[cloudripper]

Edit: include note on PBMs

In the US, insurance companies and Pharmacy Benefit Managers (PBMs)[0] are the biggest threat to smaller, independent pharmacies. Even if your neighborhood has a Mom and Pop pharmacy (a rarity, as you suggest), if most insurance providers do not provide coverage for that pharmacy I doubt many folks will go there. Instead they would go further across town or use online services - driving independent pharmacies out of business.

On the side of the PBMs influence, the consumer might not see a difference in the price in order for the indie pharmacy to stay competitive, but the cost of medicine for indie pharmacy can be much higher than the corporate pharmacy - meaning they make no money on a sale and in some cases actually lose money. (I recently learned that in some cases, specifically with GoodRx, indie pharmacies can be forced to pay the PBM when a customer uses a PBM discount card at their pharmacy - so the consumer pays the PBM and the pharmacy pays the PBM)

Large corporate pharmacies have the strength and power to influence insurance providers and PBMs - and some even control them. That in my mind is the bigger issue in the US.

0: https://www.reuters.com/legal/litigation/goodrx-pbms-accused...