Man held in cage Small operators in the health-care industry are seeing their profits squeezed by a tightly interwoven web of distributors, retailers and health-plan administrators. (Photo: Shutterstock)

Over 20 years, Brian Komoto built a thriving pharmacy in California’s Central Valley. Each day, his nurses would travel the vast agricultural region’s roads to help hepatitis C patients take a grueling regimen of shots.

Then, in 2016, 20 percent of Komoto’s business vanished, practically overnight. The insurer Centene Corp. purchased the health plan that covered his patients — many of them Hispanic farm workers who had developed a level of trust with Komoto’s traveling nurses. Centene had its own mail-order pharmacy, and it told the patients to go there instead, he said.

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