The news: Amazon Pharmacy is expanding same-day prescription delivery to about 4,500 US cities and towns by the end of 2026. Idaho and Massachusetts will also be two additional states where Amazon’s same-day medication delivery will be offered.

Why it matters: Amazon has been working to grow its pharmacy presence with new services and features, aiming to offset its lack of physical locations through speed, convenience, and low prices.

• Amazon said it achieved faster delivery speeds in 2025 across the entire US using a range of methods, including electric vehicles, e-bikes, kiosks, and even ferries and horses in remote areas.
• Amazon’s RxPass program offers certain generic drugs for a $5-a-month subscription, which is now available to Prime members in 48 states.
• Its logistics network delivers prescriptions to remote Alaska towns and tribal communities within a few days—faster than other mail-order services, according to Amazon.

However, there are signs Amazon is still struggling to meaningfully scale its pharmacy business:

• It’s seen opaque pharmacy customer growth. Amazon said in 2024 that its pharmacy customer base had doubled over the past year, and in its Q2 2025 earnings report, said it grew 50% year over year—but it provided no specific figures in either case.
• Its pharmacy has a minimal market presence, and represents a tiny fraction of its business. Amazon doesn’t break out pharmacy revenues, but Evercore estimated the segment generated about $2 billion in sales in 2024, per Business Insider—the most recent market estimate—a small slice of Amazon’s $638 billion in total revenues that year. Industry estimates peg that Amazon has a 1% to 2% US pharmacy market share.
• Same-day delivery scale is hard to gauge. Amazon said it would expand same-day prescription delivery to half of the US last year, but it’s unclear whether it met that target. The company didn’t reference the goal in this week’s pharmacy delivery expansion announcement, instead citing “4,500 cities and towns”—a figure that’s difficult to translate into population reach. The company may have realized that offering same-day Rx delivery to most of the country is hard to justify with a small customer base.

Implications for the pharmacy market: Online pharmacy use has grown in recent years. But digital-only pharmacies may struggle to attract and retain customers who can opt for online or in-person services from familiar retail and mass merchandiser pharmacies. Plus, smaller pharmacy operators are more likely to have less favorable reimbursement and contract terms with PBMs than larger companies, meaning turning a profit from stocking expensive medications proves difficult.

Online-only pharmacies have a role in the broader market, but scaling will require creative strategies:

• Prescription discounts with transparent pricing
• Speedy and safe medication delivery
• Around-the-clock virtual pharmacist support
• Partnerships with pharma brands’ direct-to-consumer initiatives to position themselves as preferred pharmacy partners while sidestepping some PBM hassles.