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.