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Unless your plan is to consolidate with a larger corporate pharmacy, the future of independent specialty pharmacies is bleak. On average, Specialty Pharmacies below 50MM or revenue are making less than 4% profit. In many cases, we don’t know the adverse effects of DIR fees on the P&L, further driving down profit. If the Specialty is in a certain therapies (ie Dermatology) not represented by PBMs then they can gain market share without risk of being undercut. However, most Specialties tend to be general in scope and hence lose differentiation. The valuation for these tends to be quite low.