It comes down to two key forces that separate many American pharmacies from many other countries: Car-centric development and slow prescription filling. In Ame

It comes down to two key forces that separate many American pharmacies from many other countries: Car-centric development and slow prescription filling. In American suburbia, having the smallest store possible isn't an advantage at all: We are mostly talking strip malls, where it takes some time to get in or out. The energy expenditure of leaving an arterial, parking and walking us much higher than just turning inside a store from a sidewalk in a trip you were already taking. This leads to minimal demand for stores that are very small, or sell cheap items. The smallest you are going to find is the restaurant with a drive-through, which is still quite big. The other issue is that instead of having most prescriptions in blisters, and a quick, automated dispensing system that lets you in an out of the store in seconds, American pharmacies just do way too much work to dispense medicine. Part is insurance and price variation, part regulation, and part just not having everything standardized and in blisters and bottles. So if you go to the pharmacy, you either call in advance, or you are going to sit there for a while. Both of those things are pushing you to sell something more in the pharmacy, so you get a build in convenience store, which is as bad at pricing as any other convenience store. The Spanish pharmacy, where you can get in and out in under a minute, and yet it's often seen as the first layer of the medical system for medical advice, is so much better, but it'd not make any sense given how the US is built, and how we regulate the pharmacy.