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. 2025 Aug 1;6(8):e251988.
doi: 10.1001/jamahealthforum.2025.1988.

Community Pharmacy Turnover and Context of Openings and Closings by Ownership Type

T Joseph Mattingly 2nd  1 , Maitreyi Sahu  2 , Kelly E Anderson  3
Affiliations

Community Pharmacy Turnover and Context of Openings and Closings by Ownership Type

T Joseph Mattingly 2nd et al. JAMA Health Forum. .

Abstract

Importance: While community pharmacies provide many valuable prescription and professional services, they are also retail businesses. Evaluating pharmacy closures through the lens of a retail business framework may provide more context on what is happening in this industry and identify potential solutions to address closures and/or shortages.

Objective: To evaluate community pharmacy turnover (openings and closings) in the US over time and by ownership type.

Design and setting: This cross-sectional analysis of all community pharmacy openings and closings in the US from 2010 to 2023 used pharmacy-level data from the US National Council for Prescription Drug Programs database. National-, state-, and county-level turnover was assessed using economic indicators of business dynamics, such as total population, population growth, household income, total firm changes for all industries, and net job creation.

Exposures: Pharmacy class type defined as either a chain pharmacy (4 or more pharmacies under common ownership) or an independent or franchise pharmacy using the US National Council for Prescription Drug Programs classifications.

Main outcomes and measures: Pharmacy turnover rate from 2010 to 2023, calculated as the sum of pharmacy openings and closings over the full study period divided by the total pharmacies in the market at the beginning of the period (2010).

Results: The analyses found that US pharmacy market turnover rate for this 14-year period was 86.8% (52 974 total openings and closures of 61 054 total pharmacies in 2010) or 6.2% annually. When comparing across pharmacy types, independent pharmacy turnover was substantially higher (152.7%) than chain pharmacy turnover (49.9%) across the entire US. Counties with high turnover were associated with net increases in pharmacies from more independent pharmacy openings over the period. Turnover rates for all businesses were higher in counties with both low and high pharmacy turnover, even when adjusting for population size.

Conclusions and relevance: This cross-sectional study found that the community pharmacy market in the US has an annual turnover rate of approximately 6.2%, with independent pharmacies opening and closing more frequently than chain pharmacies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mattingly reported grants from Skaggs Scholars Program during the conduct of the study; personal fees from Arnold Ventures and Pharmaceutical Care Management Association outside the submitted work. Dr Sahu reported grants from the US National Pharmaceutical Council and research consulting fees from the Pharmaceutical Care Management Association outside the submitted work. Dr Anderson reported grants from Skaggs Scholars Program during the conduct of the study; research consulting fees from the Pharmaceutical Care Management Association; and grants from Arnold Ventures outside the submitted work.

Figures

Figure 1.
Figure 1.. Openings and Closures of Chain Pharmacies and Independent/Franchise Pharmacies From 2010 to 2023
National retail pharmacy opening and closures at specific physical locations from 2010 to 2023 show that chain pharmacy types (defined as 4 or more pharmacies under common ownership) experienced net gains per year from 2010 to 2015 followed by net declines from 2016 to 2023. Meanwhile, independent or franchise owners experienced a relatively flat net change over the entire period with a mix of years with net gains or net losses. Circles indicate net gain or loss each year.
Figure 2.
Figure 2.. Pharmacy Age at Time of Closure for Chain and Independent or Franchise Pharmacies
The frequency distribution of pharmacy age at the time of pharmacy closure reveals different patterns for independent/franchise pharmacies and chain pharmacies. Independent/franchise age data shows a substantial right tail distribution with a large frequency of closures occurring in the first 5 years of ownership with a long tail demonstrating a small number of older (>40 years) pharmacies. Chain pharmacies have a smaller spike in the first year followed by a relatively consistent frequency for 1 to 27 years of age before the distribution of closures drops.
Figure 3.
Figure 3.. Net Pharmacy Changes and Churn per 10 000 Population
A, Differences in pharmacy growth (positive net change) vs pharmacy decline (negative net change) at the state level adjusted for population. B, US states with greater churn (larger sum of openings and closures) vs states with lower churn (smaller sum of openings and closures) adjusted for population.
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