For decades, one of the most frustrating parts of filling a prescription has happened after the clinical decision is already over. The prescriber selects a medication, sends it to a pharmacy, and only then does the patient discover what it will actually cost.
If the copay is too high, the pharmacy may begin searching for alternatives. The patient may call the doctor’s office. A different pharmacy may have a lower cash price. Insurance may prefer another product. The prescription may need to be transferred or rewritten. In the worst case, the patient simply walks away without the medication.
Epic wants to move that decision much earlier.
On October 15, Epic announced Prescription Marketplace, a new feature planned for summer 2027 that will allow clinicians and patients at health systems using Epic to compare what a medication will cost at different pharmacies before the prescription is sent. The system will place the patient’s estimated insurance price alongside cash prices supplied by participating pharmacies, allowing the patient to compare options while still inside the prescribing workflow. Epic says Amazon Pharmacy, Mark Cuban Cost Plus Drugs, Costco, and LillyDirect are working with or supporting the initiative, and that any pharmacy will be able to share its cash prices with health systems using Epic.
At first glance, this looks like another medication price-transparency feature. It is potentially much more important than that.
The decision about where a prescription gets filled may be moving upstream.
Pharmacy selection could become part of prescribing
Today, Epic already offers a Real-Time Prescription Benefit tool that can show prescribers what a patient is expected to pay through insurance and surface alternatives during prescribing. Epic says that capability helped patients save more than $250 million in 2025. Prescription Marketplace would add another layer by comparing the insurance price with pharmacies’ cash prices before the prescription is routed. That means the conversation in the doctor’s office could shift from simply asking which medication should be prescribed to also asking where that medication should be filled and whether insurance is even the lowest-cost way to purchase it.
That is a meaningful change in workflow.
Historically, pharmacy selection has often been influenced by geography, habit, insurance networks, an existing relationship with a pharmacist, or whichever pharmacy is already stored in the patient’s medical record. Price problems frequently appear later, after the prescription reaches the pharmacy.
Epic is trying to surface more of that information before the prescription leaves the prescriber’s screen.
Fierce Healthcare described the feature as bringing pharmacy price shopping directly into the doctor’s office and the prescribing workflow. Depending on the medication, insurance coverage, and pharmacy, Epic says a cash price can sometimes be lower than the patient’s insured price.
For patients, that could remove an enormous amount of friction. For pharmacies, it may change where competition begins.
The pharmacy may have to win the prescription before it ever arrives
This is the part pharmacy leaders should pay attention to.
Imagine a patient sitting in an exam room while a medication is being prescribed. Instead of automatically sending it to the pharmacy the patient has always used, the patient can see several options on the screen. One pharmacy may offer a lower cash price. Another may offer delivery. Another may already be familiar. An online pharmacy may be cheaper but require shipping. A local pharmacy may cost slightly more but offer immediate pickup and direct access to a pharmacist.
The prescription has not been sent yet.
The patient is effectively choosing among pharmacies before any of them have received the prescription.
That changes the traditional sequence of competition.
Many pharmacies have historically had the opportunity to demonstrate their value after the prescription arrived. The pharmacist solved an insurance problem, helped find a lower-cost alternative, coordinated with the prescriber, answered a medication question, arranged delivery, or built enough trust that the patient returned the next month.
If more information about price and pharmacy choice appears upstream, some of that competition could occur before the pharmacy gets its first opportunity to interact with the patient.
For pharmacy owners, the question becomes uncomfortable but important: if your pharmacy appeared on the same screen as Amazon Pharmacy, Costco, Cost Plus Drugs, and other local or national options, why would the patient select you?
The answer cannot automatically be, “Because we are the closest pharmacy.”
Price transparency makes value more visible, but it may also make pharmacy look more interchangeable
There is an obvious benefit to greater transparency. Patients should not have to wait until they reach the pharmacy counter to discover that a medication is unaffordable.
Epic says more than four in ten U.S. adults report that cost has prevented them from taking medications as prescribed, citing national survey data. Its stated goal is to help patients identify affordable options earlier and reduce abandonment.
The challenge for pharmacies is that putting prices side by side can make the prescription look increasingly like a product being compared across retailers.
If Pharmacy A lists one price and Pharmacy B lists another, the easiest measurable difference is cost.
But pharmacies are not identical fulfillment points.
One may offer same-day delivery. Another may specialize in a disease state. One may provide adherence packaging for an older adult managing 12 medications. Another may have pharmacists who know the patient’s complete history. One may coordinate directly with a local physician office. Another may provide compounding, immunizations, chronic-disease services, specialty expertise, medication synchronization, caregiver support, or easier access to a pharmacist.
The difficult part is that many of those advantages are harder to display on a price-comparison screen.
That creates a strategic problem for pharmacy.
If price becomes easier to compare, the rest of the pharmacy’s value has to become easier to understand.
The future pharmacy may need a clearer reason to be chosen
Independent pharmacies have spent years arguing that their value extends beyond the prescription itself. Prescription Marketplace could make that argument more important, not less.
If a patient can see a lower cash price somewhere else before leaving the doctor’s office, loyalty can no longer be assumed. Pharmacies may increasingly need to give patients a specific reason to choose them even when another option appears cheaper.
For some pharmacies, that advantage will be convenience. A patient may prefer a local pharmacy because the medication is available immediately rather than delivered in several days.
For another, it may be access. Being able to speak directly with a pharmacist who knows the patient’s history can have tremendous value when therapy becomes complicated.
For specialty pharmacies, the advantage may be disease-specific expertise, benefit navigation, monitoring, financial assistance, or coordination with the patient’s care team.
For an independent pharmacy serving older adults, it might be synchronization, packaging, caregiver coordination, and home delivery.
For another pharmacy, the differentiator may be a service most competitors do not provide at all.
The strategic lesson is that a pharmacy should be able to articulate its value without relying entirely on the prescription being routed there automatically.
That becomes especially important if pharmacy choice increasingly happens while the prescriber and patient are still discussing the medication.
Any pharmacy being allowed to submit cash prices is an important detail
One of the most consequential parts of Epic’s announcement is easy to overlook.
The company says any pharmacy will be able to share its cash prices with health systems using Epic.
That means this is not being described solely as a marketplace for the handful of large companies involved in developing it. Epic is positioning the system as something other pharmacies could potentially participate in as well.
The details will matter enormously.
How pharmacies submit and maintain prices, how frequently those prices are updated, what information patients see besides price, how pharmacy options are displayed, whether availability can be communicated, and how local pharmacies appear relative to national competitors could all affect how useful the marketplace becomes.
Epic has announced the product more than half a year before its planned summer 2027 release, so many operational questions remain.
But pharmacy leaders do not need every technical detail before thinking about the strategic implications.
The direction is already visible: price transparency is moving closer to the point of prescribing.
Cash prices are becoming part of the healthcare workflow
Another important shift is the growing visibility of cash pricing alongside insurance.
Patients have traditionally been taught to present an insurance card at the pharmacy and assume that using insurance is the normal path to the best price. The growth of discount programs, direct-to-consumer pharmacy models, transparent cash-price pharmacies, and manufacturer channels has made that assumption less reliable for certain medications.
Epic’s new marketplace formalizes that comparison within the electronic health record.
Mark Cuban, co-founder of Cost Plus Drugs, framed the value proposition around letting patients know when the same medication can be purchased at a substantially lower cash price than their insurance price. Amazon Pharmacy similarly emphasized giving consumers the ability to compare insurance and cash options and decide whether delivery or pickup works better for them. Costco said placing pricing information inside the clinical workflow could reduce abandonment at the pharmacy counter.
That is another example of the boundaries around pharmacy changing.
The EHR is no longer simply helping decide what medication should be prescribed. It is increasingly becoming part of the infrastructure determining how the patient accesses and purchases that medication.
For pharmacists interested in the future of the profession, that intersection between prescribing, benefits, pricing, technology, and pharmacy distribution is worth watching closely.
The competitive environment is expanding beyond the pharmacy down the street
A generation ago, the most obvious competitor to a community pharmacy was another pharmacy nearby.
That comparison is becoming much less useful.
A patient may now choose among a traditional chain pharmacy, an independent pharmacy, a warehouse club, a mail-order pharmacy, a specialty pharmacy, Amazon Pharmacy, Cost Plus Drugs, a manufacturer-supported platform such as LillyDirect, or another digital pharmacy model.
Some compete on price. Some compete on speed. Some compete on convenience. Some compete through insurance networks. Some compete through direct relationships with manufacturers. Some compete by owning the patient experience from the online visit through medication delivery.
Epic’s Prescription Marketplace could bring more of those choices onto the same screen.
Fierce Healthcare noted that the announcement arrives amid a broader shift toward transparent pricing and direct-to-consumer medication models. Amazon has continued expanding its pharmacy services, Cost Plus Drugs built its model around transparent cash pricing, and Lilly has been building LillyDirect as a more direct pathway for accessing certain therapies.
For traditional pharmacies, the competitive landscape is therefore no longer defined only by what exists within five miles.
The competition may be every organization capable of getting that medication to the patient conveniently and affordably.
This could also change what happens inside the prescriber’s office
There is another side of the marketplace that pharmacists should consider.
Prescribers may become more involved in pharmacy-selection decisions.
If a clinician can see that one medication costs a patient $75 through insurance at one pharmacy but has a substantially lower cash price elsewhere, it becomes difficult to treat price as something for the pharmacy to solve later.
Affordability becomes part of the prescribing conversation.
That is probably good for patients. A medication that is never filled cannot produce its intended outcome.
But it also means prescribers and their teams may need to interpret more information during an already crowded visit. Price may vary by pharmacy, insurance status, product, quantity, and other factors. The cheapest option may not always be the most convenient or clinically practical. A patient may value an existing relationship with a pharmacist more than a modest price difference.
Technology can surface the information.
Patients and healthcare professionals still have to decide what matters.
That creates another reason pharmacists should be involved in the design of these systems. Pharmacy access is not purely a pricing problem. It involves clinical needs, supply, benefit design, distribution, adherence, patient preferences, and the operational realities of medication use.
Price transparency could reward pharmacies that know exactly what they are
For pharmacy owners, this development is not a reason to panic about a feature that will not launch until 2027.
It is a reason to sharpen the business model.
Ask what your pharmacy is actually competing on.
If the answer is price, can you compete there?
If the answer is service, which service?
If the answer is trust, how is that relationship created and maintained?
If the answer is convenience, what specifically makes you more convenient?
If the answer is medication expertise, does the patient experience that expertise or is it invisible behind the dispensing process?
If you specialize in a particular population, does the community know that?
If you provide delivery, adherence packaging, synchronization, chronic-disease support, specialty expertise, or caregiver coordination, is that value clear enough to influence where someone sends a prescription?
The pharmacies with the strongest future may not necessarily be the ones that try to beat every competitor on the same dimension.
They may be the ones that become extremely clear about why a particular patient should choose them.
Price transparency can expose price differences.
It can also expose a lack of differentiation.
The most important question may be surprisingly simple
Epic plans to release Prescription Marketplace in summer 2027. The feature is still under development, and we do not yet know exactly how pharmacy choices will be presented across every health system or how widely it will ultimately be adopted. Epic’s announcement also reflects the company’s own description of the product and its expected benefits, so its real-world impact will need to be evaluated after launch.
But pharmacy leaders can use the announcement now.
Open a blank page and imagine your pharmacy listed beside Amazon Pharmacy, Costco, Cost Plus Drugs, a large chain, and several local competitors inside the patient’s medical record.
Then ask one question: why should the patient click on us?
Do not answer with what makes you proud of the pharmacy. Answer from the patient’s perspective.
Maybe the reason is price. Maybe it is trust. Maybe it is speed. Maybe the pharmacy can solve access problems better than anyone else. Maybe it offers services that make managing medications dramatically easier. Maybe the pharmacist knows the patient’s family and catches problems no algorithm would see. Maybe the pharmacy serves a specific population better than a national platform ever could.
Whatever the answer is, it needs to become clear.
For years, pharmacies have often received prescriptions first and competed for the patient’s loyalty afterward.
Epic’s new model suggests a future in which patients may compare their options first and decide where the prescription should go second.
That is a subtle change in workflow with potentially significant consequences.
The pharmacy of the future may not be able to depend solely on being the place where the prescription happens to arrive.
It may have to earn the prescription before it is ever sent.
Resources & Citations
- Epic. “Prescription Marketplace Will Let Patients Compare Pharmacy Cash Prices Before Leaving the Doctor’s Office.” October 15, 2026. Epic’s primary announcement of Prescription Marketplace, including its planned summer 2027 launch, comparison of insured and cash prices before prescribing, participation by Amazon Pharmacy, Mark Cuban Cost Plus Drugs, Costco and LillyDirect, and Epic’s statement that any pharmacy will be able to share cash prices with health systems using Epic.
- Fierce Healthcare. “Epic Teams Up With Amazon Pharmacy, Eli Lilly and Mark Cuban to Launch Prescription Drug Pricing Tool.” October 15, 2026. Independent reporting on the planned marketplace, partner organizations, the integration of price comparison into the prescribing workflow, and the broader movement toward price transparency and direct-to-consumer pharmacy models.
- Pharmaceutical Commerce. “Epic, Amazon, Cost Plus Announce Point-of-Care Cash Price Tool.” October 17, 2026. Additional industry coverage confirming the planned summer 2027 release and the marketplace’s intended comparison of pharmacy cash prices with patients’ insured costs before prescriptions are sent.
