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The state of America's pharmacies is, in a word, bleak.Pharmacies should, in theory, be a reliable business. Seven in 10 Americans take some sort of prescription medication, creating a huge stream of potential revenue: Pharmaceutical expenditures in the US <a target="_blank" href="https://academic.oup.com/ajhp/article-abstract/81/14/583/7657643">hit $722.5 billion in 2023</a>. What's more, many pharmacies serve as a convenient destination for all sorts of essentials, from aspirin to mascara. They are, in a sense, one of the last places where Americans go to shop in person on a regular basis.Despite these advantages, even pharmacy megachains are struggling to survive in the current environment. Last week, Walgreens <a target="_blank" href="https://www.businessinsider.com/walgreens-pharmacy-closing-1200-stores-turnaround-effort-2024-10">announced</a> it would be closing 1,200 stores over the next three years, saying that some 25% of its outlets weren't profitable. Its rival CVS, which has shuttered hundreds of stores over the past few years, announced this month that it planned to shed nearly 3,000 jobs to cut costs. Rite Aid, meanwhile, closed a slew of stores after <a target="_blank" href="https://www.businessinsider.com/rite-aid-bankruptcy-new-jersey-store-closures-2023-10">filing for Chapter 11 bankruptcy protection</a> in late 2023.Even in pharmacies that remain open, there's often next to nothing inside the store. Many items on the shelves are <a target="_blank" href="https://www.businessinsider.com/walmart-walgreens-cvs-lock-merchandise-to-deter-theft-frustrates-shoppers-2022-12">locked up</a>, and good luck finding an employee to help you free the jailed deodorant or shampoo, given how <a target="_blank" href="https://www.businessinsider.com/cvs-ohio-fine-understaffing-pharmacy-prescription-backlog-inspection-medicine-2024-2">woefully understaffed</a> many pharmacies are. The demise of pharmacies is also part of the "<a target="_blank" href="https://www.businessinsider.com/retail-apocalypse-helped-spark-a-rapid-descent-into-dystopia-2021-3">retail apocalypse</a>," which has <a target="_blank" href="https://www.businessinsider.com/bank-financing-urban-planning-pandemic-retail-apocalypse-vacant-storefront-2023-10">intensified since the onset of the pandemic</a>. The convenience chain 7-Eleven just announced it's closing hundreds of stores nationwide. What started as a consequence of COVID-19 lockdowns feels like it's becoming a permanent feature of America's retail landscape. If you want a nearby place to pop into and grab a bag of chips or a bottle of NyQuil, you may be out of luck.For pharmacies, the reckoning has been triggered by a confluence of trends, from the shift to online shopping to the convoluted way Americans pay for healthcare. For a while, the pandemic actually helped pharmacies paper over some of their deeper problems — all those vaccines and home-test kits brought in a lot of business. But now, the underlying issues are proving impossible to avoid. "None of these things is a new factor," Elizabeth Anderson, a senior managing director and healthcare-equity research analyst at Evercore ISI, told me. "But you compound that for years and years and years, and eventually you get to kind of a breaking point."Big chains like Walgreens and CVS make their money in two main ways: selling prescriptions in the back of their stores and selling everyday goods out front. The problem for companies is that both sides of the business are under pressure from outside forces.First, there's the rise of e-commerce. In the age of Amazon, people can buy toilet paper and ibuprofen and greeting cards and snacks online and have them delivered right to their door, often at lower prices. Not to mention no hunting around for an associate to open a glass case. (Amazon <a target="_blank" href="https://www.axios.com/2024/08/02/amazon-drug-store-thefts-online-customer-boost">has actually said</a> the lousy experience at brick-and-mortar pharmacies has been a boost to its business.) On the retail level, pharmacies are also competing with big-box stores like Walmart or Target, as well as cheaper options like Dollar General, which has been working to win over budget-conscious consumers. The more expensive and less convenient pharmacies become, the more customers defect.Chain pharmacies are competing with not just their rivals for retail dollars — but also themselves. As Walgreens and CVS stores have proliferated over the past decade or so, many of their locations are basically right on top of each other. It's tough to make a store profitable when there's an identical one two blocks away."Walgreens and CVS have been on a massive expansionary push," Neil Saunders, a managing director at the retail consultancy GlobalData, said. "They've just opened stores willy-nilly, and they've ended up with portfolios that are too big. There's too much overlap."On the other end of the business, pharmacies are expensive to run. Renting the physical space and paying an educated workforce of pharmacists mean that the fixed costs are high. There's not a ton of room for cutting corners, except for downsizing the workforce, which makes the customer experience worse. The pharmacy end of the business is also under pressure from mail-order operations and from grocery stores and big-box chains like Walmart, which have added pharmacies in some of their locations. Beyond costs and competition, revenues at the big chains are being further squeezed by pharmacy benefit managers, who serve as the industry's middlemen. Pharmacies order drugs directly from manufacturers, dispense them to a patient, and are then reimbursed by the PBMs on behalf of the patient's insurer. But PBMs have been lowering the rates at which pharmacies are paid for handing out prescriptions — generally their top source of revenue. Sometimes the reimbursements are actually lower than the cost of acquiring the drug — which <a target="_blank" href="https://ncpa.org/newsroom/qam/2023/11/01/local-pharmacies-say-theyre-struggling-afford-glp-1s">pharmacies say</a> is happening with GLP-1s like Ozempic and Wegovy."The simple part is that prescriptions are not profitable," said Douglas Hoey, the CEO of the National Community Pharmacists Association, which represents independent pharmacies. PBMs, he said, are the "judge, jury, and executioner" on who gets paid what, and pharmacies from Walgreens to the little shop down the street don't have much power to push back. "The pharmacy really doesn't have any negotiating leverage because the PBM says, 'Well, pharmacy, if you don't give me everything I ask for, then I'm going to not allow patients to get their drug benefit at your pharmacy," he added.The larger chains should, in theory, be able to weather the storm better than smaller shops. After all, they've got the scale and leverage a mom-and-pop operation lacks. But even with their market dominance, they're no match for the PBMs. A decade ago, Walgreens tried to push back against Express Scripts, a major PBM, in an attempt to earn more from prescriptions. Walgreens ultimately gave in, <a target="_blank" href="https://www.nytimes.com/2012/07/20/business/walgreen-and-express-scripts-settle-their-dispute.html">losing an estimated $4 billion in the battle</a>. (CVS has a leg up in this area because it owns Caremark, one of the big three PBMs.)As pharmacies falter in the back of the store, they create a negative feedback loop in the front. Walgreens was never the best place to get many staples, given the high prices and limited selection, but customers could be counted on to grab a few items as they walked down the aisles to pick up their prescriptions. Now that more and more patients are getting their medications by mail or at the grocery store, the retail end has dried up. Pharmacies "were never designed to be an appealing place to go and get toilet paper," said Jason Goldberg, the chief commerce-strategy officer at Publicis Groupe, a global marketing firm. "Toilet paper was a profitable item to sell to someone that came in for a Lipitor prescription," he added.Walgreens did not respond to a request for comment. But a spokesperson for CVS told me that the company was in a "better place now" than it was a few years ago. The decision to shutter stores was made back in 2021, they said, based on factors like "population shifts, consumer buying patterns, and a community's store density." Even after the "realignment" is finished, the spokesperson added, 85% of Americans will still live within 10 miles of a CVS pharmacy.As more and more pharmacies close their doors, Americans ultimately have fewer places to shop in person. One of the reasons for the decline of pharmacies, in fact, is how badly they've handled the retail end of their operations. For starters, faceless chains supplanting independent pharmacies diminished the loyalty customers felt for their local stores. In a mom-and-pop location, you could develop a relationship with the pharmacist, get trusted counseling, and have a pleasant conversation about how your kid's soccer team is faring. In the current landscape of commoditized pharmacies, there's no such thing as personalized service. Waits to pick up prescriptions are long, customer service is often subpar, and if you do have a problem, places are often so understaffed they can't help even if they want to. The pharmacy experience, to put it plainly, often sucks. In many places, there's no longer such a thing as a quick, easy run to a Duane Reade. Whether you believe <a target="_blank" href="https://www.businessinsider.com/why-we-dont-actually-know-whether-retail-theft-big-problem-2024-3">retail theft</a> is as big a problem as some executives say it is, a lot of items are now locked away, which eats into sales and leads customers to shop elsewhere. Brian Tanquilut, a healthcare-services-equity research analyst at Jefferies, said pharmacies were also narrowing their stock-keeping-unit counts — basically, the number of items they keep in stock — to better manage cash flows and inventories, but the move means there are fewer options for customers. I've often found myself frustrated by all the empty shelves at my local pharmacy, and I know a lot of people who feel the same way. From a consumer standpoint, it starts to feel like, what's even the point?Pharmacies don't need to lose 50% of their retail traffic for it to be a disaster, Goldberg told me. Just 10% is enough. And things can go into a tailspin, fast. "You get 10% less traffic, so you sell a little less stuff, so you staff one less person," Goldberg said. "So you make a few more customers dissatisfied."Other convenience chains are also struggling to hang on to their customers. People aren't popping into 7-Elevens as often as they used to — in part because they aren't commuting to and from work as often, and in part because they aren't smoking as much and don't need to grab a pack of cigarettes. (Healthier habits, apparently, are bad for business.) What's more, price-conscious consumers are now going out of their way to seek out lower prices, stopping by the local dollar store for some cut-rate options."Things are very cyclical in retail, and you see the rise and fall of a lot of formats and chains," Saunders, the retail consultant, said. "There was a period when the drugstores were on the ascendancy, and the independent chains were really on a downward curve. Now what we are seeing is drugstores having gone past their peak, and now they're in a very difficult spot."With Walgreens closing stores, Saunders was blunt about the company's future. "They have got to set out a pathway to growth, both to convince investors and to stabilize the business," he said. "I'm not sure that they have done that convincingly yet. They are very focused on managing the decline in the business, trying to change the business structurally and in organizational terms, but they haven't really set out a proposition, especially for how they win in retail."It seems strange to mourn the demise of corporate giants like Walgreens and 7-Eleven. These, after all, are the very corporations that helped decimate local businesses, from the friendly neighborhood pharmacy to the five-and-dime. But their passing feels like it marks yet another transitional moment in American culture, as the entire concept of "running out to the store for a minute" goes the way of music on MTV and the landline. What does it mean to have so few places left to grab the things we need? What will we become of us when every last transaction, from our Slurpees to our statins, is handled electronically?At a minimum, the struggles of pharmacies like Walgreens mean that more Americans will now have no place to fill their prescriptions within striking distance of their homes. An estimated 15.8 million people — about 4.7% of the population — <a target="_blank" href="https://academic.oup.com/healthaffairsscholar/article/2/4/qxae035/7630415#google_vignette">already live in pharmacy deserts</a>. Some pharmacies are <a target="_blank" href="https://www.washingtonpost.com/business/2023/10/22/drugstore-close-pharmacy-deserts/">shuttering</a> in communities of color and moving to whiter areas. And rural communities, which often have only a single pharmacy in town, could be hit especially hard by the widespread closings."You're talking about closing a store that not only is important for a community for their prescriptions, but they can pick up other supplies at that store," Nick Fabrizio, a senior health-policy lecturer at Cornell University, said. "If it's gone, now they're driving 20 miles or 30 miles to find another option."For the pharmaceutical industry, there are no obvious fixes. Steven Anderson, the CEO of the National Association of Chain Drug Stores, said there's an "urgent need" for congressional action on PBMs, which are already under scrutiny by <a target="_blank" href="https://www.ftc.gov/news-events/news/press-releases/2024/09/ftc-sues-prescription-drug-middlemen-artificially-inflating-insulin-drug-prices">government regulators</a>. But competitors like Amazon aren't going anywhere, and <a target="_blank" href="http://Walgreens.com">Walgreens.com</a> isn't exactly an online behemoth. "It's really a multifactorial problem that I don't see getting better anytime soon," Fabrizio said. And as pharmacies and other quick-stop stores continue to close their doors, we may look back one day in the not-too-distant future and realize we were living through the golden age of convenience, when getting whatever you needed was always right around the corner.<a target="_blank" href="https://www.businessinsider.com/author/emily-stewart">Emily Stewart</a> is a senior correspondent at Business Insider, writing about business and the economy.

The end of convenience: What the downfall of Walgreens means for America

<ul class="summary-list"><li>Overemployment is growing as workers seek financial independence and early retirement.</li><li>Three double-dippers are sacrificing their social lives, health, and sleep to work long hours.</li></ul>The pay and benefits of a full-time job aren't always enough to sustain an employee's lifestyle and monetary goals. As a result, some people are choosing <a target="_blank" href="https://www.businessinsider.com/working-multiple-remote-jobs-dont-feel-guilty-overemployed-secret-jobs-2024-2">overemployment</a> as an avenue for maximizing profit.Business Insider spoke with three people who worked up to a total of 80 hours a week at multiple jobs to achieve their goals — including <a target="_blank" href="https://www.businessinsider.com/fire-movement-how-to-hit-financial-independence-freedom-grant-sabatier-2024-4">financial independence</a>, <a target="_blank" href="https://www.businessinsider.com/boomer-retiring-early-nervous-about-money-2024-5">early retirement</a>, and property ownership. But, their social lives, sleep, and hobbies took a hit in the process.Here's everything they sacrificed to secure their futures.<h2 id="89566fd1-d898-4b73-b6e4-3ee71a0c42ab">A Canadian woman sacrificed friends, hobbies, and sleep to retire early</h2>In June, 25-year-old <a target="_blank" href="https://www.businessinsider.com/worker-overemployed-remote-jobs-retire-30s-fire-stressed-2024-6">Jane</a>, who withheld her last name for privacy reasons, told BI that she started working two full-time jobs during her last year of college, hoping to retire in her 30s. From 9-to-5, she worked a remote marketing job, and from 5 to 10, she worked a low-lift customer service job.The flexibility of her remote role allowed her to squeeze in time for homework, while the passivity of her service job gave her a respite from the mental demands of her 9-to-5.After graduating, keeping two jobs was a no-brainer. She landed a 9-to-5 as a marketing specialist and kept her service job. In the first half of 2024, she earned $43,000 in Canadian dollars and saved up 70% of her salary. All the while, she was <a target="_blank" href="https://www.businessinsider.com/millennial-living-home-challenging-societal-norms-2023-12">living at home</a> and renting out her college property.Though she was getting closer to her goal of early retirement, she struggled to find the time or energy to maintain her hobbies, social life, or sleep schedule."When the sun goes down at 6 p.m. in winter, I've had days where I look out of the window and realize I've had no sun or exercise all day," Jane told BI.She reduced her customer service job by 10 hours a week to alleviate exhaustion but still felt burned out."I know it's not good for my physical and mental health or my sleep, but I'm so focused on my goal that I'm willing to sacrifice that for a few more years."<h2 id="ec8f53f5-c9ef-4a0f-8606-2b7d53e8470c">This project manager took jobs on each coast to work 12-hour days</h2>After her project management job went remote during the pandemic, 30-year-old <a target="_blank" href="https://www.businessinsider.com/over-employed-double-dip-how-to-work-multiple-jobs-2024-4">Kendall McGill</a> told BI she used the time at home to start a contract job with Apple.But, when her manager found out about the job and confronted her with concerns, McGill said she knew she had to be more secretive if she wanted to keep double-dipping.In September 2022, she left her full-time job and created a job-juggling system to avoid legal and professional consequences. However, it required major upkeep.McGill told BI that she steered clear of jobs with mandatory hours, in-person meetings, and <a target="_blank" href="https://www.businessinsider.com/micromanager-boss-being-better-manager-tips-advice-2020-9">micromanagement</a>. She even took jobs on opposite coasts to work 12-hour days without crossover. The most extreme tactic was her interview technique."I have multiple résumés highlighting different skills and jobs rather than listing all my jobs simultaneously. If it ever does come up, I make it seem like the dates overlap less than they did," McGill told BI.The one time that an interviewer asked about overlap, she didn't get the job.Despite the risky overlaps and long hours, McGill said she was happy with her choice. She was able to buy a house using four months of savings and felt motivated to keep working multiple jobs."We've been sold this American dream, but how can you achieve it with inflation, a pandemic, layoffs, and all these other things? The only way is to beat the system, find a loophole, and get around it."<h2 id="2796e545-ebb0-4fb4-8e2a-5d75f4393859">An over-employed man sacrificed his social life, but lost both jobs in one month</h2><a target="_blank" href="https://www.businessinsider.com/how-to-double-dip-work-two-jobs-2023-9">Davrick Hayes</a> got his first quality assurance job in 2014 after he stumbled across an ad that said, "Get paid to play video games." He knew he found a hidden gem because the relatively easy job required no previous experience and had room for growth.When he moved from LA to North Dakota during the height of the pandemic and found himself with more time than ever, he decided to get another full-time QA job.He said that he managed both jobs by multi-tasking. He kept a watchful eye on automated tests for one company while running manual tests for the other. During five months of double-dipping, he made $110 per hour.The only downside was that he had to sacrifice his social life, which he said was manageable until the pandemic lockdowns ended. Though it was tough, Hayes planned to continue both jobs until he lost them both within one month in early 2023."I was super stressed about my finances because I had just closed on a house and didn't expect to lose both jobs within a month," Hayes told BI.Luckily, the money he made from double-dipping gave him the financial security to take on just one job and enjoy more work-life balance.If you are overemployed and would like to share your story, please email Tess Martinelli at <a target="_blank" href="mailto:tmartinelli@businessinsider.com">tmartinelli@businessinsider.com</a>

3 double dippers who work multiple full-time jobs share what they sacrifice for the sake of higher earnings

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The end of convenience: What the downfall of Walgreens means for America

Emily Stewart

3 double dippers who work multiple full-time jobs share what they sacrifice for the sake of higher earnings

Tess Martinelli

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