Independent and chain pharmacies, by the numbers

Between 2010 and 2021, 26,145 retail pharmacies in the United States closed and 30,773 opened, according to a study published in Health Affairs in December 2024¹. For most of that stretch openings won. From 2018 on they did not, and the country ended the period with a net loss of 2.1 percent of its pharmacies over those last three years.

Who closed is the more interesting finding. Independent pharmacies, owned by a pharmacist or a small group and usually running one to a handful of stores, closed at a much higher rate than chain stores over the full 12 years. Yet in the years when the total fell, the net decline came mainly from chains.

Both kinds of pharmacy dispense the same FDA-approved drugs and answer to the same state boards of pharmacy. What differs is ownership, the neighborhoods they serve and how each has held up under reimbursement pressure.

How many there are

Independents are counted every year by the National Community Pharmacists Association (NCPA), the trade group for independent pharmacies. Its 2026 Digest, released Oct. 4, 2026³, estimates 18,988 independent community pharmacies, essentially unchanged from 18,960 in 2025. The 2025 edition⁴ had put the 2024 count at 18,984. NCPA says independents make up nearly 37 percent of US retail pharmacies and that no single chain has more stores than all independents combined.

For all retail pharmacies, the Health Affairs authors used National Council for Prescription Drug Programs data, which they treat as a census. Their count¹ rose 7.7 percent, from 59,902 pharmacies in 2010 to 64,530 in 2021.

What the closure research found

The study followed every retail pharmacy that operated at some point from 2010 to 2020, a cohort of 88,930 stores. By 2021, 29.4 percent of them had closed. The paper's exhibits¹ break the result down by pharmacy type and neighborhood.

After adjusting for neighborhood and market factors, an independent's risk of closing was 2.33 times a chain's, the authors reported¹. Independents had the higher risk in every neighborhood and market category they examined.

Those two findings fit together once openings are counted. Many independents closed, but enough new ones opened that their total grew 2.3 percent from 2018 to 2021, while chain counts fell 5.0 percent. A summary from the University of Southern California's Schaeffer Center² made the same point about the 2018 to 2021 decline.

Neighborhood mattered too. Pharmacies in predominantly Black and Latinx neighborhoods faced higher closure risk than those in predominantly White ones. Predominantly Black neighborhoods saw the steepest drop from 2018 to 2021, with 4.8 percent fewer pharmacies of any type and 12.6 percent fewer chain pharmacies, according to the study¹.

A closed independent is more likely to leave a gap. Independents were more than twice as likely as chains to be the only pharmacy in their neighborhood, 10.0 percent against 3.7 percent.

The paper did not measure causes. Its authors pointed to reimbursement pressure and pharmacy network design as likely contributors, and recommended policies to bring more independents into Medicare and Medicaid preferred networks. They also said they could not assess whether pandemic-related factors or growth in mail-order use played a part, which leaves the link to mail-order pharmacy an open question.

Pharmacy deserts and the Part D distance rules

Definitions of a pharmacy desert vary, and most start from distance to the nearest store. NCPA's 2025 Digest release⁴ reported that roughly one in eight US neighborhoods met the criteria for a pharmacy shortage area developed with the University of Southern California.

Federal rules address access only for Medicare drug plans. Under 42 CFR 423.120⁵, a Part D plan's retail network must, on average, put 90 percent of urban enrollees within 2 miles of a network pharmacy, 90 percent of suburban enrollees within 5 miles and 70 percent of rural enrollees within 15 miles.

Those standards apply to a plan's network as a whole. A plan can meet them while one neighborhood loses its only store, so residents in that position typically travel farther, use another network pharmacy, or turn to delivery or mail. GxRadar's pharmacy finder lists pharmacies registered in the federal NPI registry by ZIP code from the federal provider registry.

Services and money

Pharmacies of both types give vaccines, counsel patients on new prescriptions, run medication reviews and sell over-the-counter products. Many check blood pressure, and some offer point-of-care testing where state law allows.

NCPA surveys its own members on services, so the figures below describe independents only. GxRadar does not have a comparable survey for chain stores.

Prescriptions are the business. The 2026 Digest³ put the independent pharmacy market at $103 billion in 2025, with more than 96 percent of sales from the prescription department. The average independent filled 65,795 prescriptions in 2025, down from 67,601 in 2024; 81 percent of its prescriptions were generics, and government programs paid for nearly half.

That last figure is why public payment rules hit independents hard. Medicaid's approach to paying for generics is covered in Medicaid and generic drug prices, and the Medicare side in Part D changes in 2025 and 2026. Chains and independents are paid through the same claims system, with rates set largely by network contracts that pharmacy benefit managers negotiate for health plans; GxRadar's explainer on how pharmacies get paid walks through a single claim.

For patients the useful questions are the same at either kind of store: whether it is in the plan's network, whether it is a preferred pharmacy, and what it charges cash customers. Those prices vary, as why the same generic costs different amounts explains, and asking for the cash price works the same way at an independent as at a chain. Medicare's open enrollment for 2027 coverage, when plans' preferred-pharmacy lists can be compared, closes Dec. 7, 2026.