Independent pharmacies see some hope

Judy Shattuck carried a prescription to the parking lot for a customer at the Pepperell Family Pharmacy in Pepperell last month. Winslow Townson for The Boston Globe

When Samuels Pharmacy in downtown Winthrop closed last month, families who had been customers for decades came to say goodbye.

After more than 60 years, the drugstore, which in 1976 was one of about 2,500 independent pharmacies in the state, had become the latest casualty in a three-decade decimation by chain drugstores.

Still, there are signs the tide may be turning, albeit slowly. According to Todd Brown, executive director of the Massachusetts Independent Pharmacists Association and a pharmacy professor at Northeastern University, over the past several years the state pharmacy board has reported a 2 to 3 percent annual increase in the number of licenses issued to independent pharmacies.

Thanks to the Affordable Care Act, more people have health insurance that covers prescription drugs. While that could change if the act is repealed and replaced — the House of Representatives approved a substantial modification last week — currently copays are generally the same at both independent drugstores and chains.

Today, some independent pharmacies have five, 10, even 15 pharmacists on staff, providing professional expertise and personal attention — just like in the old days.

While it’s still an uphill struggle for independent pharmacies, which according to state regulation must be open 60 hours a week, many say the future is looking brighter.

“The key for most of us is that we all compete with the chains and each other,” said Mike Reppucci, owner and operator of the Inman Pharmacy in Cambridge since 1982. “Every person has a choice of where to fill a prescription. . . . Because there is so much pressure, we’re all looking for ways to add value.”

Samuels Pharmacy in Winthrop.John Blanding/Globe staff/Globe Staff

For Reppucci, who employs 10 pharmacists, including himself, that means dedicating some of his staff to medication counseling, including how to use Naloxone, a drug used to reverse an opioid overdose.

Other independents increase revenue by offering compounding, which involves making medicines from scratch, pill packaging, and counseling, often for chronic diseases such as cancer and HIV. They also offer immunizations and other services for a fee.

Independent pharmacies say they often can fill prescriptions more quickly because they utilize more flexible schedules for pharmacists, unlike chains that schedule staff based on daily volume projections.

To track inventory, they use computerized systems that automatically reorder over-the-counter products.

Chain drugstores make their profits from sales of nonprescription items and beauty and household products, which represent 95 percent of their sales.

Those who have switched to independent pharmacies cite convenience and personal attention.

Customers and staff moved about in the Pepperell Family Pharmacy.Winslow Townson for The Boston Globe

“I had used chains, but quite honestly, the waits were ridiculous,” said Stow resident Chet Jacobs, 74, who about 10 years ago switched from a chain to Acton Pharmacy, an independent that is part of a three-store family business run by Saad and Raied Dinno.

“The bottom line, what I like about Acton Pharmacy, is they take particular care [about] drug interactions,” Jacobs said. “We have a number of drugs in our home, and on a number of occasions, the pharmacist has called the doctor to ask, ‘Are you sure?’ ”

Still, there are roadblocks. Third-party administrators, known as prescription benefits managers, control about 78 percent of the market.

Contracts between PBMs and insurance companies require patients on maintenance drugs to purchase them in bulk through the mail. That means independent pharmacies end up filling one-time orders only, which is far less lucrative. The PBMs also negotiate rebates and discounts, a system that independent pharmacies have challenged at the State House and in Washington, saying it lacks transparency.

“Independent pharmacies have no problem competing with other pharmacies. The issue is being allowed to compete,” Brown said.

Independent pharmacies are often family-run, with couples, parents, and adult children or siblings filling prescriptions.

“They treat us like family. They’re a local business, and it doesn’t cost more money,” Jacobs said.

David Benoit, vice president for patient services at Northeast Pharmacy Service Corp., a group purchasing organization, sees the independents as a throwback to the days when the pharmacist’s greeting was a clinical question. “We found out a lot of things by asking ‘How are you?’ ” he said.

Owner Tracie Ezzio shared a laugh with customer Lynne Henderson in the Pepperell Family Pharmacy.Winslow Townson for The Boston Globe/Globe Freelance

At the Pepperell Family Pharmacy on a weekday afternoon, the store is buzzing with customers, each greeted at the door by an employee. In addition to prescriptions, the store carries over-the-counter medications, personal care products, greeting cards, gifts, candy, and more.

In 2007, Tracie Ezzio opened the pharmacy, located next door to a walk-in clinic on Main Street. Three years ago, she put her daughter, Larissa Hubbard, in charge of a second store, the Tyngsboro Family Pharmacy in Tyngsborough.

The businesses employ five pharmacists, including Ezzio and Hubbard, and are open every day, almost 80 hours a week.

Ezzio enrolled in the pharmacy program at the University of Connecticut in 1972, the same year her grandfather closed Johnson’s Drugs in Freeport, Maine, after 42 years in business.

She worked briefly for a chain after graduation from pharmacy school, and for years was an employee of an independent pharmacy.

“I remember mothers nursing their babies in the back and watching my mom interact with the customers,” said Hubbard, who graduated from the Massachusetts College of Pharmacy and Health Sciences and went to work for her mother after she graduated. “I saw the reassurance and respect.”