CVS Health vs Walgreens in the U.S. Pharmacy Market

A Tale of Two Pharmacy Giants: Walgreens vs. CVS in America’s Drugstore Market

Ubiquitous Stores, Divergent Paths

On opposite corners of countless American streets sit two familiar signs: Walgreens and CVS. These pharmacy giants dominate the U.S. drugstore landscape with a combined footprint of nearly 20,000 stores nationwide. Both chains are ubiquitous fixtures of daily life – a place to pick up prescriptions, grab a snack, or get a flu shot – yet behind their similar storefronts, Walgreens Boots Alliance and CVS Health have charted very different courses. Over the past few years, their strategies, market positions, and financial fortunes have diverged in striking ways. This analytical look examines how each company is positioned in the U.S. pharmacy retail sector and how they are adapting to a rapidly changing healthcare retail environment.

Market Positioning: Footprint and Presence

Walgreens and CVS have each achieved a truly national presence. Walgreens Boots Alliance, through its Walgreens stores (and a handful of legacy names like Duane Reade), operates just under 10,000 U.S. locations. CVS Health, not far behind, runs roughly 8,800 U.S. retail locations. In terms of sheer scale, Walgreens holds a slight edge in store count. Its locations tend to be a bit larger on average, contributing to a total of about 128 million square feet of retail space across the country. CVS stores collectively occupy roughly 100 million square feet in the U.S.. Both chains blanket all major markets and many rural areas, ensuring that most Americans are within a short drive of at least one of their outlets.

Despite this comparable scale, there are subtle differences in how each built its empire. Walgreens, founded in 1901 in Illinois, expanded largely through organic growth, planting stores in urban centers and suburban street corners alike. CVS, born in 1963 in Massachusetts, grew not only by opening new stores but by aggressively acquiring regional chains – from People’s Drug in the Mid-Atlantic to Longs Drugs on the West Coast – to extend its geographic reach. The result today is that both companies have coast-to-coast coverage. If there is any distinction, Walgreens historically had a stronger presence in big cities and downtowns, while CVS’s acquisitions gave it a foothold in diverse regions (for example, CVS absorbed many Eckerd and Sav-On stores in the South and West). However, these differences are marginal now; each company operates in nearly every state, often with multiple stores in the same town, frequently facing one another in direct competition across intersections.

Revenue and Productivity: Sales per Square Foot and Employee

While their store footprints are similar, Walgreens and CVS differ dramatically in revenue scale – a reflection of divergent business models. CVS Health generates an enormous annual revenue of roughly $374 billion, more than double that of Walgreens Boots Alliance’s approximately $147 billion. This gap is not because CVS’s pharmacies sell so many more products per store; rather, it stems from CVS’s evolution into a diversified health conglomerate. CVS’s top-line figure includes not only drugstore sales, but also a massive pharmacy benefits management business and a major health insurance division. By contrast, Walgreens’ revenue is dominated by its retail pharmacy and over-the-counter product sales in stores, with far fewer outside streams.

The result is that CVS achieves eye-popping productivity metrics. When dividing revenue by physical footprint, CVS earns an estimated $3,700 in annual sales per square foot of space – an unusually high figure for any retailer. (By comparison, Walgreens brings in roughly $1,150 per square foot – still high for retail, but a fraction of CVS’s level.) In terms of human resources, CVS generates on the order of $1.7 million in revenue per employee, versus about $0.47 million per employee at Walgreens, based on their workforce sizes and revenues. These disparities underscore how CVS’s integrated model allows it to do more with less in a physical sense: much of CVS’s revenue comes from managing insurance plans and prescription benefit contracts – businesses that require huge transaction volumes but not aisles of store shelving. Walgreens, being more purely a retailer, naturally has more employees running cash registers, pharmacy counters and stockrooms relative to its revenue.

It’s important to note that if we isolate the retail pharmacy operations alone, the productivity gap is smaller. According to industry data, CVS’s revenue specifically from U.S. pharmacy and drugstore activity is about $130 billion, while Walgreens’ is about $121.5 billion, virtually neck and neck. On a per-store basis, both companies sell a similar mix of prescription drugs (their largest revenue driver) and front-of-store products like health and beauty aids or snacks. In pure retail terms, analysts estimate CVS’s sales per square foot in its pharmacies are on par with or slightly above Walgreens’. But CVS’s non-store businesses (insurance premiums, mail-order pharmacy services, etc.) dramatically boost its total revenue beyond what the brick-and-mortar footprint alone would suggest. Thus, CVS’s revenue per employee soars because many employees are in corporate or technical roles managing claims and benefits, whereas Walgreens’ large workforce is mostly customer-facing in stores. This contrast highlights how each firm’s strategy – diversification at CVS versus retail focus at Walgreens – translates into different efficiency metrics.

Shifting Market Share in the U.S. Pharmacy Sector

The competitive balance between CVS and Walgreens in the U.S. has seen notable shifts over the past 3–5 years. Traditionally, Walgreens was the single largest player in the American pharmacy market by retail sales. As recently as 2020, Walgreens (including its U.S. alliance with Rite Aid stores it acquired) commanded about 22.8% of the U.S. pharmacies and drugstores market, while CVS had around 19.3%. In other words, five years ago Walgreens held a clear lead in market share.

Fast forward to 2025, and CVS has overtaken its rival. CVS now accounts for roughly 21% of U.S. pharmacy retail revenues, edging ahead of Walgreens’ approximately 20% share. This changing of the guard reflects trends in both companies’ performance. CVS managed to expand its retail prescription volume and sales each year, even as the overall industry grew, thereby boosting its share. Walgreens, on the other hand, saw its share slip from the mid-20s to just under one-fifth. By 2023, Walgreens’ U.S. retail pharmacy segment actually began to shrink in volume, posting a small decline in prescriptions filledreuters.com. Some of Walgreens’ slippage can be attributed to external factors – for instance, the wind-down of the pandemic-era surge in vaccinations and COVID-19 test sales hit Walgreens harder in 2023reuters.comreuters.com – but there are structural issues too. Walgreens faced weaker retail sales in categories like beauty and personal care and lost some price-sensitive customers to competitors.

The collapse of Rite Aid has also played a role in redistributing market share. A decade ago, Rite Aid was the third-largest drugstore chain, but it has steadily eroded – selling many stores to Walgreens in 2018 and then filing for Chapter 11 bankruptcy in 2023. By 2025, Rite Aid’s share of the U.S. pharmacy market dwindled to under 2%. CVS and Walgreens have collectively absorbed some of Rite Aid’s business as that company closed stores or sold assets. Notably, CVS’s gain of a couple percentage points in share since 2020 correlates with Rite Aid’s final decline; CVS appears to have captured prescription customers in markets where Rite Aid retreated. Walgreens, despite buying a large chunk of Rite Aid stores earlier, did not see a lasting boost – partly because integration challenges and store overlaps led Walgreens to shutter some of those locations, and partly because other competitors stepped up.

Walmart is one such competitor that has quietly grown its pharmacy footprint inside its big-box stores. Walmart’s share of the pharmacy market ticked up to nearly 10%, making it the solid number three player now. In addition, grocery chains (like Kroger and Publix) and membership clubs (Costco, Sam’s Club) collectively account for a significant portion of prescriptions. And in recent years, online and mail-order pharmacies have become a small but fast-growing slice of the pie. Amazon’s entry via Amazon Pharmacy (after acquiring the start-up PillPack) and independent mail-order services are beginning to nibble at the edges of the market, especially for maintenance medications.

All of these factors mean that while CVS and Walgreens remain the twin giants, controlling about 40% of U.S. pharmacy sales combined, the dynamics within that duopoly are shifting. CVS’s bold moves beyond the traditional drugstore model may be giving it an edge in capturing more customer spend (through things like membership programs tied to insurance or offering broader health services). Walgreens, facing headwinds, is now hustling to defend its once-dominant position on Main Street.

Vertical Integration vs. Partnerships: Two Business Models

Perhaps the clearest difference between CVS and Walgreens is their strategic posture – how each has chosen to grow and define its business model in the broader healthcare value chain. CVS Health’s strategy has been one of vertical integration: it has deliberately expanded beyond retail pharmacies into other healthcare sectors to create a multifaceted health services company. Most famously, CVS acquired the major health insurer Aetna in 2018, instantly transforming itself into one of the nation’s largest insurance companies. Years earlier, CVS also bought Caremark, making it a leading pharmacy benefit manager (PBM) that administers prescription drug plans for insurers and employers. These moves mean CVS now straddles insurance, PBM, and retail pharmacy — effectively controlling or influencing multiple links of the drug supply chain. This vertical integration aims to give CVS cost advantages (they can negotiate drug prices knowing they manage the benefits too) and customer retention benefits (an insurance member might be encouraged to use CVS pharmacies, for instance). As industry analysts note, chains like CVS (and at one time Rite Aid) acquired PBMs to “leverage vertical integration to become more competitive.” By owning a PBM, CVS can ensure a steady flow of customers to its stores and negotiate better terms on medications. Owning an insurer goes even further – CVS can capture premium dollars and pay itself for healthcare services delivered at its pharmacies or in its in-store clinics. The company has branded itself as “CVS Health” to reflect this broader scope, and its corporate mantra is building “a world of health” around the consumer, not just running drugstores.

Walgreens Boots Alliance, in contrast, has pursued a partnership-driven model to broaden its reach in healthcare. Rather than acquire an insurer outright, Walgreens has opted to team up with or invest in specialized healthcare companies. One major prong of Walgreens’ strategy has been a partnership with VillageMD, a primary care clinic operator. Walgreens invested billions into VillageMD and began opening “Village Medical at Walgreens” clinics co-located with its drugstores – with an ambitious goal of 500–700 clinics across more than 30 U.S. markets. The idea is to turn Walgreens locations into healthcare hubs where patients can see a doctor and fill their prescriptions in one stop, expanding Walgreens’ role in preventive and primary care. Additionally, Walgreens took stakes in other health service firms: for example, it invested in CareCentrix, a home-care coordination company, and Shields Health Solutions, which focuses on specialty pharmacy. Instead of buying these companies outright and internalizing them, Walgreens’ approach has been to form joint ventures or minority investments, keeping the businesses somewhat separate. Even in the pharmacy benefits arena, Walgreens did not buy a PBM; instead, it partnered with established PBMs (for instance, a long-running alliance with Prime Therapeutics) to handle mail-order fulfillment and specialty drugs.

This partnership strategy reflects Walgreens’ historically more conservative, retail-focused culture. However, it comes with risks. Executing in partnership can be complicated, and Walgreens has faced some setbacks. Its massive investment in VillageMD, for instance, has yet to turn the corner to profitability – in fact, Walgreens recently had to write down about $5.8 billion on the value of that investment after clinic expansion proved too rapid and costly. In late 2023, under financial pressure, Walgreens and VillageMD decided to scale back their clinic rollout, closing 160 underperforming clinics and exiting some markets to cut losses. This illustrates the challenge Walgreens faces in trying to become a healthcare provider: it requires patience and deep pockets, and so far it’s been a drag on earnings. CVS, by comparison, has been running in-store MinuteClinic locations for much longer (since the 2000s) and has integrated them with its insurance and PBM data, arguably giving it a head start in the clinic game.

Another area of difference is in retail partnerships: Walgreens has been open to outside collaborations – for example, it partnered with FedEx to offer package pick-up/drop-off in stores, and with lab testing companies to host diagnostic services in some locations. CVS tends to build capabilities in-house or through acquisitions, integrating them under the CVS brand (for instance, CVS’s walk-in clinics are wholly owned, and its online pharmacy and PBM services are part of the CVS ecosystem).

The two approaches — CVS’s vertical integration vs. Walgreens’ partnership ecosystem — each have pros and cons. CVS’s model gives it more direct control and a bigger share of each healthcare dollar (since it touches insurance, delivery, and dispensing), but it also means managing a huge, complex organization (insurance subsidiaries, claims processing, etc.) and carrying significant debt from those acquisitions. Walgreens’ model is more flexible and potentially less capital-intensive (sharing investment and risk with partners), but it relies on successfully aligning multiple independent players and has so far resulted in slower diversification of revenue. The marketplace is essentially testing these models in real time: CVS’s bet is that being an all-in-one healthcare company drives loyalty and efficiency, while Walgreens’ bet is that it can remain a pharmacy retailer at heart and plug into healthcare growth areas through alliances without overextending itself.

Financial Resilience and Credit Health

From a financial resilience standpoint, CVS currently appears to be on firmer ground than Walgreens, though both face challenges. One telling indicator is their credit ratings. According to CoStar’s tenant database, CVS carries a credit rating equivalent to a “B” grade (65 score), whereas Walgreens is rated a notch lower at “C” (46 score). In practice, CVS’s debt is still considered investment-grade by major rating agencies (Standard & Poor’s rates CVS BBB, a low investment-grade rating). Walgreens, on the other hand, has seen its credit ratings fall into “junk” territory in recent years – for example, Moody’s has rated Walgreens’ debt B1 with a negative outlook, a non-investment-grade status as of early 2025.

These ratings reflect underlying business performance and balance sheet strength. CVS, even after borrowing heavily to buy Aetna and other assets, has maintained steadier profits and cash flows to service its obligations. In the U.S. pharmacy segment, CVS has remained profitable each year, though margins are shrinking (CVS’s retail pharmacy operating margin fell from about 6.7% in 2020 to nearly 2.4% by 2025). Still, CVS’s diversified earnings – including profits from insurance premiums and PBM services – give it multiple cushions. The company’s enormous revenue base also provides scale efficiencies. Walgreens, by contrast, has hit a rough patch. Its core U.S. retail pharmacy business swung to a loss recently; in 2023 Walgreens’ U.S. segment had an operating loss of several billion dollars, a stark reversal from solid profits a few years prior. Much of this loss was driven by one-time charges – notably a hefty $6.8 billion charge for opioid litigation settlements that Walgreens recorded in 2023. Even aside from legal costs, Walgreens’ earnings have been under pressure due to higher labor costs, falling COVID-related sales, and investments in new ventures that have yet to pay off.

Investors and creditors have grown concerned as Walgreens’ debt levels remain high and its earnings falter. The company responded by announcing aggressive cost-cutting: at the end of 2023 Walgreens set plans to trim $1 billion in annual costs, including closing at least 150 U.S. stores that were underperforming. It also replaced its CEO in 2023, bringing in a new chief (Tim Wentworth, a veteran of the insurance industry) to help right the ship. The aim is to restore investor confidence by improving efficiency and focusing on core strengths. But for now, credit markets view Walgreens as a riskier bet than CVS – hence Walgreens’ removal from the S&P 500 index and higher borrowing costs for its debt.

CVS isn’t without issues either. Its acquisitions left it with substantial debt (around $80 billion as of 2024), and rating agencies have put CVS on a negative outlook watch, meaning if CVS’s profitability slips or if it takes on more debt, a downgrade could follow. In late 2024, Moody’s signaled it was considering downgrading CVS to just one notch above junk, citing “stagnant earnings” and the strain of debt-fueled dealmaking. In other words, CVS is not far from its own precipice. However, the difference is that CVS has a larger and more diversified profit engine to pull itself up – for instance, if prescription margins are down, perhaps its Aetna insurance arm is having a good year, or vice versa. Walgreens lacks this diversification, so its fortunes are tied more tightly to the ebb and flow of retail pharmacy trends.

In summary, CVS currently enjoys greater financial resilience with a still-solid credit profile and multiple revenue streams to buffer shocks, while Walgreens is under financial stress, working to cut costs and regain stability. How each manages their debt and invests in future growth (without over-leveraging) will be crucial to their long-term viability.

Workforce and Operational Scale

The human and operational scale of these companies is massive – and here, Walgreens actually out-sizes CVS. Walgreens Boots Alliance employs roughly 311,000 people worldwide (the vast majority in the U.S.). CVS Health, after its acquisitions, employs around 218,000 people in its various divisions. If one focuses solely on the U.S. retail pharmacy operations, Walgreens’ headcount advantage is even clearer: Walgreens has more stores, and each store typically has a full staff of pharmacists, technicians, and front-of-store clerks. CVS, while still employing hundreds of thousands, has fewer standalone stores and some centralized operations (like mail-order pharmacy fulfillment centers) that can be highly automated. Moreover, a portion of CVS’s total employees work in its insurance and corporate offices, rather than in retail settings.

This difference in employment structure speaks again to the two models. Walgreens’ workforce is primarily in customer-facing roles at pharmacies and in field operations. These include pharmacists counseling patients, pharmacy techs filling prescriptions, store managers and cashiers, and so on. Walgreens relies on this army of store staff to drive sales and service, which is a traditionally labor-intensive model. CVS also has a huge retail staff doing the same kind of work, but alongside them is a sizable contingent of employees like claims processors, insurance customer service reps, nurses for its in-store clinics, and PBM account managers. In theory, CVS’s integrated approach could allow some efficiencies – for example, better coordination between the pharmacist and the insurance arm can reduce administrative back-and-forth – but it also means CVS’s operational workforce spans a broader range of specialties.

Both companies have faced labor challenges in recent times. A nationwide pharmacist shortage has affected Walgreens and CVS alike, forcing temporary reductions in pharmacy hours at thousands of stores. Employee burnout and wage pressures are issues, especially after the pandemic increased workload for pharmacy staff with vaccine drives. In October 2022 and again in fall 2023, some Walgreens pharmacists and technicians staged small-scale walkouts to protest working conditions, a sign of strain in the workforce. CVS has similarly had to increase incentives to recruit and retain pharmacists as competition for talent grows.

On a positive note, the vast scale of these employers means they can implement changes across the board efficiently. For instance, when CVS decided to raise its minimum wage for hourly workers, it affected tens of thousands of employees and put pressure on Walgreens to match it to stay competitive in hiring. Both firms have also invested in training programs to enable pharmacists to provide more clinical services (like health screenings or prescribing certain medications), effectively expanding the role of their workforce in delivering healthcare, not just dispensing pills.

Operationally, each company runs extensive distribution networks to keep stores supplied. Walgreens historically has had its own distribution centers and also leveraged its alliance with AmerisourceBergen (a major drug wholesaler in which Walgreens has held a stake) to streamline supply chain logistics. CVS, similarly, operates regional warehouses and uses its buying power (augmented by the Caremark PBM side) to purchase drugs in bulk. Their supply chains are sophisticated operations in themselves, ensuring that tens of thousands of products – from lifesaving drugs to shampoo bottles – flow to every corner pharmacy on time.

In summary, Walgreens and CVS are two of the largest private employers in the country. Walgreens’ workforce is larger, reflecting its slightly bigger store base and focus on retail operations, while CVS’s slightly leaner headcount relative to revenue reflects how its employees’ efforts leverage technology and integration to generate more sales per person. How each company manages its human capital – keeping store employees happy, productive, and able to take on new healthcare tasks – will influence their success as much as any corporate strategy.

Industry Trends Shaping the Future

Both Walgreens and CVS operate within the broader currents of the U.S. healthcare and retail sectors, and they must navigate several key industry trends that are reshaping pharmacy retail. These trends provide context for many of the strategic moves the companies are making:

• Rise of Generic Drugs: In the past decade, generic medications – cheaper copies of brand-name drugs – have come to dominate prescriptions. Generics now account for nearly 90% of all prescriptions filled in the U.S., yet because they are low-priced, they represent only about 14-15% of total drug spending. This has created a profit squeeze for pharmacies: dispensing a generic yields only a slim margin, so higher volume doesn’t necessarily mean higher profit. Both CVS and Walgreens have felt this pressure and have adjusted their strategies accordingly. They increasingly focus on higher-margin products and services to compensate. As one industry analysis noted, “the rise of generics is reshaping pharmacy revenue strategies”, pushing pharmacies toward high-margin biologic drugs and expanded healthcare services to boost profitability. In practice, this means CVS and Walgreens are promoting specialty pharmaceuticals (expensive drugs for complex conditions) and investing in clinical services like vaccinations and testing, where they can justify higher fees.

• Mail-Order and Online Competition: The convenience of having medications delivered to one’s doorstep has led to growing popularity of mail-order and online pharmacies, especially for patients on chronic therapies. A McKinsey study cited in industry reports confirms that mail-order and online pharmacies are increasingly popular, particularly among patients managing multiple prescriptions. Companies such as Mark Cuban’s Cost Plus Drugs, an online pharmacy startup, have drawn attention for offering generics at very low prices by shipping directly from manufacturers. Meanwhile, giants like Amazon have entered the fray, leveraging their e-commerce prowess to offer prescription delivery (often at aggressive price points or with techy conveniences like automatic refills via Alexa). These developments have not gone unnoticed by CVS and Walgreens. Both chains have beefed up their own mail-delivery pharmacy options and smartphone apps to enable easy online ordering of prescriptions. CVS can utilize its Caremark PBM to mail meds to insurance plan members, and Walgreens has invested in improving its digital pharmacy platform. Still, the traditional drugstore model – a patient visiting a counter – is under pressure from these alternative channels. To entice customers to keep coming in person, CVS and Walgreens have expanded same-day delivery, curbside pickup, and other services emphasizing speed and convenience. The battle is on to offer the best of both worlds: the immediacy of a local store with the ease of an online service.

• Demographic Shifts: The aging of America is, on balance, a tailwind for the pharmacy industry. As the population of seniors grows, so does the demand for medications. Older adults (65+) are heavy prescription users, often managing multiple chronic conditions, which means frequent pharmacy visits or refills. CVS and Walgreens have positioned themselves to serve this aging demographic through programs like senior discounts, Medicare plan consulting, and in-store clinics specialized in chronic disease monitoring. However, the demographic story has nuances: the over-65 population, while growing, is still a minority of the total population, and younger consumers have different expectations (for example, Millennials might be less loyal to a particular pharmacy and more inclined to try digital health solutions). Both companies are trying to cater to all ages – offering more accessible healthcare services that appeal to seniors, while also modernizing the shopping experience (mobile apps, reward programs, etc.) to attract younger customers. Another aspect is the increase in the number of people with health insurance in the past decade (due in part to the Affordable Care Act), which has increased overall prescription utilization. More insured consumers mean more prescriptions being written and filled, a positive trend for pharmacies. CVS’s acquisition of Aetna was partly a play on this dynamic – blurring the line between insurer and pharmacy to capture the full insured patient’s spending.

• Preventative Care and the Expanding Role of Pharmacies: One of the most significant shifts in recent years is the push to turn drugstores into one-stop health care destinations. No longer are CVS and Walgreens content to simply dispense medications; they are now administering vaccines, conducting diagnostic tests, and even managing primary care visits in-store. Both companies played a crucial role during the COVID-19 pandemic, delivering tens of millions of vaccine doses and tests, which in many ways accelerated the public’s comfort with receiving medical services at a pharmacy. Post-pandemic, this trend continues with flu shots, COVID boosters, travel immunizations, and routine health screenings becoming staple offerings at these stores. Industry observers have noted that drug stores have introduced more preventive care services to their product mix, turning their stores into “one-stop health shops.” On any given day, a customer might get a blood pressure check or diabetes screening at CVS’s MinuteClinic or at a Walgreens pharmacy counter. The idea is to integrate pharmacies into the broader healthcare delivery system as community health hubs – a vision strongly championed by CVS’s leadership and one that Walgreens is now also embracing via its clinic partnerships. Preventative care services not only drive additional revenue but also increase foot traffic and foster customer loyalty (someone who comes in for a flu shot might also pick up their prescriptions and some groceries). It’s a bet on pharmacies becoming an accessible touchpoint for basic healthcare, especially important in areas with doctor shortages.

• Competitive Convergence: The lines are blurring between pharmacies, clinics, and retailers. CVS and Walgreens find themselves not only competing with each other, but also with big-box retailers and supermarkets that have pharmacies (Walmart, Target (whose pharmacy business is now run by CVS in a store-within-a-store format), Kroger, etc.), and with pure e-commerce players. This has spurred a wave of consolidation and partnership. Walgreens and CVS have each acquired or partnered with medical service providers (as discussed earlier) to protect their market share. Smaller independent pharmacies have struggled to compete on price and many have closed or sold out, increasing the share held by the big chains – yet, paradoxically, the overall concentration of the industry is still moderate because so many different types of players (mass merchants, online startups, etc.) are in the fray. The competitive landscape is thus a mix of consolidation (fewer mom-and-pop drugstores) and new competition (tech-driven entrants and cross-industry incursions). CVS and Walgreens are at the center of this storm, adjusting their sails by expanding service offerings and embracing e-commerce and delivery to stay relevant.

Looking ahead, both companies will need to continue adapting to these trends. For example, the pressure from PBMs on drug reimbursement (an ongoing issue where fees and clawbacks imposed by PBMs can make filling prescriptions less profitable for pharmacies) might drive further vertical integration – CVS already owns a PBM, and Walgreens might deepen partnerships or find new ways to improve its negotiating position. Healthcare policy changes can also sway fortunes: expanded roles for pharmacists (such as prescribing authority for certain medications, which some states are allowing) could benefit these chains, while regulatory crackdowns on drug pricing or reimbursement could pose challenges.

In essence, the pharmacy retail sector is in flux, and CVS and Walgreens are reinventing themselves not just as stores, but as healthcare companies on the front lines of community health. Whichever company manages to ride the waves of generics, digital disruption, and changing patient expectations more deftly may come out on top in the next chapter of this long-running rivalry.

Conclusion: A Dual Transformation

In the saga of Walgreens vs. CVS, there is no definitive victor – instead, we see two incumbents striving to transform in parallel, each in its own way. The U.S. pharmacy retail sector that they lead is not a static, mature market but one undergoing significant change. CVS Health, with its vast revenues and bold vertical integration, has positioned itself as a healthcare giant that just happens to also run pharmacies. Walgreens Boots Alliance, with its storied Walgreens brand, is leveraging partnerships and a retail-first mindset to broaden into healthcare while trying to stay true to its pharmacy roots. Both companies face hurdles: CVS must prove that its acquisitions and size can yield synergies and growth (and that it can manage its debt), while Walgreens must rekindle growth in its core business and show that its newer health initiatives can bear fruit.

For American consumers, this competition has tangible effects. It means more services available at the local drugstore, potentially more convenience and possibly better prices as each chain seeks to lock in loyalty. It also means there could be fewer independent pharmacies over time, as the big two tighten their grip, which raises questions about access in underserved areas. Regulators and industry watchers will no doubt keep an eye on how these giants use their market power – together CVS and Walgreens handle a significant share of prescriptions, and their business decisions (from drug pricing to store hours) can impact public health.

In an era of rising generic drug use, mail-order medicine, aging populations, and preventative care on every corner, CVS and Walgreens are both trying to be the answer to a key question: What is the future of the neighborhood pharmacy? Their rivalry – now more than a century in the making – is pushing each to innovate and evolve. And as they do, Americans standing at the pharmacy counter are witnessing a retail drama that is about much more than picking up pills; it’s about who will define the front door of healthcare in the United States.

December 11, 2025, by a collective of authors at MMCG Invest, LLC, feasibility study consultants

Sources:

CVS Health Corporation. 2024 Annual Report. Woonsocket, RI: CVS Health, 2025.Official annual report detailing CVS Health’s consolidated results, including approximately $372.8 billion in 2024 revenue and segment breakdown across Health Services, Health Care Benefits and Pharmacy & Consumer Wellness.

CVS Health Corporation. “CVS Health Corporation Reports Fourth Quarter and Full-Year 2024 Results.” Press release, 12 February 2025.Earnings release summarizing 2024 financial performance, revenue growth drivers, and guidance for 2025.

CVS Health Corporation. Notice of Annual Meeting of Stockholders and Proxy Statement 2025.Proxy filing describing 2024 financial results, capital allocation and the rollout of the CVS CostVantage reimbursement model. SEC

Walgreens Boots Alliance, Inc. “Walgreens Boots Alliance Reports Fiscal Year 2024 Earnings.” Press release, 15 October 2024.Official release detailing WBA’s fiscal 2024 sales of approximately $147.7 billion, segment results and outlook.

Walgreens Boots Alliance, Inc. Form 10-K for the Fiscal Year Ended August 31, 2024.SEC filing providing detailed breakdown of segment sales, including U.S. Retail Pharmacy revenue of about $115.8 billion, and discussion of strategic initiatives and risks.

KFF (Kaiser Family Foundation). “Public Opinion on Prescription Drugs and Their Prices.” 4 October 2024.National polling data on perceptions of drug prices, support for Medicare price negotiation and self-reported affordability issues among U.S. adults.

KFF (Kaiser Family Foundation). Data Note: Prescription Drugs and Older Adults. August 2019.Analysis of prescription drug use and cost-related non-adherence among adults aged 65 and older in the United States.

McKinsey & Company. “Meeting Changing Consumer Needs: The US Retail Pharmacy of the Future.” March 17, 2023. Strategic insight on U.S. retail pharmacy consumer behavior, channel preferences and the evolution of “pharmacy of the future” models.

Amazon.com, Inc. “Amazon to Acquire PillPack.” Press release, June 2018.Announcement of Amazon’s acquisition of online pharmacy PillPack, signaling its entry into the U.S. pharmacy market.

Amazon.com, Inc. “Introducing Amazon Pharmacy: Prescription Medications Delivered to Your Door.” Company announcements and coverage, November 2020.Launch materials for Amazon Pharmacy, describing price comparison tools and integration with Prime benefits.

Mark Cuban Cost Plus Drug Company, PBC. “Our Business Model.” Company information, accessed 2024–2025.Description of Cost Plus Drugs’ transparent generic pricing model (direct-from-manufacturer cost plus fixed markup and fees) and PBM-disintermediation intent.

Mark Cuban Cost Plus Drug Company, PBC & 9amHealth. “Cost Plus and 9amHealth Partner to Offer Lower-Cost Metabolic and Obesity Medications to Employers.” Joint announcement, 2025.

Reuters and other outlets. Coverage of Rite Aid Corporation’s Chapter 11 filings (2023–2025) and subsequent store closures.News reporting on Rite Aid’s bankruptcy, restructuring and eventual liquidation of its U.S. retail pharmacy footprint.