Marsha K. Millonig, B.Pharm., M.B.A. Catalyst Enterprises
Marsha K. Millonig, B.Pharm., M.B.A.

The National Community Pharmacists Association (NCPA) held one of the first “live” pharmacy events last month with the return of its annual meeting in October. I made it a point to attend the National Alliance of State Pharmacy Association’s fall meeting held in conjunction with the NCPA event. Both were well attended, and it was evident people were happy to finally collaborate and connect in person after having so many professional and personal disruptions due to the COVID-19 pandemic. The association released its 2021 NCPA Digest at the event, and findings show community pharmacy holding its own despite continued challenges.

Based on the 2020 data, independent community pharmacy sales were over $67 billion, with 93% derived from prescriptions dispensed. As of June 2021, the number of independent pharmacies numbered 19,397. Net margins were slim due to continued margin pressure on prescription drugs from third-party payers and government contracts, performance incentives, and direct and indirect remuneration (DIR) fees. Coverage of prescriptions included 55% from government programs, 35% from commercial third-party programs, and 10% from other non-third-party programs.

As of the writing of this column, current statistics for age groups fully vaccinated in the United States are:

  • 75+ are at 83%
  • 65–74 are at 88.2%
  • 50–64 are at 76.1%
  • 40–49 are at 68.7%
  • 25–39 are at 60.4%
  • 18–24 are at 56.2%
  • 12–17 are at 50.5%

Details may be found at Mayo Clinic’s site.


Average sales in 2020 were nearly $3.5 million, with a $60,123 increase from 2019. Gross profit margins declined slightly, however, from 22% in 2019 to 21.9% in 2020. Gross profit dollars increased, however, by $11,029. The average community pharmacy dispensed 57,678 prescriptions, 185 per day, an increase from the 57,414 dispensed in 2019. That included 30,000 renewed prescriptions (52%) and 27,678 new prescriptions (48%). These numbers have been in decline since 2016, so it was welcome news to see the increase. Many independents continue to operate multiple pharmacies, with 32% having ownership in two or more.

These numbers reflect the readiness of America’s independent pharmacy network as part of the public health infrastructure, especially during the pandemic, notes NCPA CEO Doug Hoey. The network has continued to provide innovative services to the public throughout the pandemic, including expanding immunization capacity to include the COVID vaccines. All pharmacies are stepping up to the plate and providing expanded immunization services. I know this firsthand as a front-line immunizer who has worked more than double my usual capacity during the pandemic in providing immunization services. We have much to be proud of as a pharmacy community.

Recently children 5 to 11 years old were green-lighted for a COVID vaccination, and pharmacies are receiving the first Pfizer vaccines as I write this column. Booster demand remains strong, in my personal experience, and many of the locations where I am providing immunizations are experiencing record numbers. There has been an increase in the number of individuals seeking vaccination for the first time, most often because of employer mandates. It has allowed for many more conversations to address vaccine hesitancy, as well as newer antiviral therapies and off-label uses of current medications. There are still too many individuals who remain unvaccinated or under-vaccinated, even though more than 433.1 million COVID vaccine doses have been given; nearly 194.2 million people have been fully vaccinated, and about 25.4 million people had received a booster dose as of Nov. 9, 2021.

The international pharmacy community has also played an increasing role in providing expanded clinical services, including immunization programs and education. The International Pharmaceutical Federation (FIP) undertook a global survey of pharmacy’s impact on immunization coverage in 2020. Some key findings:

  • Some 70% of respondents confirmed that pharmacists play an active role in educating the public on vaccine-preventable diseases and serve as vaccine advocates.
  • Pharmacy-based vaccination (PBV) is available in at least 36 countries and territories, 16 more than in the FIP’s 2016 survey.
  • Nearly 1.8 billion people can now access vaccination services at a community pharmacy around the world — almost twice as many as in the 2016 survey.
  • Vaccine administration is authorized in 26 countries and territories, compared with 13 in 2016. However, 66 countries and territories have yet to authorize this — two-thirds of those surveyed — though many indicate they are in planning stages.

Study authors note that as countries report outcomes from PBV programs, more countries are likely to come on board. The study is accessible to FIP members at

In addition to the immunization report, FIP recently released its global report on community pharmacy as well. Like the NCPA Digest, the FIP report looks at the scope of community pharmacy practice as well as its workforce, regulations, and reimbursement models. The good news is that since 2016, there has been a 12.1% increase in the average density of community pharmacists per 10,000 patient population and an 11.2% increase in community pharmacies per 10,000 patient population.

As in the United States, community pharmacy globally is meeting the ongoing challenges and continues to provide important services to patients. I’ll focus on expanded pharmacy services both in the United States and globally in an upcoming column. These expanded services will be important to distinguish community pharmacies from emerging digital pharmacy competitors — a topic I’ll address at the American Society for Automation in Pharmacy’s annual conference March 15–17, 2022, in Amelia Island, Fla. Registration is open now. This is a conference worth attending. CT

Marsha K. Millonig, B.Pharm., M.B.A., is president and CEO of Catalyst Enterprises, LLC, and an associate fellow at the University of Minnesota College of Pharmacy Center for Leading Healthcare Change. The author can be reached at