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Pharmacies are an essential part of the healthcare system. They dispense prescription medications, operate under strict regulation, and serve as the final step between doctors and patients. Yet despite their central role, pharmacies often make very little money on the prescriptions they fill. This video explains why pharmacies struggle to generate profit, even as prescription volumes continue to rise. It breaks down how the modern pharmacy business actually works, including insurance reimbursement, pricing controls, and the role of pharmacy benefit managers, or PBMs, which act as intermediaries between drug manufacturers, insurers, and pharmacies. These systems determine how much pharmacies are paid for each prescription, often after the medication has already been dispensed. Using a real-world pharmacy chain as a case study, the video shows how fixed operating costs, regulatory requirements, and reimbursement pressure combine to compress margins. It explains why higher prescription volume does not necessarily lead to higher profitability, and why many pharmacies rely on front-of-store sales simply to stay viable. The result is an industry that provides an essential public service while operating with consistently low margins. This is not a story about inefficiency or poor management. It is an examination of the structural forces that shape pharmacy economics, and why even indispensable businesses can struggle to make money under modern healthcare systems.