For Dimple Lagdiwala, saving independent pharmacies isn’t about resisting change—it’s about reshaping policy, operations, and purpose so small businesses can keep serving patients.
At the Edge of Collapse
Independent community pharmacies have long served as neighbourhoods’ invisible health infrastructure. Yet in 2025, many sit at a precarious precipice. Squeezed margins, opaque middlemen, shifting regulations, and reimbursement cuts have pushed dozens to shutter or merge.
In this moment of crisis, Dimple Lagdiwala emerges as a rare voice straddling operations, advocacy, and vision. Once a pharmacy owner himself and now a consultant, Lagdiwala argues that the fight to save independents is not defensive—it’s strategic. ‘We must stop building on reactive foundations,’ he says. ‘The future is in designing affordably adaptive systems, not resisting the tide.’
What Went Wrong—and What Can Go Right
Lagdiwala identifies three systemic pressures that now threaten the survival of independent and medically integrated dispensing (MID) pharmacies:
– Reimbursement compression and PBM dominance: When three PBMs control nearly 80% of prescription volume, independents must accept ever-narrowing margins to stay in networks. Meanwhile, discount contracts often fail to cover the cost of specialty or oncology drugs.
– Regulatory constraints on dispensing practices: New interpretations of anti-kickback laws and the end of public-health emergency provisions have limited oral oncolytic dispensing from clinics, forcing patients into mail-order channels or long travel distances.
– Scale illusions overshadowing local value: Many independents try to compete by scaling, but challenging chains on size is rarely viable. Instead, Lagdiwala recommends doubling down on service chains that can’t easily mimic direct patient relationships, counselling, cross-referrals, and wraparound care.
He frames his reform prescription not as resistance, but reimagination.
Policy as Strategic Leverage
Lagdiwala has emerged as a policy strategist, pushing reform measures that could recalibrate power in pharmacy. His proposals include:
– PBM transparency reforms—mandatory disclosure of spread pricing and rebate flows.
– Reimbursement parity legislation—requiring PBMs to reimburse independent pharmacies fairly.
– Reform of anti-kickback interpretations—restoring flexibility for physician practices and clinics to dispense while preserving compliance.
– Prompt-pay mandates and bans on retroactive clawbacks—enforcing predictable, stable payments for community pharmacies.
He argues that changes like this are not just fair—they’re fiscally prudent. When independents collapse, patients move to more expensive systems, hospitals see more readmissions, and local trust erodes.
Operational Resilience Through Strategic Differentiation
Policy fixes alone are insufficient. Lagdiwala underscores the need for operational reinvention:
– Precision service over broad coverage: Independents should not aim to match chains on scale. Rather, they should specialize: clinical counselling, complex drug regimens, patient adherence support, and financial navigation.
– Collaborative access networks: Forming consortia or alliances for group purchasing, shared technology platforms, and unified advocacy can help balance power dynamics.
– Tech adoption with human layering: AI for inventory forecasting, smart dispensing, and patient alerts—coupled with human care navigation—can allow leaner operations without sacrificing service.
The Human Side of Pharmacy
Lagdiwala cautions that technical and regulatory strategies must not overshadow the human dimension. Community pharmacies remain powerful for their relational bonds with patients—trust, proximity, empathy.
‘Policy and process must be rooted in trust,’ he says. ‘When a patient calls the local pharmacy, they expect someone on the phone to care.’
He envisions independent pharmacies as health hubs, integrated into primary care networks, offering preventative screenings, education, adherence programs, and serving as local touchpoints in an increasingly digital system.
Balancing Risk and Purpose
Lagdiwala’s path has not been without challenge. He recounts threading delicate lines—balancing compliance, financial viability, and patient access. His vision requires courage: embracing risk in the service of systemic repair.
But for Lagdiwala, the mission is clear. ‘Independent pharmacies are guardians of access in underserved areas,’ he says. ‘Their survival is not optional—it’s central to just healthcare.’
His leadership offers both roadmap and rallying cry: reform must be bold, innovation must be relational, and advocacy must be grounded in real patient lives.
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