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About the authors: Mitch Barnett is an associate professor with Touro University College of Pharmacy in California and an adjunct (clinical) associate professor with the University of Iowa College of Pharmacy. Dr. Barnett received his BS degree in pharmacy, MS in pharmacy administration, and PharmD from the University of Iowa. He has published numerous articles and is a frequent reviewer and served on the editorial boards for several peer-reviewed journals. Dr. Barnett’s research focuses on using pharmacy claims data to adjust for comorbidity and severity of illness, the implementation of pharmacy guidelines in practice, and the measurement of pharmacy faculty workload and stress. He maintains an active full-time practice at Ryan Pharmacy, an independent community pharmacy located in rural Iowa.

Eric Fromhart is CEO of Secure340B, a company he founded to bridge the gap between independent pharmacies and health care providers participating in the 340B Drug Pricing Program. He has served as guest speaker at national conferences and delivers many workshops on pricing and on contracting with third-party payers throughout the country. Eric is an expert in 340B contracting and negotiations.



After completing this chapter, readers should be able to

  1. Identify different types of negotiation styles.

  2. Describe the attributes of a positional-driven negotiation.

  3. Describe the attributes and proper usage of a principled-driven negotiation.

  4. Differentiate between positional- versus principle-driven negotiation approaches.

  5. Discuss the use of motivational interviewing (MI) in the context of negotiating, and provide examples of its use.

  6. Identify the steps involved in MI, i.e., Desire, Ability, Reasoning, Need, Commitment, Activation, and Taking Steps (DARN CAT).


Gary Rosen, PharmD, has been practicing pharmacy in a variety of settings since graduating from pharmacy school several years ago. Owning an independent pharmacy has been a dream of Gary’s since entering pharmacy school. Gary and his family decide to move to a small town and purchase the town’s sole independent community pharmacy, Taylors Drug Store. The pharmacy has served patients in town for 30 years, has a reputation as a pillar in the community, and maintains a good working relationship with the local hospital and its providers. However, over the years, Taylors Drug Store has been impacted by many changes in the health care environment, specifically in the pharmacy industry: pharmacy benefits manager (PBM) involvement, reimbursement cuts, chain pharmacy expansion, regulations, competition, fluctuating drug prices, specialty pharmacy, discounts, and chargeback or rebate (e.g., direct and indirect remuneration [DIR] fees). Faced with adapting to these changes, Gary has begun looking at alternative, creative methods to remain competitive, sustain profitability, and continue serving the community as a pharmacy owner. Gary quickly realizes that nearly all of the potential opportunities will require him to explore new agreements (or significantly expand existing ones) ...

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