Amazon is impacting independent pharmacies. Here's how they are fighting back.

Significant changes are coming to the pharmacy industry, including CVS Health's $69 billion merger with Aetna, Cigna's $67 billion deal for Express Scripts, and the entrance of Amazon. Roger Paganelli, owner of Mt.

Significant changes are coming to the pharmacy industry, including CVS Health's $69 billion merger with Aetna, Cigna's $67 billion deal for Express Scripts, and the entrance of Amazon. Roger Paganelli, owner of Mt. Carmel Pharmacy in the Bronx, NY, is working to get health plans to pay him to enhance care for their patients via a group called the Community Pharmacy Enhanced Services Network. Under that arrangement, independent pharmacists help ensure that patients leaving the hospital receive the correct doses of their medications, and integrate their care with medical support outside the hospital. Mt. Carmel follows up with patients if they have not come in for a refill, for instance, and staff helps patients sync up their prescriptions so that they need to come in only once or twice. Similarly, the Community Pharmacy Enhanced Services Network (CPESN) seeks to help pharmacies reach deals with health plans to care for their patients. The group estimates that there are almost 2,000 pharmacies working under that type of arrangement. Troy Trygstad, PharmD, MBA, PhD, executive director of the CPESN, says the number of pharmacies in the network has been growing at a rate of about 100 pharmacies a month for the past 18 months. Meanwhile, the National Community Pharmacists Association estimates there were 22,041 independent pharmacies nationwide in 2016, down about 1,000 since 2011.