Why Adding Pharmacy to Your Grocery Delivery Network Just Makes Sense
Our guide to how grocers can add prescriptions to grocery deliveries: integrate pharmacy systems, coordinate third-party providers, and capture higher margins per order.
U.S. shoppers have embraced digital grocery: 67% bought groceries online in 2024, and a record 80 million households placed an e-grocery order in February 2025. At the same time, supermarkets and mass merchants dispense roughly one-third of all prescriptions, representing about $200 billion of the $609 billion U.S. retail-pharmacy market. As traditional drug chains contract, Bain projects the grocer’s share will rise to 40% by 2029.
Despite this overlap, most retailers still run grocery delivery and pharmacy fulfillment on separate tracks. One van drops off milk; another delivers metformin, duplicating routes, fees, and labor across millions of orders each month.
Early integrators show the value of merging those flows. Walmart launched nationwide same-day pharmacy-and-grocery delivery in October 2024, leveraging a store network within 10 miles of 90% of Americans. This model pools two high-frequency purchase cycles into a single stop, lifting basket margins while lowering per-order delivery costs.
The infrastructure exists, the economics work, and the competitive window is open. Grocers that align pharmacy with grocery delivery now stand to capture higher margins and stronger customer loyalty.
In this piece, we’ll break down why integrating pharmacy into grocery delivery is a timely opportunity, what leading grocers are doing to make it work, and the operational steps any retailer can take to capture the same results.
The Pieces for Adding Prescriptions to Grocery Orders are Already in Place
Major grocers have spent the past five years building national same-day delivery engines. For example, Walmart now reaches 93% of U.S. households. Grocers deliver to front doors hundreds of thousands of times each day, creating dense, repeatable routes that can absorb more volume with almost no extra miles.
Grocers have made major investments in delivery, partnering with third-party providers like Uber and Roadie and building owned fleet capabilities. Meanwhile, their stores often house full-service pharmacies that have operated for decades, filling thousands of prescriptions daily and maintaining long-term relationships with customers who visit monthly or weekly.
Yet the systems remain separate. And this is a huge missed opportunity.
Take Mrs. Johnson, as an example. She schedules her weekly grocery drop-off for 6 p.m. At 5 p.m., the pharmacy texts that her blood-pressure medication is ready, but the app can’t attach that prescription to tonight’s grocery route. She either drives to the store or waits for a second courier to arrive later.
This scene plays out for millions of customers every day. The vans are already on the road, the drivers know the routes, the pharmacists have the orders in hand, and the customer is waiting at home. The only missing piece is orchestration: technology that lets Mrs. Johnson click “add to delivery” and get everything she needs in one stop.
How Grocers are Making the Connection
Leading grocers are taking different approaches to solve this challenge, but they share a common goal: one delivery, one fee, maximum convenience.
Walmart became the first major retailer to fully integrate prescriptions into their grocery delivery flow in October 2024. Customers simply add medications to their grocery cart, and everything arrives together. The technical complexity behind the scenes (HIPAA compliance, temperature control, insurance verification) is significant—but invisible to customers.
Publix found a streamlined solution by working with their delivery partners. Gig drivers already delivering groceries now pick up sealed prescription bags from the pharmacy counter. Customers pay just $2 to add prescriptions to their grocery delivery, compared to $10.99 for standalone prescription delivery. The price difference reflects the operational efficiency of combining trips into one gig worker's route.
Grocers that succeed in pharmacy-and-grocery integration start by listening to customers like Mrs. Johnson. These grocers understand where the friction lies in their daily routines and use existing assets to remove it. Publix’s model is a strong example, especially in its Florida home base, where a large share of customers are seniors with higher medication needs and, in many cases, reduced mobility. For these shoppers, the ability to receive groceries and prescriptions in one trip supports their health, lowers costs, and strengthens their connection (and loyalty) to the store.
The Business Case for Pharmacy Delivery Integration is Compelling
The economics of pharmacy delivery integration work on multiple levels.
- McKinsey estimates that a $100 in‑store grocery basket delivers about $4 in net profit, while the same basket fulfilled for home delivery can generate a –$13 margin before fees. That gap is one of the biggest challenges for online grocery profitability.
- Adding a single prescription to that $100 delivery can shift the equation. A maintenance medication often brings in around $12 in gross profit while adding only a few dollars in incremental handling and routing costs. That’s enough to move a loss-making order closer to breakeven—or even into the black.
If Mrs. Johnson adds her blood‑pressure prescription to her weekly grocery order, the pharmacy profit offsets most of the extra cost to deliver both. The retailer gains a healthier margin, and Mrs. Johnson gains the convenience of one knock at the door instead of two. It’s a small operational change with an outsized financial impact.
Pharmacy customers also demonstrate exceptional loyalty patterns. Someone filling maintenance medications returns monthly, predictably. When you simplify a shopper’s experience by delivering everything together, you strengthen that relationship and increase their grocery attachment rate.
Plug in your metrics into our interactive ROI calculator below
Understanding the Technical Orchestration
The challenge to integrate grocery with pharmacy is both operational and technical. Grocers are dealing with two fundamentally different order systems that need to work together seamlessly while maintaining compliance and efficiency.
Consider what happens behind the scenes: A prescription ready for pickup sits in your pharmacy management system. Meanwhile, a grocery order comes through your e-commerce platform. These systems typically don't talk to each other. Different order IDs. Different payment flows. Different compliance requirements.
The orchestration challenge involves many elements:
- Order matching: Creating a shared identifier between pharmacy and grocery systems without exposing protected health information.
- Timing coordination: Synchronizing prescription readiness with grocery shopping windows and delivery slots.
- Compliance management: Ensuring HIPAA-protected data stays within appropriate systems while still enabling operational coordination.
Provider integration: Updating delivery providers with multi-stop pickups while maintaining single-order economics. Major gig providers like Uber and Roadie have specific workflows for pharmacy pickups built into their driver apps; the key is triggering these correctly.
Two Paths to Integration
Successful implementations typically follow one of two flows:
Both approaches work, but the key is making the experience seamless regardless of starting point. The customer sees one cart, one payment, and one delivery… even though multiple systems are coordinating behind the scenes.
What Successful Implementation Really Looks Like
When done right, the customer experience is remarkably simple. They're shopping for groceries online and get a notification after they’ve ordered: "Your medication is ready. Add to your upcoming order for free?"
One click, and it's done.
Or they get a text that their prescription is ready with a link to schedule delivery. That link opens their grocery app with the prescription already added to cart, inviting them to add grocery items to the same delivery.
Behind this simplicity, behind the scenes, requires sophisticated orchestration:
- Real-time communication between pharmacy and e-commerce systems
- Automated HIPAA compliance workflows that work with gig drivers
- Dynamic routing updates sent to delivery provider apps
- Intelligent batching algorithms
- Seamless updates to gig platforms to add pharmacy stops to existing routes
For a full-plan, take a look at our 90-day implementation roadmap below.
The Role of Orchestration Platforms
Investing in specialized technology will accelerate this success. While grocers could build these capabilities in-house, this is typically an 18-24 month project requiring significant technical resources and ongoing maintenance.
Modern orchestration platforms like Nash provide the technical foundation to launch within months, not years. Here's what effective orchestration handles:
The Competitive Window Is Now
Pharmacy delivery integration is moving from a nice-to-have to a baseline expectation. Early adopters are locking in loyalty and building operational advantages that grow over time. Once customers experience the convenience of getting prescriptions with their groceries, they change their habits, and begin ordering more often, spending more per basket, and consolidating more of their shopping with one retailer.
For grocers, the benefits multiply with every combined delivery. Margins improve as fixed costs are spread over higher-value baskets, routes become denser, and pharmacy and grocery operations work in tandem rather than in silos. McKinsey research shows that even modest gains in route efficiency can lift last‑mile productivity by double digits, and basket size increases of $8–$15 per integrated order are common in pilots.
Most grocers already have the pieces in place: partnerships with platforms like Uber and Roadie, in-store pharmacies serving thousands of loyal customers, and mature digital ordering systems. The opportunity to connect them is one every grocer should take advantage of.
Want to see how the Nash infrastructure advantage works? Set up a demo today.