The Top 15 U.S. Pharmacies of 2024: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies

Next week, Drug Channels Institute (DCI) will release our 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 16th edition of our popular and comprehensive examination of the entire U.S. drug pricing, reimbursement, and dispensing system.

For 2024, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $683 billion, up 9% from the 2023 figure. GLP-1 agonist drugs remained the most significant driver of prescription revenue at retail pharmacies, accounting for more than 80% of dispensing revenue growth for 2024.

The table below—one of 268 in our new report—cues up DCI's first look at the 15 largest organizations that battled for those revenues. For a sneak peek at the complete report, click here to download our free 30-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits). We’re offering special discounted pricing if you order before March 31, 2025.

Will PBMs be able to maintain their position as the leading pharmacies? Find out at my upcoming live video webinar, PBM Industry Update: Trends, Challenges, and What's Ahead, on April 4, 2025, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

RACK 'EM UP: THE TOP 15

The table below shows DCI’s estimates of the largest pharmacies ranked by total prescription dispensing revenues for 2023, excluding revenues from the administration of COVID-19 vaccines. For important information about these figures, please see the table’s footnotes and the Notes for Nerds section below.

[Click to Enlarge]

Observations on these figures:

• For 2024, the top 15 companies accounted for about three-quarters of total dispensing revenues from retail, mail, long-term care, and specialty pharmacies. The largest four companies operating pharmacies—CVS Health, Walgreens Boots Alliance, Cigna, and UnitedHealth Group—accounted for half of total U.S. prescription dispensing revenues in 2024.

• The total share of the largest 15 companies decreased slightly compared with their 2023 share, due primarily to the significant revenue losses for Rite Aid. For the first time, Elevance Health appears on our list due to its acquisitions and launch of its own mail pharmacy.
  
  We review the market changes and acquisitions that affected the 2024 revenues and growth rates for the largest retail chains in the following sections of DCI’s new report: Section 2.3.3., for the largest specialty pharmacies in Section 3.3.2., and for the largest PBMs in Section 5.2.2.

• Five of the largest pharmacies operate central fill mail and specialty pharmacies that are part of vertically integrated organizations that also own an insurer and a PBM: CarelonRx (Elevance Health), CVS Caremark (CVS Health), Express Scripts (Cigna), CenterWell (Humana), and Optum Rx (UnitedHealth Group). This reflects the growing role of specialty drugs in the pharmacy industry. We estimate that specialty drugs accounted for a majority of prescription revenues at these pharmacies.

• In the report’s Section 12.3.1., we update our analysis of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels. Exhibit 261 provides a fully revised and updated version of DCI’s infamous vertical integration chart.
  
  The revenue figures in the chart above reflect combined dispensing revenues from all entities within these organizations. Page vii of the 2024 report overview provides a handy matrix summarizing the current roles that these companies play in the drug channel.

While the industry racked up strong revenue growth, the retail pharmacy shakeout accelerated. Over the past four years, the three largest drugstore chains have found themselves behind the eight ball, collectively cutting nearly 3,000 locations. Rite Aid has emerged from bankruptcy as a private company, while Walgreens Boots Alliance is attempting a bank shot with its acquisition by Sycamore Partners. Meanwhile, independent pharmacies are still in the game, as new openings have helped balance store closures.

Stay tuned to Drug Channels to see who lines up the next big shot—and who scratches under pressure.

NOTES FOR NERDS

Our estimated prescription revenue data may not correspond with figures from other public sources for the following reasons:

• We have computed or estimated the figures on a calendar-year basis. The fiscal years for many public retail companies do not correspond to calendar years.

• Many companies do not report prescription revenues. We have therefore used various methods and sources to estimate the data. Where relevant, we have adjusted previously reported figures based on new disclosures of prescription revenues.

• As noted in the footnotes to the table above, we have made various adjustments to account for the pro forma impact of mergers and acquisitions. Year-over-year growth rates were also computed based on the prior year’s pro forma revenues. Pro forma revenues are computed based on the year in which an acquisition was completed.

• To permit comparability with previous years’ figures, the table above excludes revenues from the administration of COVID-19 vaccines. As we discuss in Section 1.4.3. (page 48), we estimate that total retail pharmacy industry revenues from administering COVID-19 vaccines were less than $1 billion in 2024.

• Prescription dispensing revenues are not equivalent to net spending on outpatient prescription drugs (reported by the Centers for Medicare & Medicaid Services’ National Health Expenditures data) or to “non-discounted spending” and “invoice-price spending” (reported by IQVIA).