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Pharmacy (shop)
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Pharmacy (shop)
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A green cross is the symbol of pharmacies in many European countries.[1]

A pharmacy (also called drugstore in North American English or community pharmacy or chemist in Commonwealth English) is a premises which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.

Brick and mortar pharmacies

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In most countries, a premises for prescription drugs is subject to legislation; with requirements for storage conditions, staff qualifications, equipment, record keeping (especially of controlled drugs) and other matters, all specified in legislation. It was once the case that pharmacists stayed within the premises compounding/dispensing medications, but there has been an increasing trend towards the use of trained pharmacy technicians,[citation needed] with the pharmacist spending more time communicating with patients. Pharmacy technicians are now more dependent upon automation to assist them in their new role dealing with patients' prescriptions and patient safety issues.

Pharmacies are typically required to have a qualified pharmacist on-duty at all times when they are open. It is also often a requirement for the owner of a pharmacy to be a registered pharmacist, but that is not the case in all jurisdictions: where permitted, many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.

The interior of a modern pharmacy in the United States

Community pharmacies offer a unique added value by building direct relationships with their customers.[citation needed] They are able to provide more personalized, dedicated care to local members of their community and even offer enhanced services such as Medication Therapy Management (MTM), Medication Synchronization, and compounding. With the aid of pharmacy management systems and different integrated technologies, these smaller pharmacies are able to keep up with their large-scale competition.

Online pharmacies

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Main article: Online pharmacy
Canisters of pills from a mail order pharmacy

Since about the year 2000, a growing number of online pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as online pharmacies) are also recommended to some patients by their physicians if they are home-bound.

While most Internet pharmacies sell prescription drugs and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription.[citation needed] Some customers order drugs from online pharmacies to avoid the "inconvenience" of visiting a doctor, or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of medication. There also have been reports of such pharmacies dispensing substandard products.[2] Of particular concern with Internet pharmacies is the ease with which people can obtain controlled substances via the Internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship.[citation needed] There are instances where an online doctor issues a prescription, for a controlled substance to a "patient" s/he has never met.[citation needed]

By country

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In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship. The Food and Drug Administration (FDA) is also heavily involved in monitoring internet pharmacies and has issued warnings against several companies who have violated the U.S. Federal Food, Drug, and Cosmetic Act that protects individuals against rogue online pharmacies. In the United States, there has been a push to legalize the importation of medications from Canada and other countries,[citation needed] in order to reduce consumer costs. While in most cases importation of prescription medications violates FDA regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.

Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost prescription drugs to U.S. consumers (who must otherwise pay one of the world's highest drug prices).[3] In recent years, many consumers in the US (and in other countries with high drug costs), have turned to licensed Internet pharmacies in India, Israel, and the UK, which often have even lower prices than in Canada.

Ethical standards

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Community pharmacists’ understanding of ethics, confidentiality, patient autonomy, trustworthiness and reliability are essential in community practice and must influence their decision making should an ethical dilemma arise.[citation needed] In some countries, community pharmacists may be asked to compromise on their values and ethical issues may arise not only because of patient's or physician's request but may also because of their employers' intrusion.[citation needed] Individual factors such as age, gender, work experience, and educational level and organizational factors such as the number of pharmacists in a pharmacy and location of pharmacy may affect the ethical perspectives of community pharmacists.[citation needed] Pharmacies have been criticized for selling in some cases homeopathic products.[4]

Duties and Responsibilities

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The International Pharmaceutical Federation has declared their vision of a community-based pharmacist:[5]

Community-based pharmacists' responsibilities include: checking and dispensing of prescription drugs, providing advice on drug selection and usage to doctors and other health professionals and counseling patients in health promotion, disease prevention and the proper use of medicines.[6]

In most countries regulations govern how dispensaries may operate, with specific requirements for storage conditions, equipment and record keeping.

Dispensing or compounding

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Most drugs are commercially made at factories and dispensed by pharmacies. Drugs that are not commercially made must be compounded from other ingredients. In 1930, 75% of medications were compounded, but by 1970 only 1% were compounded.[7]

Support staff

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To help pharmacists be able to take on extended roles, it is common for them to work as part of a team that can include pharmacy technicians, dispensing assistants and counter assistants.[8]

Ownership

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In parts of mainland Europe, the pharmacist is required to own the pharmacy of which she or he is the licensee. Under this arrangement, a pharmacist can be the operator of only a single outlet.[9] In the UK, 60% of all community pharmacies are owned by companies that own multiple pharmacies.[10]

In the United States, more than 25% of independent owners have ownership in two or more pharmacies.[11]

Most of Australia's and New Zealand's community pharmacies are owner-operated.[12][13] In Australia, pharmacists recognise the need to integrate professional pharmacy services into the health system to meet the changing health care needs of the population.[14]

Society and culture

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A survey conducted by PrescribeWellness found that almost half of Americans older than 40 years-old value pharmacies that offer preventative care services, and would be willing to transfer their prescriptions to pharmacies that offer those services.[15] Patients also value pharmacies where they can receive medical advice concerning their prescription medications, how those medications may interact with each other, and receive over-the-counter drug recommendations for the management of common ailments.[15] In a survey of over 1,000 U.S. adults older than 40 years-old conducted by Propeller Insights, 67% of patients responded that they would prefer that their pharmacist discuss new prescriptions with them, rather than their physician, because they viewed their pharmacist as "better at explaining side effects and has more time to spend with them."[15]

The American Association of Colleges of Pharmacy recommends that consumers choose a pharmacy at which they can have a consulting relationship with the pharmacist.[16] Anyone using drugs benefits when they have easier access to a pharmacist. Being timely includes both processing the request quickly and having drug stock available to fill the prescription.[16] Some consumers need drugs delivered to their home, perhaps by mail, and may select a pharmacy that offers that service.[16] Different pharmacies may charge different prices for the same drugs, so shopping for lower prices may identify a pharmacy offering better value.[16] In addition to fulfilling prescriptions, a pharmacy might offer preventive healthcare services like vaccinations.[16] Up-to-date technology at a pharmacy can assist a patient with prescription reminders and alerts about potential negative drug interactions, thereby reducing medical errors.[16]

By country

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In United Kingdom

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It is becoming more common for pharmacists to take on extended roles that provide more clinical care directly to patients as part of a primary care team. There are around 11,400 community pharmacies in England. Many are open for extended hours in the evenings and weekends and they are accessible without appointment.[17][18]

In the English NHS there were 438 million visits nationally to community pharmacies for health related reasons in 2015.[19] More than 1.1 billion prescription items were dispensed in 2022. More than £10 billion is spent on prescribed drugs annually.[20] Under the 2005 NHS Community Pharmacy contract all community pharmacists in England and Wales provide:[21]

  • Dispensing Service
  • Repeat Dispensing Service: This allows the patient to collect regular repeat prescription medicines for an agreed period of time, without having to go back to their GP
  • Disposal of Unwanted Medicines.
  • Promotion of Healthy Lifestyles.
  • Signposting to other Services.
  • Support for Self-Care: advice on treating minor illnesses and long term conditions.

Widely available Advanced Services:

  • Medicines Use Review & Prescription Intervention.
  • New Medicine Service. For patients who have been given their first prescription for a medicine to treat Asthma and COPD, Type 2 diabetes, Hypertension or Anticoagulant Therapy.
  • Appliance Use Review Service.
  • Flu Vaccination.

Enhanced Services which are not available unless locally commissioned:

  • Minimising Adverse Effects and Admissions Related to Medicines.
  • Discharge and Transfer Planning.
  • Managing Dental Pain.

The introduction of the digital hospital-to-pharmacy referral service, which was to launch in July 2020, as part of the new community pharmacy contract, was postponed to 15 February 2021 because of the COVID-19 pandemic in England. It will enable hospitals to digitally notify community pharmacies when patients are discharged and may need advice on taking new medicines, and about changes to their prescriptions.[22]

In 2022 the average pharmacy carried out around 19 consultations per day, averaging 5.6 minutes each - about 65 million consultations across 10,800 pharmacies in the year.[23]

In Vietnam

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According to IQVIA, Vietnam had 55,300 drugstores in 2016, of which 185 belonged to modern drugstore chains.[24][25] In 2021, the total number of drugstores decreased to 44,600, but the number of drugstores in modern chains increased to 1,600.[26][27] According to a report by VNDIRECT Securities Company, Vietnam had about 70,000 drugstores in 2022, including 59,000 traditional retail drugstores (accounting for 84%) and 11,000 chain drugstores (accounting for 16%). The revenue of Vietnam's pharmaceutical retail market reached about 80,000 billion VND. According to a report by MBS Securities Company in 2023, the size of Vietnam's pharmaceutical market is about 6-7 billion USD,[28][29] with more than 3,000 modern chain drugstores.[30][31]

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See also

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References

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Pharmacy (shop)

View on Grokipedia
from Grokipedia

A shop, also termed a retail or community , functions as a commercial outlet dispensing prescription medications, over-the-counter s, and allied products such as personal care items to the general public, with operations supervised by a licensed to verify prescriptions and counsel on usage. These establishments trace their lineage to ancient practices of and selling remedies, evolving through medieval apothecaries into regulated retail entities by the 18th and 19th centuries, when separation from medical practice and standardization of drug preparation became formalized amid industrialization.
In modern healthcare systems, shops serve as frontline access points for , administering immunizations, conducting basic screenings, and optimizing therapeutic outcomes through adherence support, thereby reducing errors in utilization that empirical studies link to substantial morbidity and costs. Subject to rigorous licensing and oversight—mandating secure storage, accurate labeling, and professional staffing—pharmacies mitigate risks from potent substances, though challenges persist in influx and dispensing inaccuracies reported in regulatory audits. Defining characteristics include diverse formats from independent outlets to chain operations integrated with supermarkets, reflecting economic pressures toward consolidation while preserving localized service in underserved areas.

History

Origins and Early Development

Early of medicinal substances originated in ancient civilizations. In , clay tablets from approximately 2100 BC contain the earliest known prescriptions, detailing plant-based remedies and incantations. Ancient Egyptian practices, recorded in documents such as the around 1550 BC, encompassed over 700 remedies using minerals, plants, and animal products, prepared by priests and healers within temple settings rather than dedicated retail outlets. Similar herbal and chemical preparations characterized Greek and Roman pharmacology, influenced by figures like Dioscorides, whose De Materia Medica (circa 50-70 AD) cataloged over 600 substances, though dispensing remained integrated with medical consultation. The establishment of specialized pharmacy shops first occurred in the Islamic world during the 8th century. Under the , public pharmacies (saydalas) emerged in around 754 AD, initiated by Caliph , separating drug compounding and retail from and treatment. By the , regulations governed pharmacy operations, including inspections for purity and accurate weighing, with pharmacists (saydali) required to undergo training and apprenticeships; this professionalization drew from translated Greek, Persian, and Indian texts, fostering advancements in and syrups. In medieval , apothecaries developed from monastic traditions where maintained herb gardens for producing tinctures, ointments, and infusions used in infirmaries. By the 12th-13th centuries, lay apothecaries appeared in urban centers, initially as extensions of spice merchants selling imported , wines, and confections alongside compounded drugs to physicians and patients. The term "apothecary," from the Latin apotheca (storehouse), denoted these vendors by the 13th century in . Shops proliferated in late medieval towns, stocking ceramic jars for storage and displaying symbols like the ; early standardization efforts included the 1498 Florentine Antidotarium, the first pharmacopeia listing preparative formulas. The Town Hall Pharmacy in , , operational since at least 1422, exemplifies this transition to enduring retail institutions.

Industrialization and Professionalization

The industrialization of pharmaceutical production in the late fundamentally altered pharmacy operations, as manufacturers began supplying standardized drugs on a mass scale, diminishing the centrality of in-house . This shift was driven by advances in and isolation techniques, such as the commercial production of alkaloids like (isolated in 1804 but scaled industrially later) and synthetic compounds, enabling companies to deliver uniform preparations that pharmacies could dispense directly. By the early , this expansion reduced pharmacists' reliance on manual preparation, allowing focus on distribution and patient interaction, though it initially strained professional roles amid declining demands. Professionalization efforts paralleled industrialization, with the establishment of formal standards and regulations to elevate pharmacy from trade to profession. The , first published in 1820, standardized drug quality and nomenclature, providing a benchmark for practitioners. The American Pharmaceutical Association, founded in 1852, advocated for ethical practices and education, influencing state-level reforms. Licensing laws emerged progressively; Louisiana enacted the first pharmacist licensure requirement in 1804, followed by New York in 1831, with all U.S. states implementing pharmacy boards by 1900 to enforce qualifications and combat adulteration. Pharmacy education formalized during this era, transitioning from apprenticeships to structured curricula. The Philadelphia College of Pharmacy, established in 1821 as the first U.S. , emphasized scientific training, a model adopted widely by the late . By 1927, California mandated three years of formal education for licensure, reflecting broader demands for expertise amid industrialized complexity. These developments, while enhancing credibility, faced resistance from traditionalists, as mass-produced drugs commoditized dispensing and prompted debates over pharmacists' clinical versus commercial identities.

Post-World War II Expansion and Chain Models

Post-World War II economic expansion, coupled with advancements in , facilitated the growth of retail pharmacies by enabling the widespread dispensing of pre-packaged medications rather than custom . This shift reduced operational complexity and costs, allowing pharmacies to scale operations and integrate into broader retail formats. In , the period from 1950 to 1979 marked a transition toward standardized dispensing practices, often termed the "Lick, Stick, Count, and Pour" era, which supported increased prescription volumes amid rising demand for antibiotics and other synthetics developed during and after the war. Chain pharmacy models proliferated in the U.S. during this time, capitalizing on , automobile access, and consumer demand for convenience. , established in 1901, expanded significantly post-war through innovative store designs and services, reaching hundreds of locations by the 1960s and introducing ahead of regulations. CVS, founded in in , by brothers Stanley and Sidney Goldstein alongside partner Ralph Hoagland, pioneered the combination of health and beauty products with integrated pharmacies, growing to over 400 stores by 1981 via acquisitions like Clinton Drug stores in 1972. , launched in 1962 in , similarly emphasized discount pricing and rapid site development, contributing to the consolidation of independent outlets into national networks. In , pharmacy expansion occurred amid varying regulatory frameworks, with chains like the UK's Boots—dating to —expanding retail presence but facing constraints from professional dispensing mandates that preserved more independent operations compared to the U.S. model. Overall, chain dominance in the U.S. reflected market-driven efficiencies, while European systems prioritized localized control, influencing the persistence of smaller-scale . By the late , U.S. chains accounted for a growing share of prescriptions, underscoring the era's commercialization of retail.

Types of Pharmacies

Brick-and-Mortar Retail Pharmacies

Brick-and-mortar retail pharmacies consist of physical storefronts staffed by licensed pharmacists who dispense prescription medications, over-the-counter remedies, medical devices, and health-related consumer goods such as vitamins and . These establishments facilitate direct interaction, enabling pharmacists to provide medication counseling, verify prescriptions for and , and address interactions or adherence issues. Unlike online alternatives, they offer immediate access to products and professional oversight, which reduces risks associated with or drugs. In the United States, approximately 60,000 community retail pharmacies operate as of 2021 data, comprising about one-third independent operations and two-thirds , , or mass merchant outlets. Independent pharmacies totaled 18,960 in 2025, with nearly two-thirds located in communities of fewer than 50,000 residents, often filling critical gaps in rural healthcare access. pharmacies numbered 36,209 around the same period, benefiting from that enable higher prescription volumes—averaging 138,000 annually per store compared to lower figures for independents. Independents emphasize personalized service, including extended consultations and customized , whereas chains prioritize efficiency, broader product assortments, and integration with grocery or retail for one-stop shopping. However, chains frequently face criticism for standardized protocols that limit individualized care, while independents report higher in areas like courtesy and prescription processing speed. Services extend beyond dispensing to include immunizations, screenings, and therapy management, with pharmacists increasingly acting as first points of contact for minor ailments under expanded scope-of-practice laws in various states. Revenue from U.S. retail prescription dispensing reached $683 billion in 2024, underscoring their economic significance despite competitive pressures. Globally, the retail pharmacy sector—dominated by brick-and-mortar formats—generated around $1.14 trillion in 2023, driven by aging populations and chronic disease prevalence. These pharmacies operate under stringent regulations requiring pharmacist licensure, secure storage of controlled substances, and compliance with standards from bodies like the FDA and state boards to prevent errors and diversion. Recent challenges include widespread closures, with thousands of locations shuttered amid reimbursement squeezes from pharmacy benefit managers (PBMs), who negotiate rates favoring high-volume chains and mail-order over independents. In May 2024, nearly 90% of U.S. pharmacies temporarily closed in against drug shortages, low s, and operational burdens. Independent pharmacies, handling lower volumes, possess limited negotiating power with PBMs and suppliers, exacerbating closures at rates sometimes exceeding those of chains. Despite this, brick-and-mortar models persist due to consumer preference for in-person verification and immediacy, with adaptations like for inventory and dispensing to counter labor shortages.

Online and Mail-Order Pharmacies

Online and mail-order pharmacies enable consumers to purchase prescription and over-the-counter medications through digital platforms or by mail, with fulfillment and delivery handled remotely rather than at physical locations. These operations typically involve uploading prescriptions electronically, verifying identity and legitimacy, and shipping medications directly to the customer's address. , such pharmacies must obtain licenses in every state where customers place orders to ensure compliance with varying state pharmacy laws. The sector has experienced rapid expansion driven by increased internet access, consumer demand for convenience, and the pandemic's acceleration of telemedicine. U.S. revenue is projected to reach $23.47 billion in 2025, reflecting sustained digital adoption in healthcare. Globally, the mail-order market stood at approximately $66.5 billion in 2023 and is expected to grow to $180.5 billion by 2033 at a (CAGR) of 10.5%, fueled by chronic prevalence and aging populations. Major players include , which holds a leading 5.26% in mail-order services, alongside , , , and . Operations emphasize secure prescription validation, often requiring electronic transmission from prescribers and review before dispensing. Automation in fulfillment centers handles and shipping, with many services offering 90-day supplies for medications to reduce refill frequency. Customer satisfaction with mail-order pharmacies rose significantly in 2025, gaining 7 points year-over-year per metrics, attributed to reliable delivery and cost savings through bulk pricing. However, dispensing controlled substances faces stricter scrutiny under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which generally mandates an in-person medical evaluation prior to prescribing Schedule II-V drugs, though temporary (DEA) flexibilities—extended through December 31, 2025—permit telemedicine exceptions under specific conditions like established patient relationships. Regulatory oversight aims to mitigate risks, with the (FDA) issuing warnings against unlicensed sites that evade verification. Illegal online pharmacies pose public health threats by distributing or adulterated drugs, often laced with , leading to overdose risks as highlighted in a CDC alert from October 2024. The DEA has noted that such operations exploit digital anonymity to traffic falsified pills, underscoring the need for consumers to verify pharmacy credentials via tools like the National Association of Boards of Pharmacy's Verified Internet Pharmacy Practice Sites program. While legitimate providers enhance access for rural or mobility-impaired patients, empirical evidence links unregulated online sourcing to higher incidences of substandard products, with global reviews estimating medicines comprise up to 10% of the market in some regions.

Specialty, Hospital, and Compounding Pharmacies

Specialty pharmacies dispense low-volume, high-cost medications for patients with complex, chronic conditions such as cancer, , , , and hemophilia, often involving biologics or therapies requiring special storage, handling, or administration like or pumps. These pharmacies provide comprehensive patient management services, including assistance, adherence monitoring, financial counseling, and coordination with prescribers to optimize outcomes and reduce hospitalization risks. In 2024, specialty pharmaceuticals accounted for approximately $265 billion in U.S. dispensing revenues across retail, mail-order, and specialty channels, representing a growing segment driven by pipeline innovations in gene therapies and orphan drugs. Hospital pharmacies operate within healthcare facilities to support and outpatient care, managing centralized distribution, preparing intravenous admixtures, and ensuring formulary compliance to minimize errors and costs. Pharmacists in these settings conduct medication reconciliation, , and participation in multidisciplinary rounds to adjust regimens based on patient-specific factors like renal function or interactions. They also oversee , , and sterile under controlled environments to meet immediate clinical needs, distinct from retail models by integrating directly with electronic health records and protocols for rapid response. Compounding pharmacies prepare customized medications tailored to individual patient requirements, such as allergen-free formulations, specific strengths, or not available commercially, adhering to standards outlined in (USP) General Chapters <795> for nonsterile preparations and <797> for sterile ones, with revised requirements effective November 1, 2023, emphasizing facility design, personnel training, and to prevent contamination. These operations differ from specialty or pharmacies by focusing on extemporaneous rather than distribution of manufactured drugs, often serving niche needs like pediatric suspensions or veterinary compounds, though they face heightened scrutiny following incidents like the 2012 Compounding Center outbreak that prompted federal oversight under Section 503A of the FD&C Act for patient-specific compounding. While basic occurs in many pharmacies, dedicated compounding facilities maintain ISO-classified cleanrooms and beyond-use dating protocols to ensure stability and sterility.

Operations and Services

Dispensing Processes and Automation

The dispensing process in pharmacies involves multiple steps to ensure accurate delivery of medications from prescription receipt to handover. This begins with receiving and reviewing the prescription for validity, including verification of the prescriber's , details, dosage, and . Pharmacists then assess potential interactions, allergies, and appropriateness using records and clinical judgment. Preparation follows, where the correct is selected, measured, and packaged, with labeling that includes name, strength, directions, expiration, and warnings as required by federal regulations. Final steps include counseling on usage, side effects, and storage, alongside for legal and purposes. Common errors in manual dispensing include incorrect selection, dosing mistakes, and flawed directions, occurring at rates that contribute significantly to adverse events. To mitigate these, pharmacies adhere to guidelines mandating verification before release and distribution of patient information like Medication Guides for certain drugs. Automation in dispensing has proliferated since the early , incorporating systems, automated counters, and software for and verification to enhance accuracy and efficiency. Systems like vial fillers from Parata or McKesson automate counting, labeling, and packaging, reducing human handling of high-volume prescriptions. In retail settings, these technologies integrate with pharmacy management software to flag discrepancies, achieving error reductions such as a drop from 19 to 7 dispensing errors per 100,000 items in centralized implementations. Empirical studies confirm automation's benefits, including a 53% overall reduction in administration errors, with 79.1% fewer dosing errors and 93.7% fewer selection errors in pharmacies adopting such systems. Retail applications similarly cut prescription filling time by up to 40 seconds per script, allowing pharmacists to focus on clinical roles. Despite initial costs, adoption yields profitability through labor savings and fewer error-related liabilities, though integration requires staff training to maintain oversight. Automated dispensing cabinets and robots also improve , minimizing stock discrepancies and expirations.

Compounding and Customization

Compounding in pharmacies refers to the preparation of medications by combining, mixing, or altering ingredients to create customized formulations tailored to individual patient needs, such as when commercially available drugs are unsuitable due to dosage requirements, allergies, or formulation preferences. This process occurs pursuant to a valid prescription and differs from by its small-scale, patient-specific nature, typically involving nonsterile preparations like capsules, creams, or oral liquids, and sterile ones like injections. Pharmacists follow documented formulas, ensuring appropriate , environmental controls, and quality checks to minimize contamination risks. United States Pharmacopeia (USP) standards govern practices, with <795> outlining requirements for nonsterile —emphasizing proper ingredient handling, labeling, and stability testing—and <797> for sterile , which mandates facilities, personnel garb, and microbial testing to prevent errors like those in the 2012 outbreak linked to a facility. These standards, revised effective November 1, 2023, prioritize quality attributes over rigid categories, requiring pharmacies to categorize preparations by risk level and implement beyond-use dates based on empirical data. Compounded drugs lack FDA premarket approval, meaning their safety, efficacy, and quality are not verified prior to distribution, heightening reliance on expertise and facility compliance. Customization through compounding addresses specific clinical gaps in retail settings, such as formulating dye-free or sugar-free liquids for pediatric patients, flavored suspensions to improve adherence, or hormone therapies in unique strengths for women’s health. It proves essential during drug shortages, enabling alternatives like compounded versions of unavailable oral chemotherapies, and for patients intolerant to excipients in mass-produced drugs. A 2021 survey indicated that 88% of compounding occurs in 503A retail or closed-door pharmacies, with applications spanning , , and veterinary care, though sterile compounding often requires specialized facilities beyond typical retail capabilities. While enhances adherence—estimated to account for up to 3% of U.S. prescriptions—its benefits must be weighed against elevated costs (e.g., expenses rose 130% from to later years) and risks of inconsistency or contamination absent large-scale testing. Retail pharmacies mitigate these by adhering to state boards and accreditation bodies, yet FDA oversight focuses on adverse events rather than routine inspections, underscoring the causal link between procedural lapses and patient harm in non-compliant operations.

Clinical Services Including Vaccinations and Consultations

Community pharmacies have increasingly incorporated clinical services to enhance access to preventive care and medication optimization, moving beyond traditional dispensing roles. These services typically encompass s, medication therapy (MTM) consultations, health screenings, and of minor ailments, driven by pharmacists' expertise in and efforts to alleviate pressure on systems. In the United States, for instance, such expansions have been facilitated by state-level legislative changes granting pharmacists authority to administer immunizations and provide targeted consultations, with evidence indicating improved rates and adherence to therapies. Vaccinations represent a core clinical service, with pharmacists authorized to administer a range of immunizations including , , pneumococcal, tetanus-diphtheria-pertussis, and boosters in most jurisdictions. As of January 2025, 47 U.S. states plus the District of Columbia permit pharmacy technicians to vaccinate adults, a sharp increase from only six states in 2020, reflecting shifts to boost coverage amid needs. During the 2023-2024 season, pharmacies contributed significantly to adult vaccinations, with projected estimates based on data from over 38,000 sites showing substantial uptake; co-administration of multiple at pharmacy visits rose from 11.6% in August 2018 to 24.0% by December 2023, peaking at over 2 million instances in October 2023. Globally, similar expansions occur, such as in where pharmacists handle travel vaccines and routine immunizations, though uptake varies with fewer than five pre-travel consultations per month reported by many pharmacies. Consultations, particularly MTM, involve comprehensive reviews of patients' medication regimens to identify issues like drug interactions, inappropriate dosing, or non-adherence, often targeting those with chronic conditions or . In one large integrated , MTM interventions revealed that 85% of patients had at least one therapy problem, with pharmacists resolving 29% through recommendations accepted by prescribers. Evidence links MTM to better cardiovascular outcomes, though results are mixed due to , and it has evolved from acute medication education to ongoing chronic disease management in retail settings over the past decade. These services are reimbursed in programs like in the U.S., yet challenges persist in uptake, with pharmacists facing barriers like time constraints and physician collaboration. Internationally, consultations extend to minor ailment prescribing, as in , , where pharmacists manage conditions like sore throats or calluses following 2025 expansions.

Personnel and Training

Roles and Responsibilities of Pharmacists

Pharmacists in retail pharmacies serve as experts responsible for verifying the accuracy and of prescriptions before dispensing. They review each prescription for validity, including checking the prescriber's authorization, correct details, appropriate selection, dosage, and instructions, while screening for potential allergies, interactions, or contraindications using history and electronic systems. This process ensures and complies with federal regulations, such as those outlined by the for controlled substances, which require pharmacists to confirm the legitimacy of orders and maintain detailed records of dispensing dates, quantities, and initials. Beyond dispensing, pharmacists provide direct counseling on use, including proper administration, storage, potential side effects, adherence strategies, and modifications to optimize therapeutic outcomes. They educate patients on over-the-counter remedies, recommend non-prescription alternatives when appropriate, and conduct to resolve issues like or non-adherence. In many jurisdictions, licensed pharmacists administer immunizations, perform health screenings such as or checks, and collaborate with prescribers to clarify orders or suggest therapeutic adjustments based on evidence-based guidelines. Pharmacists also oversee operational duties, including inventory management to ensure drug availability, proper storage under controlled conditions (e.g., temperature monitoring for refrigerated biologics), and compliance with hygiene and security standards to prevent diversion or errors. They supervise support staff, such as technicians, in tasks like labeling and packaging while retaining ultimate accountability for all dispensed products. Legally, they must refuse to dispense invalid or unsafe prescriptions, document interventions, and report adverse events or suspicions of abuse to authorities, upholding ethical standards of beneficence and non-maleficence amid varying state laws on scope of practice.

Support Staff and Technician Duties

Pharmacy technicians in retail pharmacies primarily assist licensed by entering prescription into electronic systems, retrieving and measuring medications, affixing labels to containers, and orders for verification. They also manage by ordering , checking expiration dates, and removing outdated products to prevent dispensing errors. These tasks occur under direct pharmacist supervision, with technicians prohibited from making clinical judgments or independently counseling patients on interactions or usage. In addition to core dispensing support, technicians process third-party insurance claims, resolve billing discrepancies, and handle non-clinical inquiries, such as refill authorizations or basic product locations. Advanced roles, enabled by and state-specific regulations, may include performing final accuracy checks on dispensed prescriptions or administering immunizations, as demonstrated in studies of expanded scopes in community settings. For instance, in U.S. retail environments, certified technicians contribute to operational efficiency by supporting medication therapy management workflows, though ultimate responsibility for safety remains with the . Pharmacy support staff, including and clerks, focus on ancillary operations distinct from prescription handling, such as greeting customers, operating cash registers, and merchandising over-the-counter items like vitamins or . They perform administrative duties like filing records, answering phones, and maintaining cleanliness, all under oversight to ensure seamless front-end service without encroaching on regulated activities. In pharmacies, these roles enhance throughput but require clear delineation from technician functions to comply with licensing laws, as support staff lack training for medication preparation or . Variations exist by ; for example, in the , support staff may undertake limited accuracy checks after specialized training as accuracy checking technicians.

Education, Certification, and Workforce Challenges

In the United States, aspiring pharmacists must complete a (PharmD) degree from an Accreditation Council for Pharmacy Education (ACPE)-accredited program, which entails four years of professional coursework and following two to four years of prerequisite undergraduate studies in sciences such as , chemistry, and . This pathway totals six to eight years of higher education, emphasizing , patient care, and pharmaceutical sciences to prepare graduates for retail dispensing and clinical roles in pharmacy shops. Licensure requires passing the North American Pharmacist Licensure Examination (NAPLEX), a 225-question assessment of general pharmacy knowledge and practice competencies administered by the National Association of Boards of Pharmacy (NABP), along with state-specific exams such as the Multistate Pharmacy Jurisprudence Examination (MPJE) in 49 states to verify knowledge of federal and state laws governing drug distribution. Pharmacy technicians supporting retail operations typically need via exams like the Pharmacy Technician Certification Exam (PTCE) or ExCPT, often requiring high school completion and , though requirements vary by state. To maintain licensure, pharmacists must fulfill continuing pharmacy education (CPE) mandates, such as 15 to 45 contact hours every one to three years through ACPE-accredited providers, focusing on updates in therapeutics, regulations, and safety to ensure ongoing competence amid evolving drug therapies and dispensing technologies. The pharmacy workforce grapples with acute shortages, with vacancy rates in community pharmacies exceeding 10% in many regions as of 2024, driven by fewer students enrolling in PharmD programs—down 8% from 2019 peaks—and retirements outpacing new graduates. Burnout affects over 70% of pharmacists, particularly in chain retail settings where women report higher rates, stemming from chronic understaffing, mandatory overtime, and performance metrics prioritizing volume over clinical judgment, which correlate with increased dispensing errors and compromised . Post-pandemic factors, including heightened workloads from expanded services like vaccinations without proportional hiring, have intensified turnover, with surveys indicating inadequate staffing as the top barrier to safe care in 2025. Corporate consolidation in retail chains exacerbates these issues by standardizing operations that reduce flexibility for work-life balance, prompting calls for reforms to incentivize retention through better compensation and reduced administrative burdens.

Ownership and Business Models

Independent Pharmacies: Advantages and Vulnerabilities

Independent pharmacies offer personalized patient care, often resulting in higher satisfaction and better medication adherence compared to pharmacies. Studies indicate that users of independent pharmacies demonstrate greater adherence to medications, particularly among low-income patients, due to tailored counseling and relationship-building. Patients consistently rate services at independent pharmacies higher than at chains across factors like overall visit quality and specific interactions. In rural and underserved communities, independent pharmacies provide critical access to medications, , and health counseling, serving as lifelines where presence is limited. They also enable cost savings for uninsured or underinsured individuals through competitive pricing and coupon utilization. These pharmacies foster strong ties, leveraging local to address specific needs and promote equity in pharmacy access. Independent owners can adapt services flexibly, such as offering specialized or vaccinations, without corporate mandates constraining innovation. Shorter wait times and direct access enhance convenience and trust. However, independent pharmacies face significant vulnerabilities from pharmacy benefit managers (PBMs), which impose low reimbursements, direct and indirect remuneration (DIR) fees, and spread pricing practices that erode profitability. Exclusion from PBM preferred networks heightens closure risk, particularly for independents in low-income or minority . Between 2010 and 2021, 38.9% of independent pharmacies closed, outpacing chain closures, with an annual market turnover rate of 6.2% where independents fluctuate more. A 2024 survey revealed 32% considering closure amid drug shortages affecting 97% of operations and persistent reimbursement declines. Additional pressures include adapting to digital tools, managing prior authorizations, and navigating annual changes, which strain limited resources. Rural independents, vital for vulnerable populations, risk creating pharmacy deserts upon closure, exacerbating access disparities. Limited bargaining power against suppliers and competitors like mail-order services further compounds financial instability.

Chain and Corporate Ownership: Scale and Standardization

Chain pharmacies, operated under corporate ownership, dominate the retail pharmacy landscape , with the largest four entities—, , Cigna, and —accounting for approximately half of total prescription revenues in 2024. operates over 9,000 locations nationwide, while maintains around 8,500 stores, enabling extensive geographic coverage and centralized . This scale facilitates of pharmaceuticals, reducing per-unit costs and allowing competitive pricing, though it also concentrates among a few corporations. Standardization across chain pharmacies enforces uniform dispensing protocols, inventory management systems, and staff training programs, which enhance and . For instance, corporate mandates for automated verification processes and integration minimize errors and streamline workflows, contributing to faster service times compared to smaller independents. These practices yield , with chains handling about 70% of distribution through integrated retail and mail-order models. However, such uniformity can limit flexibility in patient consultations, as evidenced by studies showing chains prioritize volume over customized in routine operations. Globally, corporate chains like and AS Watson exhibit similar scaling, with operations spanning multiple countries and emphasizing branded consistency to build consumer trust. In competitive markets, entry by standardized chains has been linked to improved adherence among , as observed in analyses of emerging economies where national standards compliance rose post-chain expansion. This trend underscores how corporate scale drives industry-wide efficiencies, though it intensifies pressures on independent pharmacies, whose has stabilized around 35% in the U.S. despite ongoing consolidation.

Franchises, Buying Groups, and Hybrid Models

Franchise models in pharmacy involve independent owners operating under a national or regional , receiving operational support, resources, and standardized systems in exchange for fees and adherence to guidelines. Prominent examples include The Medicine Shoppe, franchised by , which emphasizes community-focused services and provides franchisees with training, demographic analysis, and store design assistance to position pharmacies as local health destinations. Other franchises like MediCap Pharmacy offer smaller-scale operations, typically 1,500 to 2,000 square feet, with low entry costs and professional layouts tailored for efficient dispensing and retail sales. These models enable owners to leverage established for customer trust and economies in purchasing, though they require upfront franchise fees—often $20,000 to $50,000—and ongoing royalties of 4-6% of revenue, alongside restrictions on decisions. Buying groups, also known as group purchasing organizations (GPOs) or , allow independent pharmacies to retain full and while pooling resources for negotiated discounts on drugs, supplies, and services from wholesalers. Member-owned entities like the Independent Pharmacy Cooperative (IPC), founded in 1983, serve over 6,000 members by offering competitive generic pricing, rebates, and business tools such as , enabling independents to counter chain dominance through power. Similarly, EPIC Pharmacies and the American Pharmacy Buying Cooperative (AAP) provide access to lower drug acquisition costs—potentially reducing generic expenses by 10-20%—and additional services like payer contracts and marketing support without mandating brand uniformity. These groups represent a significant portion of U.S. independents, with networks like the Federated Pharmacy Network (FPN) covering approximately 16,000 locations nationwide, helping members achieve profit margins comparable to chains despite smaller scale. Hybrid models blend elements of franchises and buying groups, often through banner programs that provide branding and promotional support akin to franchising but with the flexibility of cooperatives, minimizing control over daily operations. For instance, Health Mart, operated by McKesson, functions as a hybrid by offering independents national advertising, patient loyalty programs, and purchasing leverage similar to a GPO, while allowing customized store layouts and service expansions without the full regulatory oversight of traditional franchises. Good Neighbor Pharmacy employs a comparable approach, combining GPO benefits for cost savings with optional branding to enhance visibility in competitive markets. These structures appeal to pharmacies seeking scale advantages—such as improved negotiations and —while preserving entrepreneurial independence, though they may involve membership dues of $500 to $2,000 annually and variable performance incentives tied to volume thresholds. In practice, hybrids mitigate risks like those in pure franchises (e.g., brand dilution from corporate decisions) and pure buying groups (e.g., limited ), fostering resilience amid pressures from pharmacy benefit managers and , with adoption growing as independents comprise about 35% of U.S. retail pharmacies but face closure rates exceeding 10% annually without such affiliations.

Regulation and Ethics

Licensing, Compliance, and Government Oversight

Retail pharmacies must obtain location-specific licenses from state boards of pharmacy in the United States, with requirements including application fees ranging from $500 to $2,000, proof of , a surety bond in some states, and pre-opening inspections to verify compliance with facility standards such as secure storage and sanitation. Individual pharmacists serving as pharmacy-in-charge must hold state licenses, typically requiring a (PharmD) degree, at least 1,500 hours of supervised , passage of the North American Pharmacist Licensure Examination (NAPLEX), and state-specific jurisprudence exams like the California Practice Standards and (CPJE). Federal licensing supplements state requirements for pharmacies dispensing controlled substances, mandating registration with the (DEA) under the (CSA) of 1970, which categorizes substances into five schedules based on medical utility and potential for abuse—Schedule I drugs like have no accepted medical use and high abuse risk, while Schedule II includes opioids like with accepted use but severe dependence risk. DEA registration, renewed every three years for a fee of approximately $731 per location as of 2023, ensures pharmacies track inventory and report theft or loss within one business day. Government oversight combines state and federal mechanisms, with state boards conducting unannounced inspections—averaging 1-2 per year per pharmacy in high-volume states like —to enforce standards on prescription validation, labeling, and patient counseling, while the (FDA) under the Department of Health and Human Services regulates drug quality, adulteration prevention, and compounding practices under sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act. The DEA focuses on diversion control, auditing records for discrepancies and investigating suspicious orders through its Automation of Reports and Consolidated Orders System (ARCOS), which monitors Schedule II-V distributions nationwide. Compliance mandates include maintaining perpetual inventories for Schedules II-V with biennial full reconciliations, storing drugs in locked cabinets accessible only to authorized personnel, verifying prescription authenticity via electronic systems like the Prescription Drug Monitoring Programs (PDMPs) in all 50 states, and retaining records for at least two years subject to immediate production upon inspection. Pharmacies must also adhere to HIPAA for patient privacy and implement quality assurance under United States Pharmacopeia (USP) <797> and <800> standards for sterile compounding to minimize contamination risks, with non-compliance triggering civil penalties up to $250,000 per violation or criminal prosecution for willful diversions. Violations have led to over 1,200 DEA administrative actions against pharmacies annually in recent years, including license revocations for inadequate controls contributing to opioid diversions.

Ethical Principles: Beneficence, Autonomy, and Justice

Pharmacists in community settings uphold beneficence by prioritizing actions that promote health and , such as providing accurate medication counseling, verifying prescriptions for safety, and recommending therapeutic alternatives when appropriate to maximize benefits and minimize harm. This principle, rooted in professional codes, requires proactive efforts like on adherence, which studies show reduces adverse events; for instance, a 2020 review highlighted how pharmacist interventions in pharmacies improved outcomes in chronic by optimizing drug therapy. Beneficence extends to societal duties, including initiatives like services offered in pharmacies, where pharmacists assess eligibility and administer doses to enhance immunity. Autonomy demands that pharmacists respect to make informed decisions about their care, including the refusal of recommended treatments or counseling, without . In practice, this manifests in obtaining for over-the-counter recommendations or dispensing generics versus brands, even when pharmacists perceive suboptimal choices, as overriding patient preferences undermines . Ethical dilemmas arise in cases of nonadherent s, such as those ignoring warnings on controlled substances; here, codes emphasize and documentation over , with a 2016 analysis noting that pharmacists must balance persuasion with respect to avoid conflicts. Professional guidelines, like those from the , interpret as recognizing individual dignity, particularly vulnerable populations, to foster trust in pharmacy- interactions. Justice in pharmacy involves equitable distribution of pharmaceutical services and medications, addressing disparities in access influenced by location, income, or insurance status. Distributive justice requires pharmacists to advocate for fair during shortages, prioritizing based on clinical need rather than profit, as seen in guidelines for critical drugs like opioids or antibiotics in settings. In retail contexts, this principle critiques high pricing models that limit affordability, with data from 2021 indicating that cost barriers contribute to 20-30% of nonadherence rates among low-income patients served by pharmacies. Codes emphasize , urging pharmacists to support reimbursement programs or for underserved patients, thereby mitigating "pharmacy deserts" where rural or urban poor face reduced service availability.

Conscientious Objection and Refusal to Dispense

Conscientious objection in pharmacy refers to a pharmacist's refusal to dispense legally prescribed medications or provide certain services due to deeply held moral, ethical, or religious beliefs, most commonly involving , abortifacients, or medications related to or therapies. This practice raises tensions between professional duties to ensure access to care and individual rights to avoid complicity in actions conflicting with personal convictions. Empirical surveys indicate that while objections exist, actual refusals are infrequent; for instance, a U.S. study found nearly 6% of pharmacists would refuse both to dispense and transfer prescriptions for certain objected-to medications, such as contraceptives. In the United States, legal protections for conscientious objection vary significantly by state, with fewer than one-fourth explicitly permitting to refuse dispensing based on religious, ethical, or moral grounds. In states without such clauses, pharmacists may face disciplinary action, termination, or civil liability for refusals, as seen in a 2024 federal appeals court ruling against a pharmacist who declined to fill an prescription, deeming it business discrimination under state law. Where protections exist, they often require prompt referral to another provider to mitigate access barriers, though at least 12 states impose no such obligation, prioritizing the pharmacist's . Notable cases include multiple refusals for like Plan B, with reports from the early 2000s documenting pharmacists rejecting prescriptions even in cases, prompting state-level regulations mandating referrals in places like Washington. More recently, in 2025, two pharmacists sued after losing employment for refusing prescriptions, arguing violations of their religious freedoms under . Internationally, approaches differ, with some pharmacy codes of ethics explicitly allowing conscientious objection provided it does not impede care, while others infer the right or impose strict limits. In the European context, protections stem from broader frameworks recognizing freedom of , though implementation varies; for example, assisted suicide legislation in permits pharmacist opt-outs under specific conditions. Australian surveys reveal divided opinions, with about half of pharmacists affirming a right to object but most agreeing to supply across vignettes, highlighting a for balancing objection with obligations like timely referrals. Globally, refusals remain rare relative to total prescriptions, but critics argue they disproportionately affect vulnerable populations in underserved areas, potentially delaying time-sensitive treatments, whereas proponents emphasize that unchecked mandates erode integrity without evidence of systemic access denial. Pharmacist codes often condition objection on non-discrimination and ensuring alternative access, reflecting a consensus that while merits accommodation, it cannot override verifiable needs.

Controversies and Criticisms

Opioid Epidemic and Dispensing Practices

The in the United States, which escalated in the late and peaked in the early , involved widespread dispensing of prescription by retail pharmacies, contributing to overprescription and diversion. From to 2012, opioid dispensing by pharmacies surged to more than 255 million prescriptions annually, equivalent to an estimated 81.3 prescriptions per 100 persons nationwide. This volume reflected aggressive marketing by manufacturers and initial medical guidelines favoring for , but pharmacies bore responsibility under for verifying prescription legitimacy before filling. Under the , pharmacists hold "corresponding responsibility" with prescribers to ensure prescriptions are issued for legitimate medical purposes, requiring scrutiny for signs of abuse such as or dosages exceeding clinical norms. The (DEA) mandates that pharmacies maintain records, report suspicious activities, and consult prescription drug monitoring programs (PDMPs) where required by state law, with non-compliance risking license revocation. Despite these safeguards, investigations revealed that some chain pharmacies prioritized volume over vigilance, filling high-risk prescriptions without adequate checks, which facilitated diversion into illicit markets. Critics, including state attorneys general, argued that lax dispensing practices by major chains exacerbated overdose deaths, which reached over 70,000 annually by 2020, many linked to prescription opioids transitioning to synthetics like fentanyl. In response, pharmacy chains faced multibillion-dollar lawsuits alleging systemic failures in oversight; for instance, CVS Health, Walgreens, and Walmart agreed to settlements totaling approximately $13 billion in 2022 to resolve claims of fueling the crisis through improper dispensing. These agreements included commitments to enhanced monitoring, such as AI-driven red-flag detection and limits on initial opioid fills, though empirical evidence on their long-term efficacy remains limited. Post-2012 reforms, including DEA quota reductions on raw opioid materials and state PDMP mandates, correlated with a 44% decline in opioid prescriptions from 2011 to 2020, dropping dispensing rates to 46.8 per 100 persons by 2019. However, dispensing practices shifted unevenly; while chains standardized protocols, independent pharmacies sometimes faced resource constraints in implementing PDMP checks, highlighting disparities in compliance capacity. Pharmacists' frontline role has since expanded to include counseling on risks and dispensing naloxone, though persistent understaffing and profit incentives from pharmacy benefit managers (PBMs) continue to challenge rigorous adherence.

Medication Errors, Burnout, and Understaffing

Understaffing in retail pharmacies has intensified since the early 2020s, driven by high turnover rates, retirements, and insufficient amid rising prescription volumes and operational demands. A 2023 survey of U.S. found that 75.8% attributed facility understaffing directly to burnout-related exits, with only 13.9% disagreeing. In settings, inadequate coverage correlates with workload pressures, as evidenced by studies linking short staffing to prolonged hours and rushed dispensing processes. Corporate mandates, such as minimizing personnel costs to maintain slim profit margins, exacerbate this cycle, independent of pandemic effects, though accelerated technician shortages by an estimated 20-30% in some regions. Pharmacist burnout manifests in , depersonalization, and reduced efficacy, with prevalence rates exceeding 70% in recent U.S. community samples across at least one dimension. Primary causes include chronic understaffing (cited by 58% as the top stressor), overwhelming daily prescription counts—often 300-500 per —and administrative burdens like prior authorizations. Post-2020, stress levels doubled compared to pre-pandemic baselines, fueled by disruptions and expanded clinical roles without proportional staffing increases. This burnout perpetuates understaffing through voluntary resignations, with 2024 reports indicating turnover rates 15-20% above industry norms in chain pharmacies. Medication errors, including dispensing wrong drugs, dosages, or labels, rise under these conditions, with empirical links to from understaffing and burnout. Community pharmacy analyses show workload deficiencies, such as solo shifts during peak hours, contribute to error rates of 1-5% per 100 prescriptions, often involving high-risk medications like anticoagulants. A 2025 study confirmed high stress from staffing shortages elevates error risk, with 71.9% of pharmacists reporting unsafe working conditions that compromise . Consequences include adverse drug events costing U.S. healthcare $42 billion annually, disproportionately from settings where understaffing delays error detection. Interventions like mandatory staffing ratios, proposed in some state legislations since 2023, aim to break this causal chain, though adoption remains limited due to economic resistance from pharmacy benefit managers and chains.

Pricing, Reimbursement, and PBM Influences

In the United States, retail pricing for prescription drugs typically relies on benchmarks such as the Average Wholesale Price (AWP), a published representing an average markup over the manufacturer's Wholesale Acquisition (WAC), though actual acquisition costs are often lower due to negotiated wholesaler discounts. For brand-name drugs, formulas commonly use AWP minus a (e.g., 15-20%), plus a dispensing fee, but these do not reflect true market dynamics, as AWP has been criticized as an inflated "sticker price" disconnected from acquisition realities. Generic drugs, which constitute the majority of prescriptions, are reimbursed via Maximum Allowable (MAC) lists set by pharmacy benefit managers (PBMs), capping payments at levels that frequently fall below pharmacies' actual acquisition costs, leading to negative margins on many fills. The National Average Drug Acquisition (NADAC), a CMS-collected survey-based benchmark updated weekly, aims to provide a more accurate floor for and some commercial plans, but its voluntary participation limits representativeness. Reimbursement to occurs primarily through third-party payers via PBM-administered networks, where the pharmacy submits claims for plus a dispensing , offset by copays. However, post-dispensing adjustments like Direct and Indirect Remuneration (DIR) fees—originally a mechanism to recoup manufacturer discounts but now applied broadly—retroactively reduce payments to pharmacies, often by 1-5% of claims or fixed amounts per script, eroding profitability and predictability. DIR fees totaled over $1.5 billion in Medicare alone in 2022, with growth accelerating due to PBM practices that shift downstream while retaining spreads between insurer payments and pharmacy reimbursements. Dispensing fees average $8-12 nationally but vary by payer; proposals for mandated minimums (e.g., $10.50 in commercial markets) could add $16 billion annually to national drug spending without addressing underlying acquisition gaps. PBMs, dominated by three vertically integrated firms—CVS Caremark, Express Scripts (Cigna), and OptumRx (UnitedHealth)—affiliated with the largest pharmacy chains and insurers, control approximately 80% of the U.S. prescription market as of 2024. These entities influence pricing by negotiating rebates from drug manufacturers (averaging 30-50% of list prices for brands), which incentivize formulary preferences for higher-rebate drugs over cheaper alternatives, including generics and biosimilars, thereby sustaining elevated net costs. Spread pricing allows PBMs to bill payers more than they reimburse pharmacies, pocketing the difference—estimated at $73 billion in inflated costs from 2018-2022 per FTC analysis—while imposing network adequacy requirements that favor affiliated pharmacies. A January 2025 FTC interim staff report documented PBM markups of hundreds to thousands of percent on specialty generics for cancer, HIV, and other conditions, with one drug's reimbursement rising 1,000% despite stable acquisition costs, squeezing independent pharmacies through below-cost reimbursements and clawbacks. These dynamics contribute to pharmacy closures, with over 1,000 independents shuttering annually since 2020, as chains leverage scale for better PBM terms, exacerbating market concentration. PBMs counter that their practices lower overall system costs via rebates passed to payers, though FTC evidence indicates limited transparency and preferential treatment for affiliates undermines this claim.

Economic and Market Dynamics

Revenue Sources, Profit Margins, and Cost Pressures

Retail pharmacies derive the majority of their revenue from dispensing, which accounted for approximately 70-80% of total sales as of 2023, with independent pharmacies contributing to a $94.9 billion segment. Front-end merchandise, including over-the-counter medications, , products, snacks, and seasonal items, typically represents 20-30% of revenue and offers higher gross margins to offset low prescription reimbursements, serving as a key profitability driver particularly for independent operators. Additional streams include pharmacy services such as vaccinations, , and , though these remain minor contributors, often under 5% of due to reimbursement constraints. Profit margins for retail pharmacies have contracted amid reimbursement dynamics, with independent pharmacies reporting a gross profit margin of 19.7% in 2023, the lowest in a decade-long tracking period, reflecting declines from prior levels around 21-22%. Net operating margins average 3-5% across U.S. pharmacies, down from historical highs near 7%, as generic drug reimbursements fail to cover acquisition costs and dispensing fees stagnate. Chain pharmacies exhibit slightly higher margins through scale economies but face similar pressures, with overall industry profitability challenged by a shift toward low-margin generics comprising over 90% of prescriptions. Pharmacy benefit managers (PBMs) exert significant downward pressure on margins by negotiating reimbursements that often fall below pharmacies' costs for generics and specialty drugs, capturing value through spread pricing and rebates that prioritize their own profits over dispenser compensation. Rising operational costs, including labor shortages and wages amid technician burnout, have increased expenses by 5-10% annually, while drug shortages and supply chain disruptions elevate acquisition prices without corresponding reimbursement adjustments. Regulatory changes, such as Medicare's drug price negotiations under the Inflation Reduction Act, introduce further liquidity strains through delayed refunds and reduced payments starting in 2026, potentially accelerating pharmacy closures. Inflation in utilities, insurance, and compliance further erodes viability, with independents particularly vulnerable as chains consolidate to mitigate these via vertical integration.

Innovations: AI, Telepharmacy, and Supply Chain Reforms

Artificial intelligence (AI) has emerged as a tool for enhancing operational efficiency in retail pharmacies, particularly through automated dispensing systems and predictive analytics for inventory management. Integration of AI with robotic dispensing has reduced medication errors by up to 80% in some hospital-affiliated retail settings, extending to community pharmacies via centralized fill models that verify prescriptions remotely before local fulfillment. In 2025, AI-driven software analyzes patient data to flag potential drug interactions and optimize adherence, with studies showing improved workflow efficiency and reduced administrative burdens for pharmacists by automating routine tasks like label generation and stock forecasting. However, adoption varies, with a 2025 survey of U.S. pharmacists revealing mixed perceptions, where 45% expressed concerns over data privacy and over-reliance on algorithms despite acknowledging benefits in precision dosing for chronic conditions. Telepharmacy enables remote pharmacist oversight of dispensing sites, addressing shortages in rural and underserved areas by allowing video consultations for prescription verification and counseling. As of 2025, 28 U.S. states have authorized telepharmacy services, facilitating over 1 million remote consultations annually in community settings to extend hours of operation without on-site staffing. This model has increased access, with implementation in community health centers reducing wait times by 30-50% and improving adherence through follow-up virtual reviews, though regulatory fragmentation limits interstate scalability. Patient acceptance is high, with 70% in a 2024 study reporting willingness to use telepharmacy for refills and education, particularly in areas with pharmacist-to-population ratios below 1:3,000. Challenges include technology infrastructure costs, averaging 50,000−50,000-100,000 per site, and ensuring equivalence to in-person verification under varying state laws. Supply chain reforms in pharmacies emphasize and resilience, driven by the U.S. Drug Supply Chain Security Act (DSCSA) mandates fully enforced since November 2023, which require unit-level tracking to combat counterfeits and shortages. Innovations like AI-enhanced have cut discrepancies by 25% in retail chains, integrating from wholesalers to predict disruptions from events like the 2024-2025 API shortages affecting generics. and automated labeling in distribution hubs, adopted by major wholesalers in 2025, streamline , reducing manual errors and labor demands amid staffing pressures. Broader reforms include FDA proposals to expedite domestic API production permitting, aiming to mitigate 80% foreign dependency risks exposed by geopolitical tensions, though implementation faces delays due to environmental reviews. These changes have lowered shortage durations from 200 days in 2023 to under 100 days in 2025 for critical retail-dispensed drugs, per industry tracking, but small independent pharmacies report higher compliance costs averaging $20,000 annually without volume offsets.

Pharmacy Deserts and Access Disparities

Pharmacy deserts refer to geographic areas where residents face limited access to pharmacies, typically defined as regions requiring travel exceeding 10 miles in rural areas or 2.5 miles in urban areas to reach a pharmacy, analogous to food deserts but focused on medication and pharmaceutical services availability. In the United States, approximately 15.8 million people, or 4.7% of the population, reside in such deserts, with occurrences spanning all 50 states and affecting both urban and rural settings. Alternative analyses, incorporating broader vulnerability metrics, estimate up to 57.1 million individuals in pharmacy deserts, of whom 72.4% live in urban areas, 10.3% in suburban, and 17.3% in rural locales. Closures of retail and independent pharmacies drive the expansion of these deserts, with over 1,300 closures recorded annually between 2009 and 2015, particularly among independents in low-margin markets. Factors include declining reimbursements from pharmacy benefit managers (PBMs), thin profit margins, and consolidation by large chains that prioritize high-volume locations, leaving underserved areas unprofitable. Rural tracts exhibit the lowest , with the smallest share of access to at least one pharmacy per 10,000 residents compared to suburban and urban tracts, even when accounting for drive times of 10 or 30 minutes. Access disparities disproportionately burden low-income, minority, and rural populations, though patterns vary regionally. In rural areas, nearly 80% of small zip codes lack Medicaid-contracted pharmacies, compared to about 50% in urban cores, exacerbating barriers for low-income patients reliant on public . Urban low-income tracts often face similar voids due to exits from economically challenged neighborhoods, leading to burdens that hinder timely medication refills and consultations. While some state-level data, such as in New York, indicate higher spatial access in high-poverty or minority tracts due to targeted pharmacy placements, national trends reveal persistent gaps in rural and high-vulnerability areas, where social determinants like transportation limitations compound the issue. These deserts correlate with adverse patient outcomes, including reduced medication adherence and worsened health metrics. Pharmacy closures are linked to clinically significant, persistent declines in adherence to cardiovascular medications among older adults, with affected s showing lower refill rates persisting up to two years post-closure. Similar effects extend to anticonvulsant therapies, where closures reduce prescription fills, potentially increasing seizure risks. Broader consequences include elevated healthcare costs from emergency visits, poorer preventive care uptake such as vaccinations, and heightened nonadherence in chronic disease management, particularly in vulnerable groups where alternative access like mail-order proves unreliable due to logistical barriers. Empirical evidence from closure studies underscores causal links between reduced pharmacy proximity and these outcomes, independent of confounding factors like patient demographics.

Societal and Public Health Role

Contributions to Vaccination and Preventive Care

Community pharmacies have expanded their role in vaccination delivery, particularly for , , pneumococcal, and vaccines, leveraging their widespread accessibility to boost rates among adults. In the United States, the Federal Retail Pharmacy Program enabled pharmacists to administer over 300 million doses of vaccines by 2023, contributing to broader equity by serving underserved and rural populations. Empirical studies indicate that pharmacist-led interventions, including direct administration and recommendations, increase uptake, with rates of recommendations ranging from 50% to 94% and notable impacts on pneumococcal vaccines exceeding those for . This accessibility has proven especially effective for older adults, where pharmacy-based (PBI) enhances coverage due to convenience, reducing barriers like transportation and scheduling. In preventive care, pharmacies contribute through , health screenings, and on topics such as and chronic disease management, often identifying unmet needs during routine interactions. Systematic reviews demonstrate that pharmacist-provided services improve rates alongside support for and cessation, with potential cost savings from early interventions estimated at $368,000 per pharmacist in integrated models like those in the U.S. system. From 2000 to 2025, community pharmacies in various countries have incorporated vaccinations, specimen collection, and surveillance testing, aiding rapid responses and reducing long-term healthcare burdens by promoting primary prevention. These efforts align with causal mechanisms of improved outcomes via decentralized access, though overall coverage gains may reflect service shifts rather than net increases in some seasonal programs.

Harm Reduction vs. Evidence-Based Critiques

Pharmacies have increasingly adopted strategies, such as distributing for reversal, providing syringe services programs (SSPs) to prevent infections, and dispensing opioid agonist therapies like and without requiring abstinence. These interventions aim to mitigate immediate risks associated with substance use, with pharmacists often serving as accessible points of contact for people who use drugs (PWUD). For instance, distribution through pharmacies has been linked to reductions in overdose mortality ranging from 25% to 46% in evaluated programs. Similarly, pharmacy-based SSPs have demonstrated effectiveness in lowering transmission rates by up to 18.2% in some U.S. locales, by facilitating sterile injection equipment exchange. Evidence supporting these practices draws from research emphasizing short-term outcomes, such as decreased infectious disease incidence and overdose events, without of increased drug initiation among non-users. Meta-analyses and scoping reviews indicate that does not encourage broader use and can connect PWUD to further treatment, though long-term rates remain low, with many participants continuing substance use. Pharmacy-specific implementations, like those in Respond to Prevent programs, highlight facilitators such as training and standing orders, which enhance access and reduce stigma. Critiques grounded in empirical data question the net benefits of over abstinence-oriented approaches, arguing that while immediate harms are curbed, these strategies may inadvertently sustain by removing disincentives to quit. A of SSPs found no overall reduction in opioid-related mortality in some randomized trials, and certain analyses suggest SEPs correlate with higher overdose deaths, potentially due to effects where users perceive reduced personal risk. Comparative studies of abstinence-based versus harm reduction interventions reveal that the former yields higher continuous abstinence rates in randomized controlled trials, particularly through structured programs like or twelve-step facilitation, which emphasize total cessation over managed use. Critics, including those from perspectives, contend that harm reduction's focus on utilitarian risk minimization overlooks causal pathways to recovery, with limited evidence for increased quitting or prevention of progression to dependence; literature supporting harm reduction often derives from institutions predisposed to non-punitive models, potentially underemphasizing longitudinal data favoring abstinence. In pharmacy contexts, dispensing practices may prioritize harm mitigation without robust integration of evidence-based counseling for abstinence, leading to critiques of insufficient emphasis on causal drivers of resolution.

Impact on Healthcare Costs and Patient Outcomes

Community pharmacies influence healthcare costs primarily through pharmacist interventions that optimize medication use, such as identifying drug interactions, recommending generics, and conducting medication therapy management (MTM) services, which have been shown to generate net savings by reducing hospitalizations and emergency visits. A of pharmacist roles across settings found substantial cost reductions, with interventions yielding average savings of $4.20 to $12.40 per dollar invested, driven by avoidance of adverse events and improved adherence in chronic disease management. Similarly, MTM programs in community pharmacies have demonstrated benefit-to-cost ratios of 3.53:1, primarily from decreased overall healthcare expenditures per , including reductions from nearly $12,000 to lower levels in targeted populations through better medication utilization. These interventions also enhance outcomes by improving clinical endpoints and metrics. Meta-analyses of pharmacist-led efforts in community and reveal significant improvements in glycemic control (e.g., reduced HbA1c by 0.5-1.0%), management, and lipid profiles among patients with and cardiovascular risks, alongside higher medication adherence rates. In cases, deprescribing recommendations from pharmacists have led to direct cost savings via discontinued unnecessary therapies while maintaining or improving health stability, with one reporting avoidance of $10,162 per patient over 30 years through prescribing optimizations. However, the net impact varies by service reimbursement and implementation scale; while supports cost-effectiveness for MTM in Medicare populations—reducing disparities in medication quality without increasing out-of-pocket expenses for most patients—underutilization due to limited payer coverage can limit broader savings. Systematic evaluations confirm that pharmacy-based of chronic medications prevents negative outcomes like non-adherence-related complications, yielding positive cost-benefit ratios, though long-term data emphasize the need for sustained integration to maximize population-level effects. Overall, empirical data underscore pharmacies' role in causal pathways to lower costs via preventive adjustments, countering higher expenses from untreated conditions.

Global Variations

United States: Market-Driven Retail

In the United States, retail pharmacies operate within a decentralized, market-oriented system dominated by private ownership and competitive dynamics, contrasting with more centralized government-controlled models elsewhere. Large chain operators, including CVS Health with approximately 9,000 locations and Walgreens Boots Alliance with around 8,000 stores as of 2024, control a significant portion of the market, collectively dispensing billions of prescriptions annually through high-volume outlets integrated with convenience retail. Independent community pharmacies, numbering about 18,984 in mid-2024, represent a declining segment, serving niche local needs but facing consolidation pressures from chain expansion and reimbursement challenges. This structure fosters entrepreneurship, with pharmacies adapting services like drive-through windows and extended hours to capture consumer demand without uniform regulatory mandates on operations. The relies heavily on prescription dispensing for , supplemented by over-the-counter products, services, and front-end such as snacks and , which account for roughly 20-30% of total income in settings. Gross profit margins on prescriptions averaged 21% in for independents, reflecting low per-script reimbursements offset by scale in chains that dispense over 138,000 prescriptions per store annually. drive negotiations with pharmacy benefit managers (PBMs) and insurers, enabling pharmacies to compete on and programs rather than fixed tariffs, though this has led to margin compression amid rising costs and disruptions. Chains leverage for bulk purchasing and , as seen in CVS's acquisition of in 2018, enhancing data-driven inventory and personalized offerings. Competition from online and mail-order pharmacies, including launched in 2020, pressures brick-and-mortar retailers to innovate with telepharmacy and rapid delivery, promoting efficiency through consumer choice rather than state directives. The absence of direct federal allows pharmacies to respond dynamically to demand, such as expanding vaccination sites during the , where chains administered over 100 million doses by mid-2021. However, this market-driven approach contributes to disparities, with independent closures accelerating in rural areas—over 1,000 independents shuttered between 2018 and 2021—exacerbating access issues in underserved regions despite overall national coverage exceeding 90% of the population within 5 miles of a pharmacy. Total industry revenue reached $609.6 billion in 2025, underscoring the sector's resilience amid competitive evolution.

United Kingdom: NHS Integration and Controls

In the , community pharmacies are deeply integrated into the (NHS), primarily through the Community Pharmacy Contractual Framework (CPCF), which governs funding and service provision. Under this framework, pharmacies dispense the majority of NHS prescriptions—over 1 billion items annually—and deliver advanced services such as medicines use reviews, emergency hormone contraception supply, and the Pharmacy First initiative, allowing treatment for seven common conditions without a GP consultation. The CPCF commits £3.073 billion in baseline funding for in 2025/26, including £900 million allocated to profit margins, representing a 19.7% increase from prior levels to support expanded roles amid NHS pressures. This integration positions pharmacies as first points of contact for , with over 10,000 participating in Pharmacy First by early 2024, though devolved arrangements apply in , , and . Regulatory controls are enforced by the General Pharmaceutical Council (GPhC), which registers pharmacies and professionals in Great Britain, mandating standards for safe care environments, including a responsible pharmacist present during opening hours to oversee operations. Ownership is restricted under the Medicines Act 1968 to pharmacists, partnerships of pharmacists, or corporate bodies primarily engaged in retail pharmacy, ensuring professional oversight while permitting chains like Boots to operate multiple sites. Recent regulatory updates, including relaxed supervision rules for pharmacy technicians effective from 2025, aim to enhance efficiency without compromising safety, as all technicians must be GPhC-registered. As of 2023/24, England had 12,009 active community pharmacies, reflecting a net increase from ownership transfers despite ongoing closures—222 in 2024—driven by funding shortfalls and rising costs. NHS funding constitutes over 90% of many pharmacies' revenue, primarily via fee-per-item dispensing and block payments for services, but critics argue persistent underfunding has led to profitability squeezes, prompting calls for reform to sustain access. The 2024/25 and 2025/26 CPCF settlement includes £215 million for initiatives like Pharmacy First and hypertension case-finding, yet pharmacy representatives highlight that without addressing reimbursement delays and drug price concessions, closures could exacerbate "pharmacy deserts" in underserved areas.

Developing Markets: Vietnam and Informal Sectors

Vietnam's retail pharmacy sector has experienced rapid expansion following economic deregulation in the late 1980s, with private outlets dominating distribution and accounting for approximately 83% of pharmaceutical spending. The market, valued at around USD 5.19 billion in revenue projections for 2025, features a high density of drug outlets at 102 per 100,000 population, though access remains uneven, with fewer outlets in rural and low-income regions. Private pharmacies serve as the primary source for 80% of consumers, who frequently self-medicate, reflecting a shift from public facilities to retail channels post-1989 reforms that tripled annual pharmacy visits by the late 1990s. Informal sectors, including unregistered drug shops and unlicensed vendors, persist alongside formal retail, particularly in rural communities where they integrate into local supply networks without official oversight. These outlets, though poorly quantified in scale, facilitate immediate access to medicines in underserved areas but operate outside legal frameworks, often dispensing antibiotics and other controlled substances without prescriptions or quality verification. via such channels predominates as the initial response to illness across income levels, driven by convenience and proximity, yet it exacerbates risks from unregulated sourcing. Key challenges in these sectors include widespread and substandard drugs, which have infiltrated even urban pharmacies, with authorities issuing urgent warnings on specific fakes lacking active ingredients or containing harmful substitutes as of September 2025. Inspections reveal compliance issues in 16.1% of retail drugstores, such as improper storage and dispensing violations, while informal sales contribute to through unsupervised antibiotic overuse. This fragmentation stems from weak enforcement in a highly decentralized market, where boosted availability but prioritized volume over quality controls. Regulatory responses under the 2016 Law on Pharmacy, amended in 2024, define counterfeits strictly and impose penalties for production or trade, yet implementation lags, with calls for harsher measures to curb even single-pill violations. Efforts to formalize chains face restrictions on consolidation, perpetuating inefficiency and vulnerability to informal competition, though growth projections to USD 7-14 billion by 2030 signal potential for structured reforms if enforcement strengthens.

References

  1. https://www.news-medical.net/health/Community-Pharmacy.aspx
  2. https://www.retaildogma.com/pharmacy/
  3. https://www.ttuhsc.edu/pharmacy/museum/pharmacy.history.aspx
  4. https://www.rpharms.com/about-us/museum/online-exhibitions/the-history-of-the-royal-pharmaceutical-society/in-the-beginning
  5. https://pharmdonline.findlay.edu/blog/role-pharmacists-healthcare-systems
  6. https://www.wolterskluwer.com/en/expert-insights/evolving-role-pharmacists-bridging-gap-healthcare-access-patient-care
  7. https://www.op.nysed.gov/professions/pharmacy-establishments/information
  8. https://www.health.ny.gov/regulations/controlled_substance/part/80/docs/80.pdf
  9. https://www.mckinsey.com/industries/healthcare/our-insights/meeting-changing-consumer-needs-the-us-retail-pharmacy-of-the-future
  10. https://www.express-scripts.com/pharmacy/blog/history-of-pharmacy
  11. https://pmc.ncbi.nlm.nih.gov/articles/PMC8459052/
  12. https://pmc.ncbi.nlm.nih.gov/articles/PMC5723183/
  13. https://pmc.ncbi.nlm.nih.gov/articles/PMC5585823/
  14. https://www.nationalgeographic.com/history/article/middle-ages-diseases-medieval-pharmacies
  15. https://thackraymuseum.co.uk/from-potions-to-pills-a-short-history-of-the-apothecary/
  16. https://www.apothecaries.org/heritage/history/origins/
  17. https://thevialstore.com/blogs/news/the-evolution-of-pharmacy-a-short-history-part-2-the-middle-ages-to-1900
  18. https://www.ideals.illinois.edu/items/134630/bitstreams/443141/data.pdf
  19. https://history.library.ucsf.edu/1919_pharmacy.html
  20. https://pmc.ncbi.nlm.nih.gov/articles/PMC6789879/
  21. https://www.goodrx.com/hcp-articles/pharmacists/history-of-community-pharmacy-in-us
  22. https://www.pharmacypracticenews.com/Clinical/Article/10-24/A-History-of-Pharmacy-as-a-Profession/75032
  23. https://hopp.uwpress.org/content/59/3/63
  24. https://pubmed.ncbi.nlm.nih.gov/31330761/
  25. https://www.walgreensbootsalliance.com/news-media/our-stories/history-pharmacy-legacy-care
  26. https://www.foxbusiness.com/business-leaders/history-cvs-massachusetts-retailer-leading-health-solutions-company
  27. https://www.businessinsider.com/drugstores-that-no-longer-exist-2019-4
  28. https://www.thebootsgroup.co.uk/history
  29. https://pharmaphorum.com/r-d/a_history_of_the_pharmaceutical_industry
  30. https://academic.oup.com/jhmas/article/79/1/39/7476674
  31. https://www.wolterskluwer.com/en/expert-insights/online-and-mail-order-pharmacy-license-requirements
  32. https://www.statista.com/outlook/hmo/digital-health/digital-treatment-care/digital-care-management/online-pharmacy/united-states
  33. https://market.us/report/mail-order-pharmacy-market/
  34. https://www.globenewswire.com/news-release/2025/02/21/3030299/28124/en/Mail-Order-Pharmacy-Market-Trends-Opportunities-and-Strategies-2019-2024-2025-2034-CVS-Health-Leads-the-550-Billion-Fragmented-Market-Followed-by-Walmart-Pharmacy-and-Kroger-Health.html
  35. https://www.pharmacytimes.com/view/mail-order-and-supermarkets-outpace-chain-pharmacies-in-customer-satisfaction
  36. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/ryan-haight-act
  37. https://www.jonesday.com/en/insights/2025/02/dea-releases-rules-on-telemedicine-prescribing-of-controlled-substances-proposes-special-registrations
  38. https://www.fda.gov/drugs/drug-supply-chain-integrity/internet-pharmacy-warning-letters
  39. https://www.cdc.gov/media/releases/2024/s1002-counterfit-prescription-online-pharmacies.html
  40. https://www.dea.gov/alert/dea-issues-warning-about-illegal-online-pharmacies
  41. https://pmc.ncbi.nlm.nih.gov/articles/PMC3571003/
  42. https://www.goodrx.com/drugs/medication-basics/specialty-pharmacies
  43. https://pmc.ncbi.nlm.nih.gov/articles/PMC4750833/
  44. https://www.drugchannels.net/2025/06/the-top-15-specialty-pharmacies-of-2024.html
  45. https://www.medacs.com/blog/the-role-of-a-hospital-pharmacist/
  46. https://www.quadrecruitment.com/us/insights/blog/hospital-pharmacist-roles-and-responsibilities/
  47. https://www.mountcarmelhealth.com/newsroom/blog-articles/pharmacy-services-essential-roles-and-departments-mount-carmel
  48. https://www.usp.org/compounding/general-chapter-795
  49. https://www.avma.org/news/usp-revised-compounding-standards-go-effect
  50. https://www.ncbi.nlm.nih.gov/books/NBK562888/
  51. https://www.fda.gov/media/97353/download
  52. https://nabp.pharmacy/news/blog/nabp-compounding-pharmacy-inspections-identify-common-deficiencies/
  53. https://www.deadiversion.usdoj.gov/GDP/%28DEA-DC-046R1%29%28EO-DEA154R1%29_Pharmacist%27s_Manual_DEA.pdf
  54. https://pmc.ncbi.nlm.nih.gov/articles/PMC3278147/
  55. https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-209
  56. https://www.fda.gov/drugs/fdas-labeling-resources-human-prescription-drugs/patient-labeling-resources
  57. https://psnet.ahrq.gov/web-mm/medication-errors-retail-pharmacies-wrong-patient-wrong-instructions
  58. https://www.fda.gov/drugs/fda-drug-info-rounds-video/medication-guides-distribution-requirements-health-care-professionals-march-2020
  59. https://www.pharmacytimes.com/view/pharmacy-automation-the-future-of-medication-safety-and-efficiency
  60. https://parata.com/
  61. https://www.mckesson.com/pharmacy-technology/solutions-software/pharmacy-management-software/
  62. https://pharmaceutical-journal.com/article/ld/replacing-automated-medication-dispensing-machines-how-to-plan-and-implement-change-when-equipment-reaches-end-of-life
  63. https://pmc.ncbi.nlm.nih.gov/articles/PMC11869230/
  64. https://medpointuk.com/the-benefits-of-pharmacy-automation/
  65. https://www.capsahealthcare.com/blog/pharmacy-automation/the-benefits-of-pharmacy-automation/
  66. https://info.rxsafe.com/blog/what-is-pharmacy-automation
  67. https://www.uspharmacist.com/article/pros-and-cons-of-pharmacy-compounding
  68. https://law.lis.virginia.gov/vacode/title54.1/chapter34/section54.1-3410.2/
  69. https://rules.sos.ga.gov/gac/480-11
  70. https://www.wolterskluwer.com/en/expert-insights/6-key-focus-areas-of-usp-795
  71. https://www.pharmacytimes.com/view/what-pharmacists-should-know-about-revised-compounding-standards-becoming-official-on-november-1-2023
  72. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers
  73. https://www.ncbi.nlm.nih.gov/books/NBK562881/
  74. https://a4pc.org/hubfs/APC_Blueprint_v5.pdf
  75. https://join.a4pc.org/hubfs/PDFs/2021_National-Compounding-Demographics-Study-FULL.pdf
  76. https://www.health.harvard.edu/staying-healthy/thinking-of-using-a-compounding-pharmacy-what-you-need-to-know
  77. https://www.fda.gov/drugs/guidance-compliance-regulatory-information/human-drug-compounding
  78. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/assessing-the-impact-of-state-pharmacist-vaccination-authority-on-vaccine-uptake-in-the-us
  79. https://pmc.ncbi.nlm.nih.gov/articles/PMC11780693/
  80. https://www.drugtopics.com/view/an-update-on-state-level-authority-on-pharmacy-immunization
  81. https://www.cdc.gov/covidvaxview/weekly-dashboard/vaccinations-administered-pharmacies-medical.html
  82. https://www.tandfonline.com/doi/full/10.1080/14760584.2025.2514517?src=
  83. https://pmc.ncbi.nlm.nih.gov/articles/PMC10391185/
  84. https://hdsbpc.cdc.gov/s/article/Evidence-of-Impact-for-Community-Pharmacists-and-Medication-Therapy-Management
  85. https://www.jmcp.org/doi/10.18553/jmcp.2009.15.1.18?mobileUi=0
  86. https://www.uspharmacist.com/article/pharmacists-duties-for-patient-care-a-primer
  87. https://journalofethics.ama-assn.org/article/pharmacist-and-prescriber-responsibilities-avoiding-prescription-drug-misuse/2021-06
  88. https://bouve.northeastern.edu/news/what-do-pharmacists-do-roles-and-responsibilities/
  89. https://www.medicalnewstoday.com/articles/what-does-a-pharmacist-do
  90. https://college.mayo.edu/academics/explore-health-care-careers/careers-a-z/pharmacist/
  91. https://www.quadrecruitment.com/us/insights/blog/retail-pharmacist-responsibilities-and-salary/
  92. https://careers.aaspa.com/career/retail-pharmacist
  93. https://www.pharmacist.com/Career/Career-Pathways/Career-Option-Profiles/Community-Chain
  94. https://pmc.ncbi.nlm.nih.gov/articles/PMC4131399/
  95. https://www.ashp.org/-/media/assets/policy-guidelines/docs/statements/community-pharmacist-role-care-continuum
  96. https://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm
  97. https://www.auamed.org/blog/medical-field-careers/what-is-a-pharmacy-technician/
  98. https://www.coursera.org/articles/pharmacy-technician
  99. https://pmc.ncbi.nlm.nih.gov/articles/PMC8051924/
  100. https://www.pharmacyregulation.org/students-and-trainees/pharmacy-support-staff-education-and-training
  101. https://www.researchgate.net/publication/247674905_Support_staff_in_community_pharmacy_Who_are_they_and_what_do_they_want
  102. https://cpe.org.uk/learn-more-about-community-pharmacy/pharmacy-teams/
  103. https://www.pacificu.edu/blog/getting-your-pharmd-how-long-pharmacy-school
  104. https://www.mcphs.edu/admission-and-aid/blog/how-many-years-is-a-pharmd-degree
  105. https://www.pcom.edu/academics/programs-and-degrees/doctor-of-pharmacy/school-of-pharmacy/blog/how-long-is-pharmacy-school.html
  106. https://nabp.pharmacy/programs/examinations/naplex/
  107. https://nabp.pharmacy/programs/examinations/
  108. https://dopl.utah.gov/pharmacy/exam-information/
  109. https://www.ashp.org/professional-development/continuing-education
  110. https://www.op.nysed.gov/professions/pharmacist/continuing-education
  111. https://www.pharmacytimes.com/view/combating-the-post-pandemic-pharmacy-workforce-shortage
  112. https://pharmacy.media.uconn.edu/wp-content/uploads/sites/2740/2025/02/Burnout-2025-Revised-DRAFT.pdf
  113. https://medshadow.org/why-pharmacies-are-closing-pharmacist-burnout/
  114. https://pharmaceutical-journal.com/article/feature/are-staff-shortages-compromising-safe-pharmacy-care
  115. https://pmc.ncbi.nlm.nih.gov/articles/PMC12346093/
  116. https://www.researchgate.net/publication/389744817_Addressing_Pharmacist_Burnout_and_Staffing_Shortages_A_Review_of_Challenges_and_Solutions
  117. https://pmc.ncbi.nlm.nih.gov/articles/PMC9607108/
  118. https://academic.oup.com/ajhp/article-abstract/54/5/531/5155022
  119. https://go.uic.edu/olsonrhi
  120. https://schaeffer.usc.edu/research/to-save-on-prescriptions-buy-at-independent-pharmacies-and-use-coupons/
  121. https://pmc.ncbi.nlm.nih.gov/articles/PMC10519705/
  122. https://ncpa.org/your-neighbor
  123. https://www.commonwealthfund.org/publications/explainer/2025/mar/what-pharmacy-benefit-managers-do-how-they-contribute-drug-spending
  124. https://www.pharmacytimes.com/view/pbm-price-negotiations-have-unintended-consequences-for-independent-pharmacies
  125. https://publichealth.berkeley.edu/articles/spotlight/research/pharmacies-left-off-preferred-networks-more-likely-to-close
  126. https://www.icsc.com/news-and-views/icsc-exchange/as-chain-drugstores-close-what-about-independent-pharmacies
  127. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2836775
  128. https://lumistry.com/blog/challenges-independent-pharmacies-face/
  129. https://www.pharmacytimes.com/view/ncpa-2024-in-spite-of-challenges-independent-pharmacies-are-continuing-to-serve-patients
  130. https://www.1870ventures.com/article/5-challenges-facing-independent-pharmacies
  131. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2831934
  132. https://ohiocapitaljournal.com/2025/01/21/independent-pharmacies-know-their-communities-but-many-are-struggling-to-stay-open/
  133. https://advisory.avalerehealth.com/insights/independent-pharmacy-challenges-and-adaptive-strategies
  134. https://www.drugchannels.net/2025/03/the-top-15-us-pharmacies-of-2024-market.html
  135. https://www.scrapehero.com/location-reports/10-largest-pharmacies-in-the-usa/
  136. https://pmc.ncbi.nlm.nih.gov/articles/PMC4177635/
  137. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=19092&context=dissertations
  138. https://www.genrxpharmacygroup.com/market-research
  139. https://www.rootsanalysis.com/key-insights/large-pharmacy-chains.html
  140. https://anderson-review.ucla.edu/india-pharmacy/
  141. https://ncpa.org/newsroom/news-releases/2023/10/15/ncpa-releases-2023-digest-report
  142. https://www.cardinalhealth.com/en/services/retail-pharmacy/pharmacy-ownership/franchise-services.html
  143. https://www.medicineshoppe.ca/en/franchising-opportunities/our-model
  144. https://www.franchisehelp.com/franchises/medicap-pharmacy/
  145. https://topfranchise.com/articles/best-6-pharmacy-franchise-business-opportunities-in-usa/
  146. https://www.ipcrx.com/pharmacy-gpo-and-buying-group-ipc-advantage/
  147. https://www.ipcrx.com/
  148. https://www.epicrx.com/buying-group/
  149. https://www.rxaap.com/
  150. https://www.fpn.org/member-groups
  151. https://www.drugtopics.com/view/franchise-or-buying-group-whats-difference
  152. https://pharmaceutical-journal.com/article/feature/pharmacy-franchises-and-buying-groups-advantages-and-drawbacks
  153. https://www.pharmaceutical-journal.com/article/feature/pharmacy-franchises-and-buying-groups-advantages-and-drawbacks
  154. https://www.wolterskluwer.com/en/expert-insights/pharmacy-business-license-requirements
  155. https://www.harborcompliance.com/pharmacy-license
  156. https://research.com/careers/how-to-become-a-licensed-pharmacist-in-los-angeles
  157. https://www.pharmacy.ca.gov/
  158. https://www.dea.gov/drug-information/csa
  159. https://www.ncbi.nlm.nih.gov/books/NBK562220/
  160. https://federal-lawyer.com/healthcare/healthcare-compliance/pharmacies-dea-compliance-guide/
  161. https://verisys.com/blog/pharmacy-compliance/
  162. https://www.wolterskluwer.com/en/expert-insights/controlled-substance-registration-requirements
  163. https://www.frierlevitt.com/articles/navigating-compliance-under-heightened-scrutiny-of-controlled-substance-dispensing/
  164. https://pharmacyconnection.ca/the-code-of-ethics-principle-of-beneficence/
  165. https://pmc.ncbi.nlm.nih.gov/articles/PMC8720823/
  166. https://www.ashp.org/-/media/assets/policy-guidelines/docs/endorsed-documents/code-of-ethics-for-pharmacists.ashx
  167. https://sop.washington.edu/pharmd/the-husky-pharmacist/code-of-ethics-for-pharmacists/
  168. https://www.pharmacytimes.com/view/ethical-challenges-pharmacists-face-when-managing-noncompliant-patients-
  169. https://link.springer.com/article/10.1007/s11096-024-01797-9
  170. https://pmc.ncbi.nlm.nih.gov/articles/PMC7194708/
  171. https://www.pharmacytimes.com/view/addressing-the-ethical-complications-of-drug-shortages-incorporating-ethical
  172. https://www.neurology.org/doi/10.1212/WNL.0000000000012571
  173. https://ocpinfo.com/pharmacy-professionals/rules-and-standards-of-the-profession/code-of-ethics/
  174. https://pmc.ncbi.nlm.nih.gov/articles/PMC9117776/
  175. https://www.sciencedirect.com/science/article/pii/S2667276625000502
  176. https://pubmed.ncbi.nlm.nih.gov/20447746/
  177. https://www.medpagetoday.com/pharmacy/pharmacy/109422
  178. https://pmc.ncbi.nlm.nih.gov/articles/PMC557172/
  179. https://www.fox9.com/news/pharmacist-prescription-refusal-lawsuit-highlights-human-religious-rights
  180. https://academic.oup.com/ijpp/article/31/2/117/7081511
  181. https://www.tandfonline.com/doi/full/10.1080/20523211.2024.2323086
  182. https://www.nejm.org/doi/full/10.1056/NEJMsb042263
  183. https://pmc.ncbi.nlm.nih.gov/articles/PMC5931075/
  184. https://pubmed.ncbi.nlm.nih.gov/40475912/
  185. https://pmc.ncbi.nlm.nih.gov/articles/PMC10713840/
  186. https://usafacts.org/articles/opioid-addiction-deaths-and-treatment-latest-analysis-data/
  187. https://www.ncbi.nlm.nih.gov/books/NBK458653/
  188. https://www.asam.org/advocacy/practice-resources/pharmacy-access
  189. https://www.tn.gov/health/health-program-areas/health-professional-boards/csmd-board/csmd-board/faq.html
  190. https://www.sciencedirect.com/science/article/pii/S2772724623000690
  191. https://www.cdc.gov/overdose-prevention/data-research/facts-stats/opioid-dispensing-rate-maps.html
  192. https://www.bmj.com/content/379/bmj.o2688
  193. https://www.npr.org/2022/11/02/1133523740/cvs-health-agrees-to-a-5-billion-settlement-in-opioid-lawsuits
  194. https://nationalopioidsettlement.com/
  195. https://www.ama-assn.org/press-center/ama-press-releases/report-shows-decreases-opioid-prescribing-increase-overdoses
  196. https://www.cdc.gov/mmwr/volumes/69/ss/ss6901a1.htm
  197. https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/jac5.1171
  198. https://www.pharmacytimes.com/view/pharmacists-report-high-levels-of-burnout-resulting-in-understaffing-and-alternative-career-paths
  199. https://pmc.ncbi.nlm.nih.gov/articles/PMC5998534/
  200. https://www.assurecare.com/articles/the-2022-pharmacy-understaffing-epidemic
  201. https://pmc.ncbi.nlm.nih.gov/articles/PMC11607704/
  202. https://pharmaceutical-journal.com/article/feature/special-report-the-stressors-burning-out-pharmacists
  203. https://www.drugtopics.com/view/student-staffing-shortages-continue-to-impact-pharmacy-profession
  204. https://journalissues.org/ibspr/wp-content/uploads/sites/6/2021/03/Al-Suwailem.pdf
  205. https://www.pcmanet.org/glossary-of-drug-pricing-terms/
  206. https://www.outcomes.com/blog/pharmacy/understanding-awp-and-your-pharmacys-drug-blend
  207. https://www.outcomes.com/blog/pharmacy/understanding-your-pbm-contract-brand-vs.-generic-drug-pricing
  208. https://pharmacy.osu.edu/news/shedding-light-nadac-how-pricing-power-influences-pharmacy-reimbursement
  209. https://www.medicaid.gov/medicaid/prescription-drugs/retail-price-survey
  210. https://www.globallegalinsights.com/practice-areas/pricing-reimbursement-laws-and-regulations/usa/
  211. https://www.pharmacytimes.com/view/white-paper-dir-fees-simply-explained
  212. https://www.nacds.org/dir-fees/
  213. https://www.ftc.gov/system/files/ftc_gov/pdf/pharmacy-benefit-managers-staff-report.pdf
  214. https://www.pcmanet.org/research/dispensing-fee-mandates-increase-drug-spending-here-is-the-data/01/22/2025/
  215. https://www.reuters.com/business/healthcare-pharmaceuticals/us-ftc-finds-major-pharmacy-benefit-managers-inflated-drug-prices-73-billion-2025-01-14/
  216. https://www.ftc.gov/news-events/news/press-releases/2025/01/ftc-releases-second-interim-staff-report-prescription-drug-middlemen
  217. https://www.ajmc.com/view/ftc-report-highlights-prescription-drug-price-markups-by-pbms
  218. https://www.pharmacytimes.com/view/pbm-reform-takes-off-in-2025
  219. https://www.ftc.gov/reports/pharmacy-benefit-managers-report
  220. https://ncpa.org/newsroom/news-releases/2024/10/27/ncpa-releases-2024-digest-report
  221. https://www.primerx.io/blog/primerx-market/otc-products-offer-pharmacies-a-revenue-bright-spot-primerx-and-primerx-market-can-help/
  222. https://www.ibisworld.com/united-states/industry/pharmacies-drug-stores/1054/
  223. https://rxadvisorinc.com/how-profitable-are-pharmacies-in-2024/
  224. https://aspe.hhs.gov/sites/default/files/documents/db1adf86053b1fda8ae9efd01c10ddc8/Pharma%2520Supply%2520Chains%2520Margins%2520Report_Final_2024.09.27_Clean_508.pdf
  225. https://drugchannelsinstitute.com/files/2024-PharmacyPBM-DCI-Overview.pdf
  226. https://drugstorenews.com/5-biggest-challenges-facing-retail-pharmacy
  227. https://shiftposts.com/2025-retail-pharmacy-trends/
  228. https://ncpa.org/sites/default/files/2025-01/January2025-ThreeAxisAdvisors-Unpacking-the-Financial-Impacts-of-Medicare-Drug-Price-Negotiation.pdf
  229. https://www.mckinsey.com/industries/healthcare/our-insights/what-to-expect-in-us-healthcare-in-2025-and-beyond
  230. https://pmc.ncbi.nlm.nih.gov/articles/PMC11932220/
  231. https://journals.lww.com/jrpp/fulltext/2025/07000/impact_of_artificial_intelligence_on_the_future_of.1.aspx
  232. https://www.drugtopics.com/view/understanding-pharmacists-perception-of-ai-is-crucial-to-pharmacy-profession
  233. https://www.uspharmacist.com/article/the-evolving-telepharmacy-dispensing-landscape
  234. https://pmc.ncbi.nlm.nih.gov/articles/PMC11633999/
  235. https://pmc.ncbi.nlm.nih.gov/articles/PMC11839528/
  236. https://www.elitelearning.com/resource-center/pharmacy-2/the-growing-practice-of-telepharmacy/
  237. https://www.sciencedirect.com/science/article/pii/S3050837125000086
  238. https://newsroom.cardinalhealth.com/Industry-leading-innovations-expand%2C-modernize-pharmaceutical-distribution
  239. https://www.hklaw.com/en/insights/publications/2025/06/us-pharmaceutical-manufacturing-and-supply-chain-2025-risks
  240. https://www.csis.org/analysis/rebuilding-resilience-us-pharmaceutical-manufacturing
  241. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808246
  242. https://pmc.ncbi.nlm.nih.gov/articles/PMC11034534/
  243. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831360
  244. https://pmc.ncbi.nlm.nih.gov/articles/PMC6806432/
  245. https://www.uspharmacist.com/article/the-impact-of-pharmacy-deserts
  246. https://www.sciencedirect.com/science/article/abs/pii/S1544319124000049
  247. https://www.cdc.gov/pcd/issues/2020/20_0066.htm
  248. https://pmc.ncbi.nlm.nih.gov/articles/PMC11017547/
  249. https://pmc.ncbi.nlm.nih.gov/articles/PMC6481442/
  250. https://jamanetwork.com/journals/jama/fullarticle/2825803
  251. https://www.sciencedirect.com/science/article/pii/S0264410X23015098
  252. https://www.sciencedirect.com/science/article/abs/pii/S1551741125000713
  253. https://pmc.ncbi.nlm.nih.gov/articles/PMC9448680/
  254. https://pmc.ncbi.nlm.nih.gov/articles/PMC10133503/
  255. https://pubmed.ncbi.nlm.nih.gov/30145351/
  256. https://www.ajpe.org/article/S0002-9459%2823%2904347-4/pdf
  257. https://www.japha.org/article/S1544-3191%2824%2900303-0/pdf
  258. https://www.cdc.gov/pcd/issues/2020/20_0317.htm
  259. https://www.medrxiv.org/content/10.1101/2025.09.12.25335325v1
  260. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-025-01238-4
  261. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-22210-8
  262. https://www.sciencedirect.com/science/article/abs/pii/S0047272722001359
  263. https://mattersnetwork.org/efficacy-of-harm-reduction/
  264. https://pmc.ncbi.nlm.nih.gov/articles/PMC11032639/
  265. https://pmc.ncbi.nlm.nih.gov/articles/PMC10198806/
  266. https://www.hsrd.research.va.gov/publications/esp/SyringeService-report.pdf
  267. https://link.springer.com/article/10.1007/s11469-025-01543-w
  268. https://pmc.ncbi.nlm.nih.gov/articles/PMC7679315/
  269. https://www.cambridge.org/core/journals/bjpsych-international/article/harm-reduction-and-abstinencebased-models-for-treatment-of-substance-use-disorders-during-the-covid19-pandemic-a-global-perspective/3384275A69CED598C0454AB2EE774A62
  270. https://pmc.ncbi.nlm.nih.gov/articles/PMC5774321/
  271. https://www.nbmtm.org/mtm-reference/significant-research-mtm-associated-cost-savings/
  272. https://www.sciencedirect.com/science/article/abs/pii/S073839912300472X
  273. https://www.jmcp.org/doi/10.18553/jmcp.2016.22.6.699
  274. https://pmc.ncbi.nlm.nih.gov/articles/PMC12440904/
  275. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811317
  276. https://pmc.ncbi.nlm.nih.gov/articles/PMC10149568/
  277. https://pmc.ncbi.nlm.nih.gov/articles/PMC3780492/
  278. https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.1815
  279. https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01952-z
  280. https://www.drugpatentwatch.com/blog/how-are-prescription-drug-prices-determined/
  281. https://www.kingsfund.org.uk/insight-and-analysis/long-reads/community-pharmacy-explained
  282. https://www.england.nhs.uk/2024/01/over-10000-nhs-pharmacies-begin-treating-people-for-common-conditions/
  283. https://www.gov.uk/government/publications/community-pharmacy-contractual-framework-2024-to-2025-and-2025-to-2026/community-pharmacy-contractual-framework-2024-to-2025-and-2025-to-2026
  284. https://www.pharmacyregulation.org/pharmacies/standards-and-guidance-registered-pharmacies
  285. https://www.pharmacyregulation.org/
  286. https://www.england.nhs.uk/long-read/pharmacy-manual/
  287. https://www.gov.uk/government/consultations/pharmacy-supervision/outcome/pharmacy-supervision-consultation-government-response
  288. https://pharmaceutical-journal.com/article/news/more-than-12000-pharmacies-reported-as-active-in-2023-2024-after-large-numbers-changed-hands
  289. https://www.rand.org/pubs/commentary/2024/10/can-community-pharmacies-help-address-the-nhss-growing.html
  290. https://cpe.org.uk/our-news/cpcf-arrangements-for-2024-25-and-2025-26-announced/
  291. https://documents1.worldbank.org/curated/en/222831563548465796/pdf/The-Future-of-Health-Financing-in-Vietnam-Ensuring-Sufficiency-Efficiency-and-Sustainability.pdf
  292. https://www.statista.com/outlook/hmo/pharmacies/vietnam
  293. https://pmc.ncbi.nlm.nih.gov/articles/PMC9897978/
  294. https://vietnam.incorp.asia/vietnam-pharmaceutical-companies/
  295. https://documents1.worldbank.org/curated/en/480911468761347026/pdf/multi0page.pdf
  296. https://pmc.ncbi.nlm.nih.gov/articles/PMC6880519/
  297. https://vietnamnet.vn/en/vietnam-issues-urgent-warning-over-five-counterfeit-drug-cases-2443515.html
  298. https://vietnamnet.vn/en/vietnam-s-fake-drug-crisis-deepens-authorities-sound-the-alarm-2404820.html
  299. https://www.researchgate.net/publication/381725402_Analysis_of_pharmacy_inspection_results_for_retail_drugstores_in_Central_region_of_Vietnam_from_2018_to_2022
  300. https://www.economica.vn/Content/files/LAW%2520%2526%2520REG/105_2016_QH13%2520Law%2520on%2520Pharmacy.pdf
  301. https://vietnamnews.vn/society/1718470/harsher-penalties-needed-to-combat-trade-of-fake-drugs.html
  302. https://www.tilleke.com/insights/vietnam-amends-law-on-pharmacy/2/
  303. https://documents1.worldbank.org/curated/en/881571489040499129/pdf/113256-WP-Pharma-Distribution-Retailing-PUBLIC.pdf
  304. https://www.credenceresearch.com/report/vietnam-retail-pharmacy-market
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