Drug Topics published one of the most practically instructive pharmacy entrepreneurship stories of the year this week. It deserves far more attention than it’s getting, because the model it describes can be replicated in nearly every market in the country.
The Person Behind the Model
Gregg Jones, PharmD, MBA, is not a first time pharmacy entrepreneur. He built a career in corporate pharmacy spanning professional services, pharmacy technology, business development, and product procurement, culminating as the National Director of Pharmacy of the Future Clinical and Business Solutions at Cardinal Health. He had seen what pharmacy could be, at scale, across the country.
Then he came home to Rhode Island and saw the gap.
“All of this led me to decide to open a cash-based model in my home state, Rhode Island, and offer pharmacist-led clinical services,” Jones said, noting that Rhode Island “seemed like it was operating a few decades in the past compared to more progressive states, and ripe for disruption.”
Jones partnered with Amanda Petrarca, PharmD, a pharmacist-in-charge who had recently left an independent pharmacy that had closed, along with local business partners Michael McMann and John Cillino, CPA, Esq., to bring Compass Core Pharmacy to life.
Jones proudly opened Compass Core Pharmacy, Rhode Island’s first cost-plus pharmacy model, in May 2025, in Warwick. The cost-plus model focuses mostly on generic medications, which “align with most of the current primary wholesaler distribution models.” The pharmacy uses multiple secondary wholesalers to attain the best generic prices for its cash-based patients.
The Business Architecture – Specifically
The operational structure behind Compass Core is worth examining in detail, because each element is a replicable decision, not a unique advantage.
Jones uses an AI-driven ordering tool called CheckMyRxCost, which he credits with significantly improving the ordering process. Compass Core Pharmacy is a Clinical Laboratory Improvement Amendments-waived pharmacy, allowing staff to provide point-of-care testing, including lipid panels, glucose, hemoglobin A1C, flu, and strep. The pharmacy carries more than 45 local vendor products, including package-free soaps, shampoos, and conditioners, which create an inviting in-store environment and generate non-prescription retail revenue.
Compass Core operates a tiered membership model alongside its cash-pay dispensing. A Standard Membership covers convenient monthly fills with pricing access. An Individual Plus One Membership adds in-depth pharmacist guidance, OTC product consultation, and quarterly medication shipments. A Family Membership covers household deliveries and pet medication savings. The premium membership tier includes in-depth quarterly pharmacist consultations, medication interaction reviews, and cost-saving alternative guidance.
That structure solves the cost-plus profitability challenge directly. Transparent cash-pay dispensing on generics generates lower per-prescription margin than traditional insurance models, by design. The membership fee provides a predictable recurring revenue stream from patients who value ongoing pharmacist access. Point-of-care testing generates additional clinical visit revenue. And the local vendor retail section generates margin from foot traffic the pharmacy is building through pricing trust.
None of these elements requires proprietary technology or exclusive partnerships. They require decisions and implementation.
“We’re not locked into Mark Cuban’s system,” Jones said. “They come to Compass Core Pharmacy and are able to save hundreds, if not thousands.”
The Market Condition That Made Rhode Island Ready
Jones identified a specific state-level dynamic that makes the disruption opportunity so clear. The same dynamic exists in dozens of markets across the country.
“Our desire to innovate is being recognized and is considered a tremendous alternative to the Rhode Island-based chain locations that continue to alienate more patients with subpar service and new technology that irritates patients more. With a large exodus of primary care physicians leaving Rhode Island, patients are seeking alternative midlevel practitioners,” Jones said.
Jones noted that with pending health insurance changes in 2026, the Compass Core model is continuing to gain traction. “Employers are facing 20% or more premium increases in Rhode Island and looking at new ways to save their employees and employer healthcare dollars.”
That employer dynamic is one of the most underexplored revenue channels for cost-plus pharmacy. A small employer group that pays $450 per employee per month in premiums, and whose employees also pay $30 to $60 per prescription in copays, has a direct financial incentive to explore a direct employer pharmacy partnership. A cost-plus pharmacy that can offer those employees access to generic medications at acquisition cost plus a transparent fee, combined with pharmacist health coaching as part of the package, competes directly on total cost of care, not just price.
The State Advocacy Signal Hidden in This Story
Compass Core Pharmacy submitted testimony to the Rhode Island Senate Health and Human Services Committee in support of three bills, S2888, S2856, and S2851, arguing that the legislation would increase access to services provided by a pharmacist, improve public health, and lower overall healthcare costs for Rhode Islanders.
This is the Zone 3 pharmacist-as-entrepreneur in full practice, operating simultaneously as a business owner, a clinical service provider, and a legislative advocate. Jones built the pharmacy, built the clinical service model, built the membership revenue layer, and then walked into the statehouse to argue for the regulatory framework that would expand what his pharmacy can legally do.
That is the complete picture of the pharmacist of 2030. And it is already happening in Warwick, Rhode Island.
The Health System Version of the Same Logic
The cost-plus independent pharmacy model isn’t the only place this thinking is gaining traction. Health systems are scaling similar logic from the institutional side.
PeaceHealth plans to broaden pharmacist-led value-based care initiatives, with their Chief Pharmacy Officer noting “one of the more important innovations is to expand the use of pharmacists to achieve add-on payments in value-based care.” Providence is scaling pharmacotherapy clinics and extending transitions-of-care services through audiovisual technology to support high-risk patients without adding workforce.
The underlying logic is identical regardless of setting: the pharmacist delivers clinical value that generates measurable outcomes, and the payment model should reflect that value rather than treating dispensing as the primary transaction. The independent cost-plus pharmacy gets there by eliminating PBM spread pricing and building clinical revenue directly. The health system gets there through value-based care contracts and add-on payment structures.
Both paths lead to the same destination: a pharmacy practice model where the pharmacist’s clinical expertise is the primary revenue driver, not the volume of prescriptions filled.
The Business Mechanics Behind the Model
The cost-plus model eliminates three of the most corrosive financial forces in traditional pharmacy: PBM spread pricing, DIR fee exposure, and insurance margin compression. Revenue comes from a transparent dispensing fee on top of actual acquisition cost, meaning every prescription is profitable by design, not by luck of the reimbursement draw.
The trade-off is volume. Cost-plus pharmacies sacrifice the patient volume that traditional insurance models provide. They compensate with clinical service revenue, membership fees, point-of-care testing, employer partnerships, and retail margin from curated product selection.
The pharmacists who pair cost-plus pricing with a deliberate clinical service program, CGM education, pharmacogenomics consultation, GLP-1 management, psychiatric medication review, MTM, create a business model that neither chains nor PBM-captured independents can easily replicate. Chains cannot replicate the clinical depth and relationship trust. PBM-captured independents cannot replicate the pricing transparency.
That combination, transparent pricing plus deep clinical relationship, is the competitive advantage the cost-plus model generates. Compass Core is already proving it works.
Your Market Analysis This Week
Research what cost-plus pricing on your top 20 dispensed generic medications would look like in your specific market. Your wholesaler account manager can give you current acquisition costs. CheckMyRxCost and similar AI-driven ordering tools can help you identify secondary sourcing options for high-volume generics.
Compare that acquisition cost-plus-fee structure to your current reimbursement on those same medications. The gap you find tells you one of two things. Either the gap is large enough that a cost-plus pivot would generate similar or better per-prescription economics than your current model, with none of the DIR fee uncertainty, in which case a partial or full transition deserves serious planning. Or the gap confirms that your current reimbursement is already competitive, and the cost-plus model’s value to your market lies in its transparency and patient trust effects rather than pure margin improvement.
Either answer is useful. Neither is available to the pharmacist who doesn’t run the analysis.
Jones framed the opportunity plainly: “We’re not locked into anyone’s system.” That is the business freedom the cost-plus model creates.
The market gap that exists in Rhode Island exists in most markets in America. Patients are paying prices they cannot explain or predict. Pharmacists are absorbing reimbursement clawbacks they cannot anticipate. Chains are closing locations and leaving communities without access. The disruption opportunity is visible and documented.
Gregg Jones and Amanda Petrarca saw it, acted on it, and built something that is already working. The template is replicable. The question is who picks it up next.
Sources: Drug Topics (The Story of a Pharmacist Going From Corporate to Cost Plus, June 2026), Warwick Post (Compass Core Pharmacy Offers Low-Cost Prescriptions, November 2025), Compass Core Pharmacy Website (About, Memberships, compasscorerx.com), Rhode Island Senate Health and Human Services Committee (Compass Core Pharmacy Testimony on S2888, S2856, S2851, April 2026), Gregg Jones LinkedIn (Professional Background and Commentary, 2026)