Management of pharmacy holdings and consumer behaviour: entrepreneurship strategies for sustainable ecosystems

Purpose This study investigates how citizens perceive and respond to the increasing consolidation of pharmacies into holding companies. It examines purchasing behaviours, consumer preferences and the social value attributed to these organisational models. The primary objective is to assess whether such aggregations can foster sustainable business ecosystems embedded in local communities – especially in the healthcare sector and in support of biodiversity – moving beyond a focus on economic efficiency alone. Design/methodology/approach The research adopts a quantitative approach through an online survey completed by a sample of 405 residents in Italy. The questionnaire explored perceptions of pharmaceutical holding companies, consumer purchasing habits, and expectations regarding product availability, pricing and service delivery. The analysis is framed within the broader context of entrepreneurship and sustainability, with particular attention to ecosystem dynamics. Findings The results indicate that consumers primarily value product availability and affordability, while also recognising the social function of pharmacies. Holding companies are generally perceived as capable of reducing costs and expanding business potential. Consumers show a willingness to switch pharmacies if product availability is ensured, and express appreciation for home delivery services – provided they are accompanied by discounts in aggregated models. These findings provide actionable insights for managers of pharmacy holdings, who can leverage customer expectations on price, product availability and service innovation to design more effective operational strategies and sustainable service models towards SDG 3. Originality/value This study provides an original perspective on pharmacy management by linking it to sustainable entrepreneurship and the promotion of biodiversity. It offers valuable insights into how aggregated organisational models can contribute to the development of local ecosystems focused on shared value and collective well-being. Beyond describing consumer attitudes, the survey also provides managerial insights, highlighting how pharmacy holdings can balance efficiency with customer trust and translate consumer expectations into operational strategies. By aligning consumer expectations with ecological and social goals, the research enriches the discourse on strategic innovation in sustainable pharmaceutical retail.