The Heart of Healthcare | A Digital Health Podcast

The Drugstore Cowboy | C.O. Bigelow Owner & Pharmacist Alec Ginsberg

Mar 30, 2026

Alec Wade Ginsberg, fourth-generation pharmacist and owner/COO of C.O. Bigelow and founder of the Drugstore Cowboy newsletter, breaks down pharmacy business realities. He talks about PBMs and how they squeeze independents. He explains why volume no longer means profit, the rise of compounding, and one policy he’d enact to fix the system.

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ANECDOTE

Why Drugstore Cowboy Started

Alec Ginsberg started the Drugstore Cowboy newsletter to explain pharmacy topics in five minutes from his front-line experience at C.O. Bigelow.
He used daily patient questions (e.g., prior authorizations, copays) and his concierge pharmacy role near NYU and celebrities as the content source.

INSIGHT

Pharmacist Role Must Shift To Clinical Services

Pharmacy evolved from apothecary compounding to modern mass-produced dispensing, shifting pharmacists from makers to dispensers after WWII.
Alec argues the next shift must be clinical services and medication management because dispensing margins are collapsing due to PBMs.

ANECDOTE

Why Bigelow Got Rid Of The Pharmacy Robot

C.O. Bigelow removed its Parata pill-counting robot after 17 years because filling volume alone no longer justified the cost.
Alec chose to refocus staff on profitable prescriptions and patient navigation rather than high-volume dispensing.

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Last year, his independent pharmacy spent $13 million on brand-name drugs for patients processed by the three biggest Pharmacy Benefit Managers (PBMs) which earned a profit margin of 0.01%.

In this episode, Halle speaks with Alec Ginsberg, owner and fourth-generation pharmacist at C.O. Bigelow, the oldest surviving apothecary–pharmacy in the United States. Alec is fighting against the forces squeezing independent pharmacies and charting a course for the future of the pharmacist.

We cover:

How the roll-up of PBMs, health plans, and retail pharmacies changed everything
What led him to remove his pharmacy’s Rx-filling robot
The dramatic decline of independent pharmacies along with the closures of big box pharmacy stores
The one health policy he would put in place today to save independent pharmacies
The history of the pharmacist's role and what’s next
What he really thinks about compounding pharmacies and the Hims vs. Novo lawsuit

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About our guest:

Alec Wade Ginsberg is the fourth-generation pharmacist, owner, and Chief Operating Officer of C.O. Bigelow Apothecary, America’s oldest pharmacy, founded in 1838 and still operating in New York City’s West Village. With a Doctor of Pharmacy degree from the University of North Carolina Eshelman School of Pharmacy, Alec bridges the clinical world of pharmacy with the realities of modern consumer culture.

At Bigelow, he oversees the brick-and-mortar beauty retail and pharmacy operations, navigating everything from prescription drug shortages to the pressures of today’s PBM-dominated marketplace. Beyond the counter, Alec is the founder and writer of Drugstore Cowboy, a weekly newsletter that dissects the intersection of drugs, business, and consumer culture — making the hidden mechanics of the U.S. healthcare system both understandable and entertaining for thousands of readers.

His work has been featured across national media, and he’s become a trusted voice for translating complex pharmaceutical issues — from GLP-1s to compounding to drug pricing — into plain English. Alec’s mission is simple: to make Americans smarter about the pills in their cabinets and the system that puts them there.

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Show notes:

Drugstore Cowboy - Alec’s free and super interesting newsletter
C.O. Bigelow - The Nation’s Oldest Apothecary
Virtual GLP-1 startups: Pill mills or the future of obesity care?

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