The K-Shaped Pharmacy Shakeout: Consolidation in Cities, Lost Access in Rural America

By Bryce Platt, PharmD

The United States has almost 8,000 fewer retail pharmacies than it did in 2018, and more than 2,000 closed in 2025 alone. Rite Aid has liquidated. Walgreens is working through a multi-year plan to shutter hundreds of stores. CVS has trimmed hundreds more.

Yet total U.S. prescription dispensing revenues for all dispensing formats reached a record $751 billion in 2025, up 10% from 2024.

Record closures and record revenue in the same year may seem contradictory, but national totals obscure very different effects on the community. The impact of the retail pharmacy shakeout on patient access has become geographically K-shaped: dense markets can absorb pharmacy closures with little loss of patient access, while rural communities can lose their only nearby pharmacy.

The economic pressures on pharmacies are similar across the country. The access consequences of a closure are not. Below, we examine what is driving the shakeout and why geography determines which communities can absorb them.

Informa Connect’s Medicaid Drug Rebate Program Summit

Informa Connect’s Medicaid Drug Rebate Program Summit
October 5-7, 2026 | Chicago, IL
Drug Channels readers save 10% with code 26DRCH10*
View Agenda | Download Brochure

The Medicaid Drug Rebate Program Summit returns to Chicago this October! Join 700 annual attendees and nearly 90 expert speakers to master complex regulatory guidelines to deliver compliant government pricing and reporting programs.

The 2026 event features:

• Direct state engagement: One-on-one Medicaid dispute resolution with 31+ confirmed states.
• Comprehensive coverage: MFP implementation, inflation rebates first invoicing, pharma tariffs, Buy America rules, onshoring strategies, PBM reforms, FTC transparency mandates, and physician-administered product challenges, 340B, AMP, URA, GTN, SPTR, FMV, FSS, Medicaid Parts D and B, and more.
• Unparalleled faculty: Industry leaders from Gilead, AbbVie, Amgen, AstraZeneca, Genentech, Eli Lilly; legal authorities from Hogan Lovells, Arnold & Porter, Covington & Burling; government representatives including CMS, OIG, VA, and 31+ state Medicaid agencies.
• Networking: Opportunities to build valuable connections with more than 700 annual attendees.

Prior attendees praise the event as “An excellent forum to meet industry professionals and gain insight into best practices, current and future, of what’s to come regarding manufacturers and government regulations.”

The MDRP Summit remains essential for anyone navigating the complex intersection of pharmaceutical economics, compliance, and government programs. With expert speakers, targeted sessions, and valuable networking opportunities, this event delivers actionable insights you can implement immediately.

View the agenda for MDRP 2026 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/MDRPSummit for further details and to register.

Drug Channels readers will save 10% off when they use code 26DRCH10 and register prior to September 18, 2026.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. Other restrictions may apply.

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The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Marie Caldwell (mcaldwell@hmpglobal.com).

A System of Record, or a System of Learning?

Today's guest post comes from Scott Filosi, Chief Commercial Officer at Valeris.

Scott explores how patient access organizations can move beyond simply tracking the patient journey to using real-time insights to improve it. He argues that connecting commercial strategy, market access, payer intelligence, and patient services can speed access to therapy, improve decision-making, and enhance the patient experience.

To learn more, download Valeris’ white paper: The Unified Ecosystem: How Valeris Integrates Intelligence and Execution for Better Patient Outcomes.

Read on for Scott's insights.

Who Will Pay for Prescription Drugs in 2034? Medicare's Surprising Rise in the Latest Government Forecasts

By Adam J. Fein, Ph.D. and Greis Kapexhiu

In late June, the boffins at the Centers for Medicare & Medicaid Services (CMS) released the latest projections for U.S. spending on healthcare. (See links below.) These data provide the latest official, nonpartisan look at the future of U.S. healthcare spending.

Notably, overall U.S. spending on drugs dispensed by retail and mail pharmacies will remain about 9% of overall healthcare spending.

However, the new forecasts reflect the reality that the Congressional Budget Office (CBO) finally acknowledged last week: The Inflation Reduction Act’s (IRA) Part D provisions will cost much more than CBO had initially estimated.

Below, we outline the factors that led to the dramatic revision to Medicare spending, along with insights on the shrinking role of private insurance and consumer out-of-pocket spending.

Taxpayers—primarily via Medicare and Medicaid—now account for a majority of U.S. prescription drug spending, outstripping the share financed via employer-sponsored insurance.

Like it or not, everyone in the drug channel should prepare to deal with the government programs as increasingly important transaction partners—along with the biggest vertically integrated insurers, PBMs, specialty pharmacies, and healthcare services that administer these programs.

The Industry Doesn't Have an Access Collaboration Problem. It Has an Accountability Problem.

Today's guest post comes from Jen Norton, President, Market Access & Value at EVERSANA.

Jen examines why fragmented ownership across development, regulatory, pricing, distribution, and field functions undermines access at launch. She argues that naming a single accountable owner for the access outcome can close "access debt" earlier, reduce pre-launch friction, and turn coverage into real patient access.

Learn more about EVERSANA's approach to access.

Read on for Jen's insights.

Drug Channels News Roundup, Mid-July 2026: Biosimilar Launch Strategy, Part D Spending Trends, Rural 340B Hospitals, What Employers Can Do About 340B, and Drug Channel Villains

By Bryce Platt, PharmD

Summer's in full swing, but the drug channel didn't take a break.

What better way to spend the summer than reading about new pharmacy resources in the Drug Channels News Roundup?

In this issue:

• The New Biosimilar Launch Playbook

• Factors Adding to Part D Cost Trends

• Rural vs. Non-rural 340B Hospitals

• The Employer 340B Playbook

Extra: Who are the Villains in the Drug Channel?

P.S. Join my nearly 40,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

Direct-to-Patient: Transforming the Manufacturer Access Model

Today's guest post comes from Chip Parkinson, CEO at Gifthealth.

Chip discusses how Direct-to-Patient (DTP) models can transform the manufacturer access model for prescription therapies. He argues that a tech-plus-touch, end-to-end approach can improve patient access, protect manufacturer economics, and increase brand trust and loyalty.

Learn more about Gifthealth.

Read on for Chip's insights.

2025 Gross-to-Net Realities at Eight Top Drugmakers: The Net Pricing Drug Channel Emerges

By Adam J. Fein, Ph.D.

Every year, Drug Channels reviews drug pricing trends at the largest pharmaceutical manufacturers. This year's disclosures provide early evidence that the economics of the U.S. drug channel—and the strategies manufacturers use to secure market access—are beginning to change.

We review the following eight companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data in the appendix.

Our review found:

• Brand-name drug list prices continued to rise modestly, while mandatory and voluntary rebates, discounts, and fees reduced net prices at seven of the eight manufacturers.

• The average gross-to-net price difference was –5.5%, reflecting an average list price increase of 3.7% and an average net price decline of 1.8%.

• For the three manufacturers that disclosed these data, rebates, discounts, and other fees reduced the selling prices of brand-name drugs to less than half of their list prices.

Sanofi's latest and historical disclosures provide one of the clearest illustrations yet of the drug channel's changing economics. Since 2020, the company's estimated U.S. biopharmaceutical sales have grown far faster than rebate payments. As a result, the share of its gross sales returned to payers as rebates declined from 51% to 39%.

Taken together, this year's manufacturer disclosures suggest that the gross-to-net bubble is growing more slowly—and even deflating in parts of the market. Meanwhile, the Net Pricing Drug Channel (NPDC) is becoming visible in manufacturers’ pricing disclosures and financial statements.

Direct-to-Consumer Shouldn't Always Mean Direct-To-Mail-Order: Why Fulfillment Choice Matters

Today's guest post comes from Divya Iyer, SVP, Head of Revenue, Pharma Direct at GoodRx.

Divya examines why direct-to-consumer strategies shouldn't default to mail-order as the endpoint for every program. She argues that preserving patient choice between retail pickup and home delivery can reduce friction, improve therapy initiation, and strengthen the overall patient experience.

To learn more about GoodRx's Pharma Direct solution, visit GoodRx Pharma Direct.

Read on for Divya's insights.

The 340B Program Hit $100 Billion in 2025: Has It Become Too Big to Reform?

By Adam J. Fein, Ph.D.

The 340B Drug Pricing Program continues to redefine the meaning of "skyrocketing."

• For 2025, discounted purchases under the 340B program reached an astounding $100 billion—23% higher than in 2024.

• The gross-to-net difference between list prices and discounted 340B purchases—a proxy for funds available to covered entities—also grew, to $79.5 billion (+$12.0 billion).

• Hospitals again accounted for 87% of 340B purchases.

• 340B purchases are now more than 70% larger than Medicaid’s net prescription drug spending. The program now accounts for nearly one-fifth of the total U.S. gross-to-net bubble.

During DCI’s June webinar, I predicted that the 340B program would move from an era of expansion and opacity to one of transparency and accountability.

But given the latest growth figures, I worry that reform of this undermanaged, out-of-control program may never happen. Has the program become too big to reform?

Read on for our full analysis—and consider whether 340B will ever face its true day of reckoning.

Click here to share your thoughts on the latest 340B data with the Drug Channels community on LinkedIn.

Medicare Embraces Site-Neutral Payments. Why Haven't Employers?

By Bryce Platt, PharmD

Provider-administered drugs are one of the fastest-growing and least-managed cost drivers for commercial plan sponsors.

Despite that, recent data from the Pharmaceutical Strategies Group show that only 35% of commercial plan sponsors currently have a site of care (SOC) program in place for specialty pharmacy. That result is surprising given the size of the savings at stake.

Medicare has figured this out and started site-neutral payments over a decade ago, but the employers who fund the bulk of commercial health spending largely haven't.

The evidence supporting SOC management is no longer the story. The real question is why so many commercial plans continue paying hospital prices when lower-cost alternatives already exist.

When Access Tightens, Prior Authorization Execution Becomes the Differentiator

Today's guest post comes from Megan Wetzel, Vice President of Product, Access and Affordability at CoverMyMeds.

Megan examines how prior authorization execution has become a strategic differentiator for biopharma brands as formulary changes and expanding utilization management put more pressure on access. She argues that building consistent, scalable prior auth execution can reduce therapy delays, improve determination time, and strengthen brand performance across the product lifecycle.

To learn more about CoverMyMeds' prior authorization solution, download their case study: From Decline to Growth: How One Brand Expanded Access in Late Lifecycle.

Read on for Megan's insights.