Disrupting the PPN: How smart pharmacies win

A decade-long relationship can be erased by a single email from an insurer.Capitalism at its best drives innovation, competition and efficiency. But in pharmacy? It’s beginning to drive exclusion, fragmentation and depersonalization.Preferred provider networks (PPNs) are not just business contracts—they are gatekeepers of access, shaping where patients go, how they get care, and what role community pharmacies are allowed to play. It is a tool designed to optimize the insurer’s financials by negotiating lower costs, ensuring rebate capture and tightening control, not patient outcomes.It also reveals a darker side of healthcare capitalism: one where care is commodified, relationships are severed, and patients become pawns in a corporate strategy.The human cost: care without a caregiverFor independent pharmacies, conversations like this with patients are becoming heartbreakingly common. And while the decision may seem administrative, its impact runs deep—undermining patient trust, pharmacist-patient relationships, and continuity of care.These networks turn pharmacy from a healthcare service into a logistics operation—with volume and efficiency prioritized over quality and connection.We see it every day. Patients confused by insurer jargon. Seniors crying in front of the counter because they must leave the pharmacy that got them through chemotherapy or helped them manage their diabetes.A 2022 Health Affairs study found that patients forced to switch pharmacies had a drop of up to 24% in medication adherence, with the largest impact seen in chronic conditions like diabetes, asthma and hypertension. Other hallmarks of the PPN system include disrupted care, marginalized pharmacists, widened wealth inequity, false savings and increased patient safety risks.We’ve arrived at the era of contract-first healthcare—where spreadsheets beat relationships. But here’s the plot twist: you don’t need to be on the list to be at the top.This isn’t about being cheaper. It’s about being irreplaceable. No PPN pharmacy can do what you do: text a worried patient at 9 p.m., spot the red flag before the doctor does. That’s care. That’s impact. That’s power. And they don’t have it. Let the PPN fill the meds. You fill the gap.Package what they can’t stealThe prescription is just the hook. The real value is in the care around the script.If you only sell pills, they can outbid you. But if you sell a relationship, they can’t touch you. You’re not the “pharmacy that fills.” You’re the brand that builds health. Every loss is a boomerang. Serve patients so well that they swing back when the system fails.Stay relevant outside the network.Train your team and flip the script—you’re not just a pharmacy, you’re a platform. PPNs treat patients like accounts. You treat them like VIPs. Empathy today can win loyalty tomorrow.Make every conversation with a patient one they’ll remember when the PPN fails them. Their plan may choose the pharmacy, but patients choose who they trust. And trust isn’t contracted. It’s earned.Loyalty can be deferred, but not deletedIt’s an unavoidable fact that some of your patients may be rerouted today—but they’ll remember how you treated them through the transition to their new provider. Your compassion during this unfair switch could be the reason they come back.And patients will come back. Not because you had the contract, but because you cared when it didn’t benefit you.PPNs may dictate where drugs go, but only you can decide where care lives.So be that pharmacy. Show up anyway. Patients will remember. And when they come back—you’ll be stronger than ever.Niki Shah is a passionate and dedicated pharmacist with extensive experience as a pharmacy owner.