Other Health and Personal Care Retailers — NAICS 45619 (United States)

A Histometrics rollup primer for public- and private-market investors. NAICS = North American Industry Classification System, the federal scheme that sorts businesses by their primary activity.

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1. Overview

NAICS 45619 is the "everything-else" tier of specialty health-and-personal-care retailing — the part of the store-based health economy that is not a pharmacy, a cosmetics counter, or an eyeglass shop, each of which has its own five-digit code. What's left splits into exactly two national industries that share a shelf but almost nothing else about how they make money:

• 456191 — Food (Health) Supplement Retailers: vitamin, mineral, protein, and herbal-supplement shops (GNC, The Vitamin Shoppe, and a long tail of independents).
• 456199 — All Other Health and Personal Care Retailers: hearing-aid centers, home medical equipment (HME) dealers, and mobility/rehabilitation shops.

The two are almost mirror images. Supplement retail is a high-traffic, self-serve, semi-discretionary cash business whose specialty-store channel has been losing share for a decade to mass merchants, warehouse clubs, and online sellers. Hearing-and-HME retail is a low-traffic, big-ticket, service-wrapped business riding a structural demographic tailwind — an aging, chronically-ill population — with a large chunk of demand paid out of pocket (hearing aids) or billed to insurers (durable medical equipment). One channel is fighting to keep customers; the other is watching its customer base grow automatically.

What unites them for an investor is the punchline: in both children there is essentially no clean U.S.-listed pure play. The marquee storefronts are privately held, private-equity-owned, or subsidiaries of foreign-listed parents, and the level as a whole is one of the most fragmented corners of American retail. Public investors reach the theme sideways — through brand makers, diversified retailers, foreign hearing groups, or home-care billers. Private investors get the direct menu: buy, build, franchise, or roll up local operators.

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2. What's inside — the two child industries and how they differ

This is where the rollup earns its keep. The two children are roughly the same size but differ on nearly every axis that matters to how you'd own them.

How to read the contrast. The receipts are split almost 48/52, so neither child dominates the dollars. But they pull in opposite directions on the two questions investors care about most:

1. Growth direction. 456191's specialty stores are ceding share (the underlying supplement category is healthy, but shoppers increasingly buy it at Costco, on Amazon, or from direct sellers). 456199's stores sit under a demographic escalator — every year the U.S. adds more of exactly the customers who need hearing aids, CPAP machines (continuous positive airway pressure devices for sleep apnea), and mobility gear.
2. Labor and economics. 456199 employs more than twice the people (72,355 vs. 33,917) on similar revenue, because a hearing fitting or an HME delivery bundles clinical service, custom programming, and insurance billing — so its revenue per employee is about half that of a self-serve vitamin shop. Supplement stores are leaner and more traffic-driven; hearing/HME is a high-ticket, low-frequency sale with a recurring aftermarket.

The one thing they share — beyond a NAICS bin — is who you can't easily buy: the actual storefronts. That single fact shapes the whole "how to invest" story in Section 10.

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3. How big it is

Our ground-truth federal figures for the level (NAICS 45619), with the children shown for reconciliation:

The children reconcile almost perfectly: their receipts sum to ~$44.6B against the level's $44.69B, and their firm counts sum to exactly 15,263. (CR4/CR8/CR20/CR50 are share ratios and the SBA — Small Business Administration — size standard is a per-industry contracting threshold, so neither "adds up" across children.)

Read on concentration — the level is more fragmented than either child. The HHI (a standard 0–10,000 concentration gauge; anything under 1,500 is "unconcentrated" by U.S. antitrust convention) falls from 167 in supplements and 97 in hearing/HME to just 63 for the combined level — effectively atomistic. That's not a coincidence: rolling two distinct product markets together dilutes any single firm's share, because a supplement chain and a hearing chain don't actually compete. The four largest firms in the whole level hold under 12% of receipts across more than 15,000 firms — this is a small-operator, franchise, and independent-shop economy, not an oligopoly. Treat the level-wide HHI as a statistical artifact of combining unrelated markets, not as evidence that any real market is that competitive.

The undercount caveat is large — and it runs in two different directions. The $44.69 billion is a specialty-storefront register, not the size of the underlying consumer economy for these goods, and it understates that economy from both children:

• Small/individual ownership dominates, so the count misses a tail. County Business Patterns (CBP) counts only employer businesses; solo, home-based, and nonemployer operators — common in both a tiny-vitamin-shop trade and a one-person medical-supply or hearing shop — fall below the line or land in other codes. No industry-specific nonemployer total is supplied here.
• Supplements: most dollars are spent outside the specialty channel. Total U.S. dietary-supplement sales are estimated around $60–73 billion (one 2024 tally put it near $72.9B) [8], versus $21.6B of specialty-store receipts — the rest flows through drugstores, supermarkets, warehouse clubs, mass merchants, online marketplaces, and direct sellers, all coded elsewhere.
• Hearing/HME: most dollars flow through rental and insurance billing. The durable-medical-equipment (DME) giants (Lincare, Apria, AdaptHealth, Rotech) mostly bill Medicare and insurers and are coded under health-care services or rental, not cash retail; Costco — a top-five U.S. hearing-aid seller — is coded as a warehouse club. Their multi-billion-dollar volumes are largely invisible to this line.

So read $44.69B as roughly a quarter-to-a-third of the true consumer spend on these goods across all channels — the brick-and-mortar specialty slice, not the whole pie. The federal file carries no industry-wide same-store sales, gross margin, online-share, or turnover data, and none is asserted here.

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4. Investable universe — where value concentrates across the children

Bottom line: for a general investor there is no clean U.S.-listed pure play on either child, or on the level. Public companies report consolidated segments, not NAICS establishments — so every name below is an exposure proxy, not a pure play. Value concentrates in three different layers, and which layer you reach depends on which child you want.

Where the value sits differs by child:

• In 456191 (supplements), the retail storefronts are private, so listed value pools upstream and sideways — in the brand makers that fill the shelves and the diversified/mass channels that increasingly capture the volume.
• In 456199 (hearing/HME), the storefronts themselves are valuable and consolidating — but they're owned by foreign-listed parents, so the listed value is on European exchanges plus a couple of U.S. home-care billers.

Two patterns worth internalizing:

1. The most direct listed exposure in the whole level is the European hearing groups. Their U.S. retail arms (Miracle-Ear, Beltone, HearingLife, Connect Hearing) are the textbook 456199 business — but you buy them in euros/francs/kroner, with foreign-exchange and foreign-market caveats [21]. AdaptHealth (Nasdaq: AHCO, ~$3.26B revenue, ~660 U.S. locations) and Accendra Health (NYSE: ACH; Apria/Byram) are the closest U.S. tickers, but both are reimbursement-driven home-care billers more than walk-in stores [20].
2. On the supplement side, the cleanest listed "supplement-heavy retailer" is a grocer — Natural Grocers (NYSE: NGVC), ~$1.33B FY2025 net sales built around a 5,000-plus-SKU (stock-keeping-unit) supplement set, though groceries still outweigh supplements [22]. Otherwise you own the product (BellRing, Simply Good Foods, Glanbia), the demand via direct sellers (Herbalife, USANA), or the channel (Amazon, Costco, Walmart) — none a pure play.

There is no dedicated NAICS-45619 ETF or index. (Company tickers, revenues, and multiples are reserved to this and Section 10 by house style; figures are from the most recent SEC — Securities and Exchange Commission — filings, where supplement or hearing-retail revenue is rarely broken out separately.)

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5. How the money works

The two children run on genuinely different engines, and lumping them obscures that — so take them separately, then note the common thread.

456191 (supplements) — high-margin, small-box, repeat-purchase cash retail. The retailer buys finished product from brands or contract manufacturers and earns the spread. Levers: private-label mix (own-brand lines carry much higher margins than price-transparent national brands, and build loyalty — but concentrate product-liability risk on the retailer); comparable-store sales (the core health metric — multi-year weakness in mall-based comps is exactly why both national chains restructured); rent as a share of sales (small ~1,500–2,000 sq ft units with operating leverage — GNC's over-exposure to expensive mall leases was a key reason it faltered); franchising (capital-light royalty-plus-wholesale income; a GNC franchise reports median unit revenue around $444K); and auto-ship/subscription, which converts a discretionary buy into recurring revenue.

456199 (hearing/HME) — product margin plus service attachment plus reimbursement. A hearing fitting bundles a several-thousand-dollar device with audiology testing, custom programming, follow-ups, financing, and warranties; most buyers pay out of pocket, so pricing power and price sensitivity are both real. Devices replace roughly every 4–5 years, making the installed base an upgrade annuity. On the HME side, economics hinge on payer mix and reimbursement rates, with Medicare competitive bidding (Section 7) as a persistent margin compressor, and on resupply annuities (CPAP masks, tubing, filters) as the profit engine. The distinctive structural feature is vertical integration: the European groups own both the device factory and the retail chain, capturing manufacturing and retail margin on the same unit.

The common thread — and the key metrics. Both children are big-ticket-ish, service- or loyalty-anchored, recurring-aftermarket businesses rather than thin-margin fast-moving retail; both monetize a mix of company-owned and franchised units; both lean on private label / vertical integration to defend margin against price-transparent competition. Compare operators within each child on comparable-store sales, revenue and gross margin per location, private-label or attachment rate, repeat/resupply rates, inventory turns and working capital, and — for the HME side — payer mix, billing-denial rates, and days sales outstanding (DSO). Capacity-utilization and regulated-utility framing do not apply to either child; this is retail-plus-service economics.

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6. Demand drivers

The level is pulled by two nearly independent demand systems — which is why it is more resilient in aggregate than either child alone.

Feeding 456191 (supplements):

• Broad, habitual usage — ~75% of U.S. adults take a supplement, a sticky, brand-loyal base [7].
• Wellness culture and specialty-ingredient cycles — categories rise and fall fast (magnesium, melatonin, ashwagandha), with personalization a stated priority for most buyers.
• The GLP-1 weight-loss wave — GLP-1 (glucagon-like peptide-1) drugs like Ozempic/Wegovy drive demand for protein, creatine, and "GLP-1 companion" supplements (a niche projected to grow from ~$4.1B in 2025 toward ~$13B by 2035) even as they may dent legacy weight-loss and snack-adjacent categories [23].
• Sensitivity to discretionary spending — basic vitamins are resilient; premium sports-nutrition and novelty products get traded down in a downturn.

Feeding 456199 (hearing/HME):

• Aging demographics — the dominant, non-cyclical driver. People 65-and-older were 18.0% of the U.S. population in 2024, up from 12.4% two decades earlier; the 85-plus cohort is projected to roughly double toward 13.7 million by 2040 [9]. Age-related hearing loss and mobility/respiratory decline rise steeply after 65.
• Chronic-disease prevalence — about three in four adults have at least one chronic condition, driving CPAP, diabetes, and respiratory resupply [10].
• Care moving into the home — U.S. home-health spending hit $169.4B in 2024, up 10.2% [25] — a broader category, but pointing the same way.
• The OTC hearing channel — the FDA's (Food and Drug Administration) 2022 over-the-counter (OTC) rule lets adults with perceived mild-to-moderate loss buy hearing aids without a prescription; early evidence suggests it is expanding the market more than cannibalizing clinical fittings [11].

Net for the level: supplement demand tracks consumer confidence and wellness fads; hearing/HME demand tracks demographics and chronic-care intensity. The two only weakly correlate — a downturn that trims supplement baskets barely touches a retiree's need for a hearing aid — which makes the combined level steadier than its more volatile supplement half.

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7. Regulation

The two children sit under two different regulatory universes, and the contrast is itself an investment fact.

456191 (supplements) — light-touch, food-not-drug. Under DSHEA (the Dietary Supplement Health and Education Act of 1994), supplements are regulated as food: the FDA does not pre-approve them for safety or efficacy; the company carries responsibility, with FDA handling post-market oversight [14]. Labels may make "structure/function" claims ("supports immune health") but cannot claim to treat or cure disease, and advertising is policed by the FTC (Federal Trade Commission) for truthful, substantiated claims [15]. The 2025–26 wildcard is the "Make American Healthy Again" (MAHA) agenda under HHS (Health and Human Services): broadly supplement-friendly, but pushing DSHEA "modernization" — a possible mandatory product listing, tighter ingredient oversight, and GRAS ("generally recognized as safe") reform — which would raise compliance costs even as it could lift category trust [24]. GNC's Chinese state-linked ownership adds recurring political scrutiny.

456199 (hearing/HME) — heavy device-and-reimbursement regime. Hearing aids and most HME are FDA-regulated devices; the pivotal recent change is the 2022 OTC hearing-aid rule opening non-clinical retail channels [11]. On the HME side, suppliers billing Medicare need accreditation, enrollment, and a surety bond, and the DMEPOS competitive bidding program (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies), run by CMS (the Centers for Medicare & Medicaid Services), directly sets prices — a standing margin pressure and consolidation forcing-function [12]. Crucially, Original Medicare does not cover hearing aids [13]; recurring bills to change that have not passed, and enactment would be a step-change demand catalyst.

The contrast that matters: in supplements, regulation is light and the risk is that it tightens; in hearing/HME, regulation is heavy and the swing factor is reimbursement policy (competitive-bidding cuts on one side, potential Medicare hearing coverage on the other). Both children also carry FTC advertising oversight [15] and product-safety/recall exposure.

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8. Consolidation

Both children are fragmented at the store level yet consolidating at the ownership level — but for different reasons and toward different owners.

• 456191 (supplements): consolidation at the edges, not the center. National retail share stays low; the action is (a) PE re-tooling the brick-and-mortar chains (Kingswood/PIP at The Vitamin Shoppe [19]), (b) online consolidation (iHerb's acquisition of Vitacost from Kroger, combining two of the largest online supplement retailers [17]), and (c) brand-side M&A (Nestlé's $5.75B purchase of core Bountiful brands). The competitive threat isn't a rival inside the code — it's the channels outside it (Amazon, Costco, Walmart, direct sellers).
• 456199 (hearing/HME): vertical integration is remaking ownership fast. The landmark event is Amplifon's ~€2.3 billion (~$2.6B) agreement to acquire GN Hearing (March 2026), fusing the world's largest hearing retailer with a top-tier device maker into a ~€3.3B-revenue group — the capstone of years of European majors buying up independent hearing chains [16]. On the HME side, competitive-bidding margin squeeze has pushed roll-ups toward scale players (AdaptHealth, Lincare, Apria/Byram, Numotion). Deal risk is real — Owens & Minor (now Accendra) and Rotech terminated a 2025 deal over regulatory-clearance doubts [20].

The through-line: in both children, independents increasingly buy product from firms that also own competing retail (GNC/Vitamin Shoppe private-label vs. independents; European device makers vs. independent hearing clinics) — a structural squeeze that keeps feeding consolidation. The best consolidators win on service, cash conversion, and private-label/vertical margin, not merely on adding locations.

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9. Risks

Shared across the level:

• Channel disintermediation. Both children face erosion by adjacent channels — Amazon/Costco/Walmart and direct sellers in supplements; Costco, OTC, and e-commerce in hearing/HME.
• Product safety and liability. Recalls, adulteration, counterfeits, and mislabeling can expose the retailer even when manufacturing is outsourced.
• Fragmentation / small-operator fragility. Thousands of sub-$10–22M shops carry thin balance sheets, owner dependence, succession risk, and labor shortages (store staff; audiologists and assistive-technology technicians).
• Private-company opacity. The marquee names disclose little; buyers must diligence debt, leases, store-level profitability, inventory, and covenants themselves.

Concentrated in 456191: regulatory tightening (DSHEA modernization, GRAS reform, ingredient bans) [24]; discretionary-spend softness and trade-down; import/tariff exposure on ingredients concentrated in China; fad/inventory concentration; GLP-1 as a double-edged force; and direct-selling/FTC risk for the MLM (multi-level-marketing) proxies. Plus foreign-state ownership scrutiny at GNC.

Concentrated in 456199: reimbursement and policy risk in both directions — competitive-bidding cuts squeeze HME margins, while the market depends on out-of-pocket hearing spend that a recession dents [12][13]; payer/referral concentration; billing-and-compliance exposure (denials, recoupments, accreditation); manufacturer-dependence / vertical squeeze; roll-up execution and leverage risk; and foreign-listing/FX risk for U.S. investors reaching the hearing names on European exchanges [21].

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10. How to invest, and the outlook

The level's defining fact — worth repeating — is that you cannot cleanly buy the storefronts in either child. The practical menu:

Public-market routes (all indirect):

1. Hearing/HME (456199) — the most direct listed exposure in the level, but foreign. Buy the European hearing groups whose U.S. chains define the category — Amplifon (Milan; Miracle-Ear), Sonova (Zurich; Connect Hearing), Demant (Copenhagen; HearingLife), GN Store Nord (Copenhagen; Beltone) [21] — accepting FX and foreign-market caveats. Or take U.S.-listed home-medical exposure via AdaptHealth (AHCO) or Accendra Health (ACH), understanding both are reimbursement-driven billers more than walk-in stores [20].
2. Supplements (456191) — indirect only. Closest listed proxy is grocer Natural Grocers (NGVC), lighter via Sprouts (SFM) [22]; concentrated demand exposure through direct sellers (Herbalife HLF, USANA USNA, Nature's Sunshine NATR) with their own regulatory risk; the product via BellRing (BRBR), Simply Good Foods (SMPL), Glanbia; and the winning channels via Amazon (AMZN), Costco (COST), Walmart (WMT), where supplements are a small slice.

Compare names on comparable-store sales, transaction and ticket growth, gross margin, private-label/attachment share, inventory turns, resupply/repeat rates, payer mix and DSO (hearing/HME), leverage, and free cash flow — and value on price-to-sales or EV/EBITDA (enterprise value to earnings before interest, taxes, depreciation, and amortization) only after adjusting for how little of each business is actually this NAICS code.

Private-market routes (the direct exposure — and the real action): this level is fundamentally a private/SMB, franchise, and roll-up story on both sides. Franchise or own a GNC/Vitamin Shoppe-style supplement store or a Miracle-Ear/Beltone hearing center; buy or build a local medical-supply/mobility shop; or back PE roll-ups of independent supplement, hearing, or HME operators — the extreme fragmentation (HHI 63) and, on the hearing/HME side, the demographic tailwind make consolidation an active theme. Diligence the things headline revenue hides: for supplements, private-label economics, lease exposure, aged inventory, customer-acquisition cost, and repeat rates; for hearing/HME, payer contracts, denial history, accreditation, referral concentration, clinician retention, and service-level data.

Outlook (forward-looking judgment; the federal data carry no forecast, so no growth rate is asserted). The level is a two-speed business, and the two speeds partly offset:

• 456191 — underlying supplement demand looks structurally healthy (sticky usage, aging, the GLP-1 protein tailwind), but the specialty store channel this code measures should keep ceding share to online and mass; value accrues to omnichannel operators with strong private label, loyalty/auto-ship, and franchise leverage — not legacy mall boxes.
• 456199 — the steadier, defensive half, with a durable demographic floor; watch the Amplifon–GN integration and whether it triggers further vertical mergers, the trajectory of OTC hearing aids, and any movement on Medicare hearing coverage or DMEPOS rates [16][11][13].

For most public investors the practical exposure is a brand maker, a diversified retailer, or a foreign hearing group; direct ownership of one of these stores remains a private-market or franchising decision — and that, more than any single number, is the signature of NAICS 45619.

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Sources

1. U.S. Census Bureau, 2022 NAICS Definitions — 45619 / 456191 / 456199 (scope and exclusions; illustrative examples). https://www.census.gov/naics/?year=2022
2. U.S. Census Bureau, 2022 Economic Census — Concentration of Sales by Largest Firms, NAICS 45619 (firms 15,263; receipts $44.69B; CR4 11.9% / CR8 18.6% / CR20 29.7% / CR50 40.5%; HHI 63.4). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
3. U.S. Census Bureau, 2022 Economic Census — NAICS 456191 (receipts $21.6B; firms 8,087; CR4 21.5%; HHI 167.4). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
4. U.S. Census Bureau, 2022 Economic Census — NAICS 456199 (receipts $23.04B; firms 7,176; CR4 15.8%; HHI 96.6). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
5. U.S. Census Bureau, County Business Patterns 2023 — establishments, employment, payroll, NAICS 456191 & 456199 (8,267 & 10,170 stores; 33,917 & 72,355 employees; $948.1M & $3.63B annual payroll). https://www.census.gov/programs-surveys/cbp.html
6. U.S. Small Business Administration, Table of Size Standards (456191 $22.5M; 456199 $9.5M average annual receipts — per-industry contracting thresholds, not size estimates). 2023. https://www.sba.gov/document/support-table-size-standards
7. Council for Responsible Nutrition / Ipsos, 2024 CRN Consumer Survey (~75% of U.S. adults use supplements). 2024. https://www.crnusa.org/newsroom
8. Nutraceuticals World / Nutrition Business Journal, U.S. Supplement Sales ~$72.9 Billion. 2024. https://www.nutraceuticalsworld.com/
9. U.S. Census Bureau, Older Adults (65+ = 18.0% of population, 2024); 85+ projections. 2025. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html
10. U.S. Centers for Disease Control and Prevention, Chronic Conditions / 85+ population. 2025–2026. https://www.cdc.gov/chronicdisease/
11. U.S. Food and Drug Administration, Establishing Over-the-Counter Hearing Aids — Final Rule (effective Oct. 17, 2022). https://www.federalregister.gov/documents/2022/08/17/2022-17230/
12. U.S. Centers for Medicare & Medicaid Services, DMEPOS Competitive Bidding Program and Enroll as a DMEPOS Supplier. 2025–2026. https://www.cms.gov/
13. U.S. Medicare.gov / CMS, Hearing aids and exams not covered by Original Medicare; H.R.500 Medicare Hearing Aid Coverage Act of 2025 (introduced, not enacted). 2025–2026. https://www.medicare.gov/coverage/hearing-aids
14. Council for Responsible Nutrition / U.S. FDA, Dietary Supplement Health and Education Act (DSHEA); Structure/Function Claims; NDI notification; cGMP 21 CFR Part 111. https://www.crnusa.org/regulation-legislation
15. U.S. Federal Trade Commission, Health Products Compliance Guidance. 2022. https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance
16. Amplifon / The Hearing Review / Bloomberg, Amplifon to Acquire GN Hearing (~€2.3B / ~$2.6B; ~€3.3B combined revenue; close expected end-2026). 16 Mar 2026. https://hearingreview.com/inside-hearing/industry-news/amplifon-to-acquire-gn-hearing-in-2-6-billion-deal
17. iHerb, iHerb Acquires Vitacost from Kroger (>$2.4B 2024 net sales; completed Jan 2026). https://www.iherb.com/pressreleases/iherb-acquires-vitacost-business/2280
18. U.S. SEC / McCarthy Tétrault / Wikipedia, GNC acquired by China's Harbin Pharmaceutical Group (via ZT Biopharmaceutical, ~$770M, 2020 Chapter 11). https://en.wikipedia.org/wiki/GNC_(company)
19. Retail Dive / Kingswood Capital, The Vitamin Shoppe sold to Kingswood Capital + Performance Investment Partners (~$193.5M; ~635 stores; closed May 2025). https://www.retaildive.com/news/the-vitamin-shoppe-private-equity-kingswood-capital-acquisition/745742/
20. AdaptHealth Corp., FY2024 Results (~$3.26B revenue; ~660 U.S. locations; Nasdaq: AHCO); Owens & Minor → Accendra Health (NYSE: ACH; Apria/Byram); Rotech deal terminated 2025. 2025. https://adapthealth.com/
21. Amplifon (Milan: AMP), Sonova (SIX: SOON), Demant & GN Store Nord (Nasdaq Copenhagen: DEMANT / GN) — investor materials; U.S. retail brands Miracle-Ear, Connect Hearing, HearingLife, Beltone. 2024–2026. https://corporate.amplifon.com/en/investors
22. U.S. SEC, Natural Grocers by Vitamin Cottage FY2025 Form 10-K (~$1.33B net sales; 5,000+ SKU supplement set); Sprouts Farmers Market FY2025 10-K. https://www.sec.gov/Archives/edgar/data/1547459/000143774925037556/ngvc20250930_10k.htm
23. Future Market Insights, GLP-1 Nutritional Support Market 2025–2035 (~$4.1B → ~$13B). 2025. https://www.futuremarketinsights.com/reports/glp-1-nutritional-support-market
24. SupplySide SJ, RFK Jr.'s HHS: mixed signals for the supplement sector (mandatory product listing, GRAS reform). 2025. https://www.supplysidesj.com/supplement-regulations/rfk-jr-s-hhs-showing-mixed-signals-for-dietary-supplement-sector
25. U.S. Centers for Medicare & Medicaid Services, National Health Expenditures 2024 Highlights (home-health spending $169.4B, +10.2%). 2025. https://www.cms.gov/files/document/highlights.pdf
26. Global Market Insights, OTC Hearing Aids Market (~$437M in 2025 → ~$884M by 2034). 2025. https://www.gminsights.com/industry-analysis/otc-hearing-aids-market