More Michigan residents are turning to mail-in prescriptions as insurance plans favor online services, but the shift is contributing to the closure of hundreds of local pharmacies, especially in rural areas, according to state officials and pharmacists
Michigan is seeing a rapid shift in how residents receive prescription medications, with online and mail-in pharmacies gaining ground as traditional drugstores close across the state. The trend is especially pronounced in rural communities, where access to in-person pharmacy services is becoming increasingly limited.
In 2024, more than 200 independent pharmacies in Michigan closed, according to the Michigan Pharmacists Association. Many of these closures are linked to the growing influence of pharmacy benefit managers (PBMs) and the rise of mail-in prescription services, which are often favored by insurance plans for their lower costs.
Mail-In Prescriptions Gain Popularity
For residents like Selena Kenny of Alpena, mail-in pharmacies such as Express Scripts have become a convenient way to receive medications. Her Medicare Advantage plan designates mail-in services as the preferred pharmacy, offering the lowest prices for ongoing prescriptions. This model is increasingly common, with insurance companies steering patients toward mail order to reduce costs.
Pharmacy benefit managers, including CVS Caremark, Express Scripts, and Optum Rx, now manage a significant share of prescription drug distribution in the United States. According to a July 2024 Federal Trade Commission report, these three companies oversee about 80% of all prescriptions filled nationwide. Their control over drug pricing and reimbursement rates has made it difficult for independent pharmacies to compete, especially as mail-in services offer lower co-pays and eliminate transportation barriers for patients in remote areas.
Impact on Local Pharmacies and Patient Care
The closure of brick-and-mortar pharmacies has raised concerns among pharmacists and state officials about the quality of care available to Michigan residents. Services such as vaccinations, timely antibiotic refills, and basic clinical care are often unavailable through mail-in orders. Eric Roath, director of government affairs for the Michigan Pharmacists Association, noted that when independent pharmacies close, communities lose access to essential health services that cannot be replaced by mail delivery alone.
While some patients remain loyal to their local pharmacy despite higher costs, many are switching to mail order due to insurance incentives. Ashley McGinn, a counselor with Michigan's State Health Insurance Assistance Program, reported that about 80% of the people she assisted in the past year chose mail-in prescriptions, largely because insurance plans made them the preferred option. In rural counties like Presque Isle, older residents with transportation challenges find mail order especially appealing, but this shift is putting additional strain on small, local pharmacies.
Financial Pressures and Industry Response
Independent pharmacists say that low reimbursement rates set by PBMs make it difficult to cover the costs of operating a physical store. John Gross, who owns six pharmacies in central Michigan, explained that the current payment structure often fails to cover even the wholesale cost of medications, let alone overhead expenses such as staff, utilities, and insurance. The competitive pricing of mail-in orders further erodes the customer base for local pharmacies.
PBMs and their industry representatives dispute claims that they are responsible for pharmacy closures. The Pharmaceutical Care Management Association, which represents PBMs, asserts that the number of independent pharmacies in Michigan has remained stable since 2022. Companies like Express Scripts and Optum Rx emphasize that their networks include independent and community pharmacies alongside mail-in options, aiming to provide flexibility and access for patients.
Regulatory Actions and Future Changes
State and federal officials are beginning to address concerns about PBMs and their impact on local pharmacies. In 2025, Michigan Attorney General Dana Nessel filed a lawsuit against Prime Therapeutics LLC, alleging that its agreement with Express Scripts to adopt lower reimbursement rates is harming small pharmacies. Prime Therapeutics maintains that the arrangement has saved patients money and supports fair reimbursement practices.
At the federal level, new legislation signed by President Donald Trump in February 2026 aims to increase regulation of PBMs and lower drug prices, though many provisions will not take effect until 2028. The Federal Trade Commission has also reported that PBMs have marked up prices on certain specialty generic drugs by hundreds or thousands of percent at their affiliated pharmacies.
As the pharmacy landscape continues to evolve, Michigan residents-especially those in rural areas-face ongoing changes in how they access prescription medications and related health services. The debate over the role of PBMs and the future of independent pharmacies is likely to continue as new regulations are implemented and insurance practices shift.
Pharmacy benefit managers play a central role in negotiating drug prices and managing prescription reimbursements for both independent and chain pharmacies. Their growing influence has led to increased scrutiny from regulators and lawmakers, with ongoing investigations and lawsuits focused on transparency, pricing practices, and the long-term sustainability of local pharmacy services in Michigan and beyond.
