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Put down the Honey Bun.

“Families should plan out meals and snacks,” said Jennifer McCaffrey of the Expanded Food and Nutrition Education Program. “We try to encourage people to eat more fruits and vegetables – especially the ones that are in season, since they’re cheaper. In Chicago, berries are very in season now, and melons will be in July and August.”

Low income families in the city are bearing the burden of rising food prices more than wealthier Chicagoans, but that doesn’t mean they have to sacrifice their health.

At the end of an aisle crammed full of vitamins, cough drops, mops, notebooks, and greeting cards, Carl Rosenthal wheeled to face a visitor to his cluttered Rogers Park pharmacy.

"What do you think the biggest challenge facing independent pharmacies is?" he demanded.

Wal-Mart and Walgreens?

"Wrong!" Rosenthal relished responding. "They are not the enemy. It's the insurance companies."

As Cook County public clinics close, healthcare costs increase, the age of the population rises, and the ranks of the uninsured grow, more and more people are depending on pharmacies for medical advice and direction. The chain stores offer only curt one-size-fits-all answers, Rosenthal asserted, while independents like him remember their customers and go out of their way to make sure that each has the best possible treatment.

Yet community pharmacies are quickly disappearing. Medicare programs and insurance companies don't pay them enough to cover the cost of running a business, Rosenthal and others said. Three bills currently in Congress could be independent drugstores' last chance for survival-but they face formidable opposition from well-financed insurance companies that argue their methods keep prices down for both pharmacies and consumers.

"I may have to close," said Rosenthal, the 55-year-old owner of Morse Clark Drugs and two other pharmacies. He had a fourth that he already had to close. "Then my only hope is that I can sell my (patient prescription history) files to one of the chains."

Introduced March 12, the Fair and Speedy Treatment of Medicare Prescription Drug Claims Act of 2007 would require Medicare and private prescription drug plans, or PDPs, to pay electronic claims to pharmacies within 14 days. It would also bar PDPs from placing pharmacy trademarks on member cards or drug information.

The bill was sent to the committees of Ways and Means and Energy and Commerce on March 20. It has 232 cosponsors, more than half of the House, including, from Illinois, Reps. Rahm Emanuel (D-Chicago), the Democratic caucus chair, and Jan Schakowsky (D-Evanston).

"I think more and more people are turning to pharmacies for good medical advice," Schakowsky said.

Another bill, the Community Pharmacy Fairness Act of 2007, would allow independent pharmacies to negotiate for contracts from Medicare and PDPs; currently community pharmacies must accept terms insurance companies propose. The bill was introduced on Feb. 8, 2007, brought up for debate in the House on Nov. 7, and sent back to the House Judiciary Committee. The legislation has 179 cosponsors, but is opposed by the U.S. Federal Trade Commission, which feels it is too broad and would raise costs.

A third bill, the Saving Our Community Pharmacies Act of 2007, was introduced on July 24 and referred to the Energy and Commerce committee. The legislation, with 139 cosponsors, would set median retail acquisition cost-a cost between the wholesale prices paid by chain stores and the higher prices paid by independents-as the basis for Medicaid reimbursements on generic drugs, likely boosting payments to community drugstores.

"Odds favor relief for independent pharmacies," according to an October issue of the Kiplinger letter. The newsletter predicted that the bills would be passed quickly.

Still, the legislations face tough resistance from insurance companies. If enacted, the legislation would cost the Medicare program at least another $32.7 billion over the next decade, according to studies by PriceWaterhouseCoopers and CRA International commissioned by the Pharmaceutical Care Management Association, which represents pharmacy benefit managers.

Chip Riddleberger, state relations manager for the Washington, D.C.-based National Community Pharmacists Association, countered that the bill would only mandate what's fair.

"These bills would level the playing field for independent pharmacies so they can be competitive," Riddleberger said.

He said community pharmacies need help: more than 1,150 independent pharmacies nationwide went out of business in 2006, according to Riddleberger's organization.

Profits are declining. Average annual sales for these pharmacies went down .8 percent in 2006 to $3.6 million from $3.7 million the year before, according to the Coalition for Community Pharmacy Action. Gross profit was an average of 22.8 percent, near its 10-year low of 22.1 percent.

The PCMA counters that these figures are in reality much higher, but Riddleberger maintains the situation is worsening because fees paid by insurance companies and the newest Medicare program, Part D, are declining to the point where, at times, they don't cover independent pharmacies' cost of acquisition of drugs.

Part D, with 1.4 million members, pays community drugstores an average of $11.40 for each prescription dispensed, according to a January 2008 federal Inspector General's report. That's little more than $10.50, the average operations cost per prescription, according to a 2007 survey of more than 23,000 independent pharmacies by accounting firm Grant Thorton LLP commissioned by the CCPA.

The Bush administration proposed fiscal 2009 budget would lower Part D payments further.

Among insurance companies, the average reimbursement to Morse Clark per prescription is only about $2, Rosenthal said.

The low profits aren't a big deal for the chain stores, Riddleberger declared, because they supplement pharmacy income with sales of shampoo, candy, magazines, toilet paper, and cigarettes from the front of their store.

"How many people do you see walk out of Wal-Mart with one bag?" he asked rhetorically.

Such purchases made up 25 percent of Walgreen Co. sales in 2007, and 30 percent of sales at CVS Caremark Corp. according to the companies' annual reports.

At Morse Clark Drugs, that figure shrinks to just 10 percent. Despite the store's brimming shelves, little money is made from the front of the store anymore. Most sales are made in candy and lottery tickets, Rosenthal said. People who used to buy cigarettes at the corner store, providing the outlets with continual income, now go to the suburbs to buy cigarettes since the taxes are so high in Chicago, he said.

Nearly all of the store's revenue comes from the pharmacist counter, not from the cash register of Kathi Miller, who as store clerk has sat near the front door for 28 years.

"You go (to Target or Wal-mart) once a month, you stock up-so we're hit hard," Miller said. "We get walk-in traffic, but we don't have a parking lot. So people driving down the street don't stop here for toilet paper or a gallon of milk."

As his blue pharmacist's coat indicates, Rosenthal is the druggist at Morse Clark. He was raised helping out at the retail stores his parents started after surviving the Holocaust. At that time drugstores dotted every block. When it came time for Rosenthal to choose his own career, he and his father eyed those pharmacies and considered them a stable step up.

And, for a long time, being the owner of three community pharmacies seemed a good choice. Morse Clark built a loyal following in the neighborhood; families brought their prescriptions there for decades, Miller said.

"He takes a personal interest in a lot of our customers," she said. "I can't tell you how many times he'll be filling a prescription and he'll say 'oh wait, we've got to call the doctor. You can't take this.'"

Employees at the store speak several languages, and nearby immigrants depend on their translation services. The strong tones of Eastern European languages can be heard throughout the pharmacy as clerks converse with customers. The store is also one of few pharmacies to offer delivery services, which some elderly clients rely on, Miller said.

Customers said they drive across town to continue patronizing Morse Clark even after moving out of the neighborhood. Many stop by just to chat or get advice on medical bills. The phone rings constantly.

Morse Clark would hold its own against the chain stores if not for the tight margins imposed by insurance companies and government programs, Rosenthal said.

"There's enough for everybody," he said. "The people who need the service and want the service will come to us."

That is, unless insurance companies tell members to use mail-order services, or continue sending them to chain stores, which are becoming increasingly ubiquitous. There are now 6,179 Walgreens nationally and 532 in Illinois. A new Walgreens opens every 16 hours, according to the company.

CVS now has 6,208 stores nationally and 224 in Illinois. And, more than two years ago, Wal-Mart Stores Inc. arrived in Chicago; soon afterward, the store started selling 300 generic drugs here for $4 each. Some Chicago aldermen are advocating for a second Wal-Mart in the city.

"I don't want to work for the chains," Rosenthal said wearily, "but I could."