Observed Customer Frustration: How Cost Plus Models Can Help

Author credit: Lucy Chen, PharmD Candidate 2026, University of Pittsburgh

During my experience at a traditional retail pharmacy, I observed the common causes of customer fraustration over two Saturdays. I tracked each instance where a customer left the pharmacy visibily unhappy, and the patterns I observed were eye-opening.

Insurance/copay issues stood out as the #1 source of fraustration, making up 44% of all the cases I observed. Many patients were surprised by high copays, faced insurance denials, or encountered medication delays due to prior authorizations.

Additionally, the inability to sync medications, another source of fraustration, is a downstream effect of the insurance-driven system. Medication synchronization was designed to allow patients to pick up all of their chronic medications in one visit, but insurance limitations on fill dates and prior authorizations frequently prevent pharmacies from aligning refills. This result in customers having to make multiple trips back to the pharmacy, which is especially difficult for elderly patients.

Observing these patterns highlighted how the traditional insurance-based pharmacy model creates barriers that directly impact the patient experience. In contrast, the cost-plus pharmacy model offers a more transparent and simplified approach. The cost-plus model eliminates insurance middlemen so that patients pay a clear upfront price based on the actual cost of the medication — no surprises, no denials.

The cost-plus model can play a valuable role in reducing patient frustration and improving access, especially for generic maintenance medications that are cheap to obtain. While no single model fits all situations, expanding transparent, direct-pay pharmacy options will be an important way to help patients regain trust and control in their medication experience.