The Top 15 Specialty Pharmacies of 2025: PBM-Affiliated Pharmacies Dominate While Health Systems and Independents Gain Ground

By Adam J. Fein, Ph.D.

Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.

For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.

However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.

Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.

Next week, the DCI team will be attending Asembia’s AXS26 Summit in fabulous Las Vegas. Please say hello if you see us!

2025 MARKET TRENDS

This post is the fourth installment in a series based on insights from DCI’s new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Here are the earlier articles in the series:

• The Top 15 U.S. Pharmacies of 2025: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies

• The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments

• Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update

DCI’S DATA AND OBSERVATIONS ON SPECIALTY DISPENSING

In 2025, retail, mail, long-term care, and specialty pharmacies collectively dispensed an estimated $293.4 billion in specialty pharmaceuticals—a 9.6% increase over the revised 2024 figure.

The chart, which appears as Exhibit 56 in our 2026 pharmacy/PBM report, ranks the top pharmacies by estimated dispensing revenues from specialty pharmaceuticals. The figures include all dispensing formats of the respective businesses. We cover many of the individual companies listed below in the subsections of the report’s Section 3.3.

[Click to Enlarge]

Our observations on today’s marketplace:

• Market share for the dispensing of specialty drugs remains highly concentrated. The top three companies accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all part of vertically integrated organizations that also own a PBM. Specialty dispensing accounted for more than one-third of PBMs’ total gross profits in 2025. (See Section 5.5. of our new report.)
  
  This concentration results largely from strategies used by both payers and manufacturers to narrow specialty drug channels.

• Hospitals and health systems have emerged as the fastest-growing participants in the specialty pharmacy market. The number of accredited specialty pharmacies operated by hospitals and health systems has expanded quickly, from 106 locations in 2017 to 553 locations in 2025. They now account for 28% of accredited specialty pharmacies. This growth is a key reason that five manufacturers (so far) have expanded 340B data submission requirements to in-house hospital pharmacies.
  
  Hospitals’ in-house pharmacies are able to generate significant profits by participating directly in the 340B Drug Pricing Program. In response to changes in manufacturers’ policies regarding external contract pharmacies, hospitals continue to expand in-house specialty pharmacy operations. Self-insured health systems also steer prescriptions to their in-house specialty pharmacies.
  
  As we highlighted last week, both Cigna and UnitedHealth have also made significant investments in businesses that work with hospitals and health systems to provide specialty pharmacy services, further accelerating this channel shift.

• A small number of independent specialty pharmacies are emerging as the winners. Taken together, the developments above are challenging independent specialty pharmacies. While independents remained the single largest category of accredited locations in 2025, they account for a minority of total specialty dispensing revenues.
  
  However, the fastest-growing independent players are larger, well-capitalized, and growing quickly. For example, the three independent specialty pharmacies shown above—PANTHERx Rare, Senderra Specialty Pharmacy, and Soleo Health—have all received substantial investments from private equity firms.
  
  Some smaller, independent specialty pharmacies also remain well-represented in manufacturers’ exclusive specialty pharmacy networks. By contrast, PBM-affiliated specialty pharmacies only have access to 20% of specialty products with exclusive dispensing networks.

Specialty drugs accounted for less than 40% of the pharmacy industry’s prescription revenues in 2025, although their share has plateaued in recent years. Specialty drugs’ share of plan sponsors’ pharmacy benefit costs is higher than their share of prescription revenues, because rebates do not impact prescription dispensing revenues.

Taken together, DCI’s latest report illustrates a bifurcating market: scale and integration drive dominance at the top, while selective access and manufacturer relationships sustain a narrower set of independent winners.

NOTES FOR NERDS

• Most companies do not report prescription revenues from specialty drugs. DCI has therefore used various methods and primary sources to estimate the data. In some cases, the companies provided us with revenue figures. Certain data have been updated based upon new disclosures since the 2025 edition of our report.

• The figures include all dispensing formats of the respective businesses. For example, the figure for Walgreens includes Walgreens Specialty Pharmacy (formerly known as AllianceRx Walgreens Pharmacy), Walgreens specialty pharmacy locations inside hospitals, the Walgreens retail specialty pharmacies, and specialty drugs dispensed within Walgreens retail drugstores.

• As noted in the exhibit’s footnotes, DCI has made various adjustments to account for the pro forma impact of mergers and acquisitions. Pro forma revenues are computed based on the year in which an acquisition was completed. Year-over-year growth rates were also computed based on the prior year’s pro forma revenues.

• Revenues in the “All other retail, mail, long-term care, and specialty pharmacies” category come from the many pharmacies now competing to dispense these expensive therapies. As we discuss in the report’s Chapter 3, the specialty market’s growth continues to draw a diverse set of companies into the business of dispensing specialty drugs.

• The market size figure excludes estimated revenues from provider-administered specialty drugs billed under a patient’s medical benefit.