Every year I look forward to the latest installment of the NCPA Digest, which goes all the way back to 1932. NCPA, sponsored by Cardinal, publishes this guide as a sort of state of the union for independent community pharmacy.
While I have used it in the past to benchmark my own pharmacies’ metrics, I have heard from a friend or two that they think the data may be skewed by the more successful stores responding more often that the struggling stores. While that may be possible, we wanted to look at the Outcomes Index data to see if the story aligns or differs with that of the Digest. I’ll first compare the 2023 and 2024 Digest numbers against the 2023 and 2024 Index. Then, I’ll share a sneak peek into what the Index can tell us is happening in 2025.
Independent community pharmacy is under enormous pressure, but the story is not simply decline—it’s transformation. When I compare the performance of our pharmacy group to the trends highlighted in the NCPA Digest for 2023 and 2024, I see a clear message for owners: we are still moving a lot of prescriptions, generating strong topline sales, and maintaining healthy generic utilization, but margin compression is real and persistent. Long-term survival will come from pairing efficient dispensing with fee-for-service clinical care and smarter contracting, not from volume alone.
Revenues and Script Counts
According to the 2024 NCPA Digest (reporting 2023 data), the average independent community pharmacy dispensed 59,644 prescriptions per year—about 191 prescriptions per day—with average annual sales of $4,997,000 and an average prescription charge of $80.37. The 2025 Digest (2024 data) shows those numbers rising to 67,601 prescriptions per year (about 217 per day) and $5,411,000 in annual sales, with an average Rx charge of $76.21. In other words, independents are dispensing more prescriptions and generating more revenue per location than they were even a few years ago.
At Outcomes, our stores dispensed a very similar number of prescriptions, from 47,632 in 2023 to 47,248 in 2024. But in those prescriptions, the average price rose from $103.83 to $107.99, representing a similar increase in top-line sales, without the additional script count.
Generic Mix and New vs. Refill
To dig into that a little, we needed to compare the Brand to Generic ratio. The Digest reported in 2023 that independents dispensed generics on roughly 83.1% percent of prescriptions, and in 84% of prescription in 2024. The Outcomes Index showed 2023 at 82.68% and 2024 at 83.13%, so its safe to say we are very closely aligned there.
While we were scrutinizing the type of drug, we also compared the New vs Refill rates. In both years, the Digest showed the balance to be right around 50/50, while the Outcomes Index kept a slight tip toward new scripts, at 54% in 2023 and 53.6% in 2024. This is very close, and likely not an explanation for the differences in revenues; but it matters to the overall type of scripts being filled.
Operationally, this aligns well with the NCPA picture of an average independent filling a mix of chronic maintenance therapy and acute care. From a business standpoint, it means most independents have a solid base of chronic patients, which is critical for both adherence programs and clinical service offerings.
Sales Up, but Margins Squeezed
Where both our internal data and the NCPA Digest ring the loudest alarm is in profitability. While the NCPA data shows revenues and script counts growing, only to maintain the same dollars of gross profit; the Index shows the script counts flat achieving a lesser increase in revenue, but also a smaller decline in gross profit.
Potential translation: compared to the Digest sample, the Index stores were more choosy in the contracts or the scripts they filled. While they didn’t see the same swell in script count, they didn’t suffer a drop off in margin per script to the same extent.
Why This Matters
As the landscape of drug pricing, reimbursement models, and fulfillment locations gets more and more complicated, it will be more important than ever to monitor the type and profitability of the drugs you’re dispensing. In addition to that, it will also become important to take a new look at your pharmacy performance to make sure you are seeing it form all the angles.
One item I urge pharmacists to watch is their expenses in relation to their gross profit, and not just in relation to their revenues. Just because script counts or drug prices are driving up the top line, doesn’t necessarily mean the pharmacy can afford a similar increase in labor or other expenses. From the Digest, we know that the cost of dispensing rose from $13.67 in 2023 to $15.00 in 2024, while gross margin percentage fell. Payroll as a percentage of sales held steady at 10.6%, which means owners are absorbing higher costs per script on thinner margins.
Another look is to see what portion of your inventory is for new vs refill scripts. By now med-sync is old news, but the concept of just-in-time inventory still has a long ways to go with most pharmacies I see. Just like we all know that we can’t afford to keep a year’s worth of inventory on the shelf, we may need to be moving that number lower in the future.
Is it a week for any generics? Maybe less than 1 day for brand refills? If you need help analyzing how to stock based on usage, our Outcomes Insights platform can provide you with many different ways to analyze your data.
What About 2025?
We can’t speak for all independent community pharmacies, but the Index shows hope on the horizon for 2025. While our annualized 2025 numbers look like script counts decreased more than last year, it looks like gross margins, and even total gross profit are going to be higher than 2024. And that’s not counting clinical revenues yet!
In the next installment, we’ll be reporting out on the clinical state of the union, sharing data on medication therapy management and other clinical services. There are many success stories to share, and many more opportunities to look forward to for ways to strengthen each pharmacy, and provide needed care for our patients and communities.
