Amazon is threatening the future of independent pharmacies. Here's how they're fighting back.

Lydia Ramsey/Business Insider

• Independent pharmacists have been facing a changing industry for decades but have managed to maintain a presence in communities around the US.
• As reimbursements dwindle, pharmacists are starting to get creative, looking for new ways to get paid by health plans.
• There are massive changes coming to the pharmacy industry. From CVS Health's $69 billion merger with Aetna and Cigna's $67 billion deal for Express Scripts, to the entrance of Amazon, independent pharmacists face tough competition.
• Business Insider spoke with more than a dozen independent pharmacists about the pressure their businesses are facing, and what they're doing to fight back.

Roger Paganelli's business in the Bronx is bustling.

Mt. Carmel Pharmacy stands at the corner of Beaumont Avenue and 187th Street, near the Bronx Zoo and Fordham University.

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