In 2024, the U.S. pharmacy landscape experienced significant shifts, with the top 15 companies accounting for approximately 75% of total prescription dispensing revenues, amounting to $683 billion—a 9% increase from 2023. Notably, the top four companies—CVS Health, Walgreens Boots Alliance, Cigna, and UnitedHealth Group—collectively captured half of these revenues.
A significant factor in this growth was the prominence of GLP-1 agonist drugs, which contributed to over 80% of the dispensing revenue increase in retail pharmacies for the year.
Here is a breakdown of the top 15 U.S. pharmacies in 2024:
| Rank | Company | Estimated Prescription Revenue |
|---|---|---|
| 1 | CVS Health | $125.7 billion |
| 2 | Walgreens Boots Alliance | $91.1 billion |
| 3 | Cigna (Evernorth/Express Scripts) | $65.7 billion |
| 4 | UnitedHealth Group (OptumRx) | $42.2 billion |
| 5 | Walmart | $30.6 billion |
| 6 | Kroger | $14.5 billion |
| 7 | Rite Aid | $13.6 billion |
| 8 | Humana (CenterWell) | $10.5 billion |
| 9 | Albertsons | $8.1 billion |
| 10 | Publix | $7.8 billion |
| 11 | BrightSpring Health Services | $6.5 billion |
| 12 | PANTHERx Rare Pharmacy | $3.6 billion |
| 13 | Costco Wholesale Corp. | $3.3 billion |
| 14 | Ahold Delhaize | $3.1 billion |
| 15 | Elevance Health (CarelonRx) | $2.9 billion |
Note: These figures are estimates and may vary based on different reporting sources.
The pharmacy industry continues to evolve, with vertical integration playing a pivotal role. Companies such as CarelonRx (Elevance Health), CVS Caremark (CVS Health), Express Scripts (Cigna), CenterWell (Humana), and Optum Rx (UnitedHealth Group) operate central fill mail and specialty pharmacies within organizations that also encompass insurance and pharmacy benefit management services. This integration reflects the growing importance of specialty drugs, which are estimated to account for a majority of prescription revenues at these pharmacies.
As the industry progresses, monitoring these trends and the strategies of leading pharmacies will be crucial for stakeholders aiming to navigate the dynamic U.S. pharmaceutical landscape.