US Pharmacy Options: More Choice, Fragmentation, and Confusion for Patients and Clinicians
Patients Choice
For patients in the U.S., getting medications isn’t as simple as just “going to the pharmacy.”
It’s a growing maze of options:
🏪 Traditional brick-and-mortar pharmacies like CVS, Walgreens, Walmart, etc., which still serve a large share of patients
✉️ Insurance-based PBM mail-order pharmacies like Express Scripts and OptumRx, which offer convenience but can be difficult to price-compare
🏥 Closed-loop systems, like Kaiser Permanente, where patients must use the in-network in-person or mail-order pharmacy
📦 Amazon Pharmacy, which offers convenience, insurance integration, and PrimeRx savings but mainly works within traditional insurance
💲 Mark Cuban’s Cost Plus Drugs, which bypasses insurance entirely, offering transparent, low prices for generics with a more limited drug offering
💻 DTC brands like Hims, Hers, Ro, and GoodRx Care, designed to deliver white-labeled branded and generic meds via telehealth for select conditions (e.g., hair loss, ED, anxiety, contraception) with most requiring a subscription for continuous medication delivery
🧾 Discount card services like GoodRx (outside of GoodRx Care) and SingleCare, offering coupons and drug delivery with cash prices that sometimes beats insurance pricing
Patients Face a Complex Landscape
For patients, this should be empowering. More choice, more access, lower cost... right?
Unfortunately, this fragmentation can be deeply confusing. Patients are forced to comparison shop like they’re buying a laptop, not life-saving medications.
Patients must weigh:
What’s covered by insurance?
Who has the best price?
Which medications are safe, effective, and legitimate?
Who can I trust?
Am I going to get my medications in time so that I can stay on my regimen and not experience any harm?
Clinicians Lose Visibility
For clinicians, it’s equally complex.
When patients get meds through third-party platforms, often without notifying their primary care teams, clinicians lose visibility into what patients are taking, when, and how. How will these medications, procured through other channels, marry with the medications prescribed by the primary care physician and in-network specialists?
This creates real risks:
Duplicate therapies
Polypharmacy, especially for complex or older patients
Dangerous drug-drug interactions
Poor adherence due to fragmented communication
Unnecessary additional testing and anxiety when drug side effects and drug-drug interactions lead to abnormal lab results
We’re entering a world where pharmacy is more consumerized but less coordinated. Patients may gain greater convenience and lower prices, but that may come at the expense of patient safety.
A Path Forward: Connected Pharmacy Infrastructure
As a healthcare product leader and physician, I believe we need smarter, interoperable infrastructure to:
Share prescribing data across systems
Enable accurate medication reconciliation
Empower patients without fragmenting their care
Choice is great, but without connected care, choice can also lead to chaos.
How are you seeing this play out in your health system or product strategy?
If your organization is navigating this medication maze, I’d love to collaborate or consult.
