The "Caremark/CVS" insurance that I have for prescriptions allows me to go to Target/CVS for covered medications, but I also have the option to mail-order (from them, of course). I also have Aetna Health Insurance just by chance (we have a choice of 3 companies @work).

Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will do most thigs). CVS is looking to be the "other other Walmart" of pharmacies. I have worked (as an intern) in many pharmacies, and I've seen several buyouts. At this point in time, I'm very happy that I made the leap from PharmD to SRE/DevOps about 11 years ago. Pharmacists will be robots in <5 years IMHO.

>Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style)

All pharmacies, electronic and brick-and-mortar, go through one of 3 wholesalers: Cardinal, AmerisourceBergen, or Mckesson. It's, "which retailer can drive distribution?"

Speaking from the US, it's too bad that pharmacists are so disempowered here. I was just in France, and my friend came down with an eye infection. He went to a pharmacist, who just gave him antibiotics and told him to come back in three days if it didn't go away.

We both agreed it would never have been so easy in the states.

While I agree that kind of ease of access to an Rx that would have otherwise required a doctor’s office visit sounds great, antibiotics is probably a bad example. Over-prescription of antibiotics is a known problem. Was your friend seen by a PA or nurse or something? Maybe that model makes sense but I hesitate to give pharmacists the added power of diagnosis.

If Amazon enters the pharmacy business is there any reason they couldn't bypass the wholesalers and buy directly from pharmaceutical companies?

No. To be clear, I don't make these regulatory decisions, I'm just relaying the reality of the situation. It's very difficult to have these discussions with people that don't even know the basics about the industry under discussion.

Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.

The pharmacist “supervises” te process. Mail order has been doing this for 20 years. There used to two big ones... Caremark and Express Scripts. Now CVS, the Comcast of drugs, swallowed both up.

Hospitals do this too. In some cases 2-3 pharmacists can cover 10-12 hospitals for off shift dispensing needs.

With the black horse cavalry running the country, we’re going to see lots of M&A activity like this.

Pharmacists must directly supervise dispensing. Many hospitals use a central-fill pharmacy where the prescriptions are filled for many hospitals.

The problem with these mergers is they allow health plans that further disadvantage other pharmacies or providers. Once those other options are eliminated we’ll see prices rise. Do people actually want the Home Depot’s of healthcare rather than the equivalent of the local hardware store? We’ll see I guess.

Optical insurance has been like this for a long time. For example, EyeMed is owned by Luxottica, who owns the majority of eye wear retailers in the USA.

Evidence suggests that they've used their monopoly to artificially inflate prices quite dramatically.

No, it isn't. I worked for CVS for about 8 years, though not as a pharmacist. Some of this information could be Indiana-specific, however:

A brick and mortar pharmacy must have a pharmacist on-site to dispense drugs. Not only are they supposed to do a final check on prescriptions filled, but they must be available for patient question and sometimes medicine requires advice from a pharmacist before it can be dispensed. In addition, there are some stricter laws for certain controlled medications and these checks must be done by a pharmacist. If the pharmacist gets sick or in a car accident on the way to work, the pharmacy can't legally open (they can section the pharmacy off with its own locks to keep the convenience store open).