Pharmacist Salaries and Employment in 2025: Retail Declines, Hospital Gains

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

It’s time for Drug Channels’ annual look at pharmacist salaries and employment. The latest data might be a tough pill to swallow.

As we predicted, the situation was grim for retail pharmacists. Employment in retail outpatient pharmacies fell by 8,200 positions in 2025, following a drop of 11,700 positions over 2023 and 2024 combined.

Meanwhile, pharmacist employment at hospitals grew by 3,000 positions, after hospitals added more than 11,000 pharmacist jobs in 2023 and 2024. Nearly half of all pharmacists now work outside a traditional retail setting.

Overall pharmacist salaries averaged $140,920, but varied widely across practice settings. Salary growth in many settings, however, did not keep pace with overall inflation.

Our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers documents how and why retail pharmacy economics are under sustained pressure. Since 2018, the two remaining national drugstore chains have collectively closed nearly 3,000 locations, reflecting margin compression and weaker front-end economics.

As always, full salary and employment data appear below for your enjoyment or sorrow. Click here to share your thoughts on the pharmacist job market with the Drug Channels LinkedIn community.

Jump to:

• Pharmacist Employment Trends

• Pharmacist Salary Trends

• Methodology

The Digital Front Door to Specialty Therapy May Not Be a Specialty Pharmacy

Today’s guest post comes from Nareda Mills, President of Patient Solutions at Inizio Engage.

Nareda examines how growing access complexity is reshaping specialty commercialization. She explores the emerging role of Non-Dispensing Pharmacies (NDPs) and argues that by improving coordination, visibility, and patient engagement, they can accelerate time-to-therapy and create a more seamless access experience.

Click here to learn more about Inizio Engage’s hub services.

Read on for Nareda’s insights.

Drug Channels News Roundup, Mid-June 2026: Biosimilar Development Barriers, Hospital Specialty Pharmacy Growth, Medicaid Incentives, Drug Pricing Tradeoffs, and the Prescription-Filling Process

By Bryce Platt, PharmD

Summer officially starts this weekend!

Consider doing a few of your lifting sets (or work meetings) outside.

The healthier you are, the longer you’ll be able to read our news roundups, so everybody wins!

In this issue:

• A Leaky Biosimilar Funnel

• Reasons for Growth in Hospital Specialty Pharmacies

• The Impact of Payment Arrangements on Medicaid Utilization

• Drug Innovation Versus Cost Containment

Extra: The Process of Filling a Pharmacy Prescription

P.S. Join my nearly 36,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

The IRA Fixed One Medicare Part D Distortion—But Patients Now Face New Tradeoffs

By Bryce Platt, PharmD

For years, Medicare Part D plans often preferred high-list/high-rebate branded multiple sclerosis (MS) drugs over lower-cost generics. That was rational behavior inside an irrational system.

The Inflation Reduction Act (IRA) offers one example of how incentives can change behavior in the system. New research in JAMA Health Forum reveals a significant reversal in Medicare Part D formulary coverage for MS drugs. After years of plans favoring brand-name drugs over generics, 2025 formularies shifted to near-universal generic coverage.

However, in return patients got narrower formularies, higher upfront costs, and way more taxpayer dollars spent than expected.

While this wasn’t the case for all drug classes, in MS, the IRA Part D redesign has forced plans to care more about net drug spending. Below, we analyze the formulary data and explain why the coverage patterns changed so abruptly—and what new tradeoffs have emerged.

Minnesota’s 340B Hospitals Make One Billion More From 340B Than They Spend on Uncompensated Care (rerun)

This week, we’re rerunning some popular posts while we prepare for today’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Bryce Platt, PharmD

Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.

In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.

The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.

As you’ll see below, our analysis describes a 340B program that generates financial gains far in excess of any contribution back to the people of the state. There is also no clear accountability for how those dollars are used.

The Top 15 Specialty Pharmacies of 2025: PBM-Affiliated Pharmacies Dominate While Health Systems and Independents Gain Ground (rerun)

This week, we’re rerunning some popular posts while we prepare for tomorrow’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Adam J. Fein, Ph.D.

Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.

For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.

However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.

Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.

Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update (rerun)

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Adam J. Fein, Ph.D.

It's time for Drug Channels Institute’s (DCI) annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. As you can see below, we have updated and revised our infamous illustration of the major vertical business relationships within the largest companies.

These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical integration strategies. Scrutiny of these companies’ actions continues to grow.

For all the details behind these companies’ operations, check out DCI’s new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments (rerun)

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from March 2026.

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By Adam J. Fein, Ph.D.

Three is still the magic number for pharmacy benefit managers (PBMs).

For 2025, 80% of all equivalent prescription claims were processed by three companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. Express Scripts continued to pull ahead of its peers, while CVS Caremark’s claim volume declined for the second year.

Independent PBMs continued to gain business from these larger PBMs, showing fragmentation at the margins. Many smaller PBMs still rely on their larger competitors for claims processing, network management, and rebate negotiation. So even if a plan sponsor chooses an alternative PBM, the Big Three can still win with behind-the scenes economics.

Below, we draw on DCI's new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers to break down the latest market share data for the largest companies.

The Big Three PBMs’ dominance persists, but they face growing regulatory and competitive constraints. The largest PBMs are restructuring their businesses in response to client demands, legislative changes, and legal pressures. The emerging Net Pricing Drug Channel will accelerate these shifts, forcing changes in how PBMs generate profits, structure contracts, and justify their role in the drug channel.

The Top 15 U.S. Pharmacies of 2025: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies (rerun)

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from March 2026.

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By Adam J. Fein, Ph.D.

Next week, the Drug Channels Institute (DCI) will release our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This 17th edition provides our most comprehensive and up-to-date examination of the U.S. drug pricing, reimbursement, and dispensing system.

For 2025, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $751 billion in 2025, up 10% from the 2024 figure.

GLP-1 agonist drugs have become the dominant driver of revenue growth. Over the past five years, increases in dispensing revenues from GLP-1 products accounted for about 60% of retail pharmacies’ total revenue growth.

The table below—one of 270 in our new report—racks up DCI's first look at the 15 largest organizations that competed for a share of those dollars. For a sneak peek at the complete report, click here to download our free 32-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits).

Pharmacy Copay Misuse: The Multi-Billion Dollar Issue Hiding In Plain Sight

Today’s guest post comes from Stephen Hom, Co-Founder, EVP & Chief Operating Officer of RIS Rx.

Drawing on RIS Rx’s proprietary data and case studies, Stephen highlights patterns that can undermine patient support program effectiveness. He argues that a more data-driven approach can help manufacturers identify hidden risks, improve program performance, and ensure that affordability resources reach the patients they are intended to support.

Request a complimentary analysis from RIS Rx.

Read on for Stephen’s insights.

The 340B Contract Pharmacy Market in 2026: A Maturing Industry Dominated by Big Chains and PBMs

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

It’s time for Drug Channels Institute’s latest exclusive analysis of the 340B contract pharmacy market, which continues to boom along with the overall program’s expansion.

However, our 2026 analysis finds that the contract pharmacy market is now entering a more mature phase characterized by consolidation, slower growth, and increasing dominance by the industry’s largest participants.

Below, we characterize the state of the marketplace:

• Nearly two-thirds of the entire U.S. pharmacy industry participates as contract pharmacies for the 340B hospitals and federal grantees.

• The number of 340B pharmacy locations declined for the third year, due largely to the retail pharmacy shakeout and manufacturers’ 340B policies.

• Meanwhile, the total number of unique contract pharmacy/covered entity relationships continues to expand. Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna, CVS Health, UnitedHealth Group, Walgreens, and Walmart—now account for a record 77% of all relationships.

The 340B program was originally designed as a narrow policy solution to address an unintended consequence of Medicaid’s best-price provision while supporting core safety-net providers. The 2026 market data illustrate just how dramatically the program’s current operations and economic incentives have diverged from that original intent.

Read on for our latest analysis of this ever-expanding profit pool for pharmacies and PBMs. For a deep dive on what the 340B program’s growth means for drug channel participants, join Adam J. Fein, Ph.D., and Tyler Novotny on June 12 for a new live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Drugs, Discounts and Data: Crafting Sustainability in an Imperfect System

Today’s guest post comes from Angie Franks, Chief Executive Officer at Kalderos.

As Angie explains, the industry still lacks the transparency needed to effectively manage where discounts occur and how funds move across stakeholders. She argues that improving visibility and coordination across the ecosystem is essential to building a more sustainable and accountable model for both innovation and patient support.

To learn more, register for Kalderos’ free webinar on June 23, 2026:
GTN Oversight: A New Standard of Transparency Is Here.

Read on for Angie’s insights.