With thousands of their brick-and-mortar stores closing and online vendors proliferating, big pharmacy chains like CVS and Walgreens are seeing their reputations slide, according to the annual Axios Harris Poll 100.

Why it matters: The souring consumer sentiment comes as pharmacy giants mount major turnaround plans in the hopes they can overcome slumping in-store sales, overexpansion and backlash from putting more products under lock and key and shortening pharmacy hours.

• "Consumers are seeking quality for their stretched dollars, and drugstore retail has developed a lot of friction and frustration," John Gerzema, CEO of The Harris Poll, told Axios. "This has opened up the opportunity for [direct-to-consumer] insurgents and others who can offer a better brand experience."

Details: Retail pharmacy giant CVS ranked 57th in reputation score among the 100 brands survey respondents identified as most visible in the country today, down from 36th last year.

• Walgreens ranked 65th, down from 51st last year.
• Both have seen their reputations drop over a three-year period.
• CVS and Walgreens saw their steepest declines in consumer perceptions of their growth and vision.

The big picture: In fielding the poll, Harris found 75% of Americans are concerned about health care today, and 38% believe care is getting worse.

• More than 1 in 5 (22%) patients who take at least one prescription medication said it was difficult to pay for their drugs in the past year.
• "Whether it's fair or not, if your out-of-pocket costs for your health care are rising, prescriptions and otherwise, some of that blame may get placed with with these retail players," said Tyler Giesting of consulting firm West Monroe.

Yes, but: The decline wasn't seen uniformly across health care. Brands like drugmakers Pfizer and Johnson & Johnson both saw improvements in their reputational scores.

Of note: Rite Aid, which is in bankruptcy and in the midst of selling off assets to competitors, has not ranked in previous polls and did not rank this year.

See the full results and methodology

As pharmacy giants look to find their footing, they could find opportunities customizing services to large employers instead of the mass consumer market.

Why it matters: The industry is shrinking its footprint and pulling back from full-service care delivery. Experts say the biggest players could refashion themselves to become de facto in-house clinics to giant corporations.

"We had a couple of years where costs were sort of not the first thing on everybody's minds," said Giesting of West Monroe.

• Now? "Health care costs and drug costs have come back to the forefront of the conversation."

Private equity is increasingly looking for ways to help business curb its health spending, and a growing number of smaller companies have found a niche in employer health clinics.

• Big pharmacy companies could find an opening, since they're already managing troves of medical data and boast valuable drug pipelines.
• As pharmacies pull back on care delivery models, that could make an ideal pivot, Giesting said.
• "They're vertically integrated, highly diversified organizations. They have an opportunity to play a very large role," he said.

Between the lines: CVS Health could be a case study. It has shuttered locations, opened smaller format stores and remains in the midst of a cost-cutting turnaround strategy. But it is still looking for a way to bridge the pharmacy counter and traditional primary care, said Peter Bonis, chief medical officer at Wolters Kluwer Health.

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Bayer is fighting to keep the popular agricultural herbicide Roundup available for farmers in the U.S. but could "reach the end of the road" and pull out of the market amid mounting challenges, CEO Bill Anderson said at an Axios event on Wednesday night.

Why it matters: Anderson said the chemical, known as glyphosate, has been repeatedly found safe and is "table stakes" for feeding the world.

• "Glyphosate combined with GMO crops is why we can feed 8 billion people in the world," Anderson said. "When I was a child, we struggled to feed 3.5 billion people in the world."

Friction point: A report from President Trump's Make America Healthy Again Commission due out as soon as today is expected to target glyphosate and other agricultural chemicals.

Between the lines: Bayer produces 40% of the world's supply of glyphosate in the U.S. and exports much of it, Anderson said.

• "If we go out, the glyphosate will still be there. It just won't be produced in America, and it puts it puts American consumers at the mercy of foreign nations."

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The FDA is requiring Pfizer and Moderna to expand warnings on the labels of their COVID-19 vaccines for the risk of heart inflammation in adolescents and young men.

The big picture: The agency cited updated estimates of cases of myocarditis and pericarditis — inflammation of heart muscle and surrounding tissue — and a post-approval study showing the persistence of heart abnormalities months after getting the mRNA shots.

• The label changes were posted on Wednesday and communicated in April 17 letters to the companies.

What they're saying: The agency said an analysis of insurance claims found an incidence of 8 cases per million doses for the 2023-2024 formulas of the shots.

• The updated warnings apply to males ages 16 to 25. Earlier warnings of heart issues for Pfizer-BioNTech's vaccine covered males 12 to 17, and for Moderna's, males 18 to 24.

Pfizer and Moderna didn't respond to requests for comment.

Catch up quick: Heart inflammation has been a known, but rare, side effect linked to the vaccines since early in the pandemic.

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