How Much Can I Make? – Pharmacist Career Insights: Surviving A Rigged Game

Host: Mirav Ozeri
Guest: Dr. Nils Moller, Holistic Pharmacist and Owner, Village Apothecary (Woodstock, NY)
Date: September 16, 2025

Episode Overview

This episode offers an unvarnished look into the daily realities of being a pharmacist—particularly as an independent pharmacy owner—in today’s complex, often monopolistic healthcare system. Dr. Nils Moller shares his personal journey, examines financial and ethical hurdles, discusses the impact of Pharmacy Benefit Managers (PBMs), and reveals how he’s adapted his business to survive. He also touches on broader industry trends, career advice for aspiring pharmacists, and the enduring rewards of genuine patient care.

Key Discussion Points & Insights

1. Becoming a Pharmacist: The Personal Journey

• Early Inspiration: Dr. Moller knew he wanted to be a pharmacist from age 14 after a career assessment and inspiration from his childhood pharmacist.
  • “I scrolled through all the different, like A to Z, literally all the different types of things you can do in healthcare. And I got to pharmacist…and it was Pete Gage. And I just thought, like, how awesome he always was to everybody...That was it for me.” [01:18]
• Education: Pharmacy requires six years of study, culminating in a doctorate. [02:11]

2. Entrepreneurship and Running an Independent Pharmacy

• Motivation to Open Own Pharmacy:
  • Influenced by mentors and an entrepreneurial spirit:
  • “It was really just me expressing my entrepreneurial desires. I don't need to go work for somebody and just like, be stuck. I need to be able to kind of like dream big and then like, have good people do good work.” [02:19]
• Respect Among Community: Community care and relationships remain a competitive edge over chain pharmacies, despite financial headwinds. [03:16]

3. ‘Rigged’ System: The Role and Impact of PBMs

• Vertical Integration & Monopolistic Practices:
  • “Chain pharmacies have purchased the intermediaries...the Pharmacy Benefit Manager (PBM)...they can then tell patients where they can go, and then they can pay themselves more than they pay me…that’s just kind of like very, very, very tip of the iceberg.” [03:16-04:44]
  • Analogy: “Imagine if...somebody dictated what hardware store you could be buying your stuff from. That's literally what happens in healthcare.” [04:44]
  • “If you put into ChatGPT, does the business of pharmacy make sense? ChatGPT will say wholeheartedly, no.” [05:23]
• Reimbursement at a Loss:
  • Pharmacies are often reimbursed below their actual costs—an unsustainable model.
  • “17% of the time we're getting reimbursed less than the cost of the drug. So...we will lose about 6% on every claim.” [06:28–07:35]
  • “Pharmacies were filling [weight loss drugs] for their patients and losing about $80 to $100 every time.” [07:44]

4. Survival Strategies & Business Realities

• Making Money:
  • “You really don’t.” Pharmacies aim to break even on prescriptions; profitability now depends on supplemental business activities. [08:09]
  • Independent pharmacies peaked in value and numbers around 2016 and have been declining since due to worsening reimbursement schemes. [08:09–09:06]
  • Chain stores also not immune: Rite Aid bankrupted, Walgreens retreating, all due to not owning a PBM. [09:06]
• Pharmacy Buying Power:
  • Small independents often buy in large groups, comparable to CVS, but low reimbursement is the central issue. [09:19-10:08]
  • Crucial Point: “There are two costs here. There's the cost of the drugs and then there's the cost of the service…We’re still not getting paid for our services.” [10:19]

5. Career Prospects for Pharmacists

• Earnings:
  • $60–$80 per hour in New York, but heavy student debt (up to $240k) limits real economic mobility.
  • “Now you’re locked in for [years]…How do you save for weddings?...buying a house, starting a family, if you have a mortgage essentially hanging over your head the minute you get out of school?” [11:09]
• Advice for Aspiring Pharmacists:
  • “You should go to pharmacy school if you're passionate about the practice of pharmacy…Otherwise, I would say there's better uses of your skill set that will be far more lucrative.” [12:23]

6. Diversification: Supplements and Beyond

• Pivoting the Business:
  • Dr. Moller added a vitamin/supplement line to diversify and stabilize revenue. [12:56]
  • “The supplement business was very strong…so I was not single threaded…I feel I would probably be bankrupt [otherwise].” [13:18]
  • Expanding to distribution of their vitamins. [13:54]
• Changing Patient Care Culture:
  • “We have to now think about money where it's like, I have to say to somebody, I can't take your insurance, I can't fill your prescription, I can't stop your medication.” [14:39]

7. Industry Trends

• Popular Drugs:
  • “Mostly cholesterol and blood pressure medication…miracle drugs, these GLP1s, the weight loss drugs…are very expensive and difficult to get.” [14:52, repeated from 00:04]
• Inventory Management:
  • Managing complexity, expiration, and costs across multiple manufacturers and SKUs to avoid financial hazards. [15:23]

8. COVID-19: Pivot, Service, and Financial Model

• The COVID Vaccine Model:
  • “Covid was the first time in my career that we got paid the same for everybody, no matter what, from the government…$40 per vaccine.” [16:44–17:49]
  • Impact: Provided financial predictability, enabled outreach to underserved communities, and “allowed us to be very generous with our time…and serve communities.” [18:06]
  • Volume: “I gave 70,000 vaccines and I have a 1400 square foot store.” [19:01]
• Post-COVID Worries:
  • Now vaccines cost the pharmacy up to $100 each; losing government support increases risk and anxiety. [19:23]

9. Political/Regulatory Concerns

• Recent Developments:
  • Concerns with new CDC leadership (RFK Jr.): “He fired them [vaccine officials] so that way he can put in a sycophant. It's a problem on a lot of different levels.” [19:55]
  • “The only reason we even survive is because of our vaccine business. If that goes away…it doesn't make sense for me.” [20:37]

10. Rewards of Pharmacy

• Patient Impact:
  • “It's literally the patience. There's nothing that makes any of it worth it except for what we could do for people.” [20:58]
  • Dr. Moller recalls designing a diet for a terminal patient, resulting in surprising health benefits long after a prognosis of days to live. [20:58–21:51]
• Holistic Care Approach:
  • Goes beyond dispensing—to supporting wellness with advice on diet, sleep, mental well-being, and more. [22:06]

11. What He Wishes He Knew

• Continuous Learning:
  • “I would have been even more aggressive about my continuing education [because] most of my focus is around the business, not…clinical stuff.” [22:42]

12. Hiring and Team Culture

• Team Selection:
  • Prioritizes smart, culturally fitting, passionate staff. Announces hiring of a new pharmacist, Kayla. [23:11]
  • “You're picking people based on the cultural fit. Are they going to fit with your organization?...Do they believe in the mission?” [23:11]

13. Staffing Needs

• Minimum Staffing:
  • Chains often run with minimal staff for efficiency; Dr. Moller prefers more staff for better patient care. [24:01]

Notable Quotes & Memorable Moments

• On the System:
  • “If you put into ChatGPT, does the business of pharmacy make sense? ChatGPT will say wholeheartedly, no.” – Dr. Nils Moller [05:23]
  • “The worst thing that somebody could say is that I want to give you my prescription business, which is the opposite of any other [industry].” – Dr. Nils Moller [06:06]
• About Care vs. Profit:
  • “I was told, you treat everybody the same and never think about money…Now we have to think about money…” – Dr. Nils Moller [13:54]
• On Patient Relationships:
  • “It wasn't because I was good at science. It wasn't because I liked the white coat. It was because I wanted to be significant for my community, like my mentors.” – Dr. Nils Moller [16:44]

Timestamps for Key Segments

• [01:18] – Dr. Moller’s inspiration to become a pharmacist
• [03:16] – How chain pharmacies and PBMs have rigged the system
• [06:28] – How pharmacies often lose money on prescriptions
• [08:09] – Present-day financial realities for independent pharmacies
• [11:09] – Real-world earnings and student debt for pharmacists
• [12:56] – Why Dr. Moller pivoted into supplements
• [14:52] – Overview of most common and “hot” medications
• [16:44] – How COVID changed the pharmacy business model
• [19:23] – Post-pandemic financial risks for vaccine inventory
• [20:58] – The real rewards: Helping patients and community impact
• [22:42] – What he wishes he knew starting out
• [23:11] – Hiring for cultural fit and passion

Summary Takeaways

• The pharmacy industry is deeply shaped by PBMs, often making profitability for independents difficult or impossible.
• Margins have shrunk severely, forcing many independents to diversify into supplements or other retail.
• Despite difficulties, direct patient care and making a community impact remain the primary rewards.
• Prospective pharmacists should enter the profession for love of care, not high earning, and be prepared for student debt and a challenging business landscape.
• Success now depends on adaptability, holistic patient care, and building resilient, value-centric teams.

This episode dispels myths about pharmacy as an easy, lucrative sector and instead paints a realistic, nuanced picture—essential listening for anyone considering the field or seeking to understand the “rigged game” at its heart.