schaeffer.usc.edu/research/pharmacy-closures-united-... The bigger thing is consolidation and independents being replaced by bigger fish because their leverage is very very low.
  - gamblor956 2mo ago
    If you read the data you would have observed that a large chunk of those store closures were by the big retail pharmacy chains, which blows your central thesis out of the water.
    - Scoundreller 2mo ago
      Maybe in absolute numbers but the situation for the ma and pa operations is worse: “Independent pharmacies, often excluded from networks by pharmacy benefit managers, were more than twice as likely to face closure compared to chain pharmacies.”
wolvoleo 2mo ago
I wonder why? My pharmacy in Spain is owned by this older lady who's had this shop for life. Not too many customers but she manages and even has a few part time staff. It pays enough to make a living. And she always knows what I need and pings me on WhatsApp if something is ready for pickup. And there's 4 such neighborhood pharmacies within 200 metre walk. No kidding. All are viable. I wonder, what changed in America? Why is the mom and pop pharmacy not viable anymore? This sounds like a much bigger problem than having to answer a couple of calls, really. I don't really understand how everything turns into a mega corp with shareholders in the US. Sure we have some of those here too but why are small businesses not viable?
- Scoundreller 2mo ago
  > I wonder, what changed in America? Why is the mom and pop pharmacy not viable anymore Deregulation at every level = small/low leverage players get squeeeeezed. Most likely in Spain (and much of the world), you have controlled pricing of drugs and fixed markups/fees at pharmacies. Quite possibly it’s illegal there for a non-pharmacist to own a pharmacy and they can’t own a bunch as a silent/relatively inactive partner either.
  - wolvoleo 2mo ago
    True all those yes. In fact the govt pays for the meds, I just pay an issuance fee of 2€ or so. You can get private health insurance but I didn't bother, the state one is fine. And yes you need to be a licensed pharmacist obviously. I think the pharmacists mainly make their money on value add stuff and non prescription drugs. People here mainly pick their pharmacy by familiarity and service not price. They're all the same anyway. I've never been to the other ones close to my house :) It's kinda weird there's so many but it works so why not. And it's nice that she knows my name and what I'm on in case of issues. I live only 5 doors down the street. I really like that about here.
  - mindslight 2mo ago
    > Deregulation at every level = small/low leverage players get squeeeeezed. I love how stating a simple truth gets you downvoted. Deregulation doesn't mean "less regulation". Maybe in the abstract, but in practice after it passes through the political machine it means increasing regulation that entrenches a handful of large "private" businesses, while removing regulations that would constrain those businesses commensurate with their market power. It's a plain fact - the players in the health care industry are closer to de facto governments rather than productive businesses in a competitive market. But yet they're allowed to squeeze pharmacy owners, patients, and anyone they can due to lack of effective regulation. That is why our small pharmacies are going away. Note that I personally favor more market based reforms (eg the sheer majority of visits/procedures/medication should have up-front prices, and those prices should be uniform no matter who might be paying). But we've currently got the worst of both worlds and I would basically support any angle of reform as long as it actually reforms rather than resulting in more regulatory capture.