Below, we share our proprietary analyses of the specialty market’s participants. DCI identified more than 1,900 pharmacy locations that have achieved specialty pharmacy accreditation from one of the two major independent accreditation organizations.
Despite growing revenues from specialty drugs, overall growth in accredited pharmacies has plateaued. However, pharmacy locations owned by healthcare providers—hospitals, health systems, physician practices, and other healthcare providers—continue to expand and now account for nearly 40% of all accredited specialty pharmacy locations.
Read on for a bit of our arithmomania. Because in specialty pharmacy, what gets counted reveals who really counts.
LET’S COUNT, COUNT!
This post is adapted from Chapter 3 of our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Even DCI can’t count the total number of pharmacies that dispense specialty drugs, since any pharmacy can designate itself a “specialty pharmacy.” Unlike other dispensing formats, a specialty pharmacy is typically not defined by state pharmacy boards. Furthermore, some specialty products are in open distribution and can be dispensed by any licensed pharmacy.
A useful proxy for the number of active specialty pharmacies comes from DCI’s proprietary analysis of pharmacy locations with specialty pharmacy accreditation from a third-party organization. Such accreditation organizations help pharmacies develop and verify their capabilities to manufacturers and third-party payers.
We therefore counted every pharmacy location that had been accredited by at least one of the two organizations that now dominate accreditation for specialty pharmacies: Other organizations also offer specialty pharmacy accreditation, but they lag far behind ACHC and URAC. Most of the locations accredited by these organizations are also accredited by ACHC and/or URAC.
ONE PHARMACY, TWO PHARMACIES…AH AH AH AH AH!
As of the end of 2025, we had identified 1,910 unique pharmacy locations that had achieved specialty pharmacy accreditation from ACHC and/or URAC. The 2025 figure marks a 3% increase over the 1,861 locations in 2024 and is more than five times larger than the 2015 figure.
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As we discuss at the bottom of this article, our methodology accounts for the growing share of pharmacy locations that have accreditation from more than one organization.
- There were 1,233 locations accredited by only one of the two organizations (URAC or ACHC), a decrease of 36 locations from the previous year’s figure.
- There were 677 pharmacy locations accredited by both URAC and ACHC, an increase of 85 locations from the previous year’s figure.
HOSPITALS ARE STILL BATTY FOR SPECIALTY PHARMACY
Pharmacies that compete to dispense specialty therapies are owned by a diverse set of organizations. These pharmacies are operated by pharmacy benefit managers, retail chains, health plans, pharmaceutical wholesalers, physician practices, hospital systems, and other organizations. There are also many independent specialty pharmacies.
Don’t let the sheer number of participants fool you. When we group these pharmacies by ownership, a clearer picture emerges of who is expanding and who is being left behind.
The chart below quantifies specialty market participation by categorizing, by corporate ownership, the 1,910 unique locations that achieved specialty pharmacy accreditation from ACHC and/or URAC. In the subsections of Section 3.3. of our latest report, we highlight leading companies and key trends for each of these categories.
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Observations:
- A minority of accredited specialty pharmacy locations are now independently owned businesses.
Only 553 (29%) of all accredited specialty pharmacy locations are independently owned businesses, including private independent pharmacies, pharmacies owned by private equity firms, and independently owned franchise locations. The share of independently owned locations has declined over time, from 59% in 2015 to 29% in 2025.
- Four out of 10 specialty pharmacy locations are operated by healthcare providers.
Hospitals’ in-house pharmacies are able to generate significant profits by participating directly in the 340B Drug Pricing Program. Hospitals are also responding to changes in manufacturers’ policies regarding external 340B contract pharmacies. Hospitals are therefore using vertical integration to internalize specialty pharmacy as a profit center and a strategic hedge.
Consequently, 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. Hospitals and health systems accounted for 15% of total accredited specialty pharmacy locations in 2017, but 28% of the total in 2025. As we highlighted in our vertical integration analysis, both Cigna and UnitedHealth have also made significant investments in businesses that work with hospitals and health systems to provide specialty pharmacy services.
Other healthcare providers accounted for a further 16% of accredited specialty pharmacies. This category includes medical practices and physician-owned clinics. Most of these locations focus on two medical specialties—oncology and urology—that frequently prescribe patient-administered specialty drugs.
The other healthcare proividers category also includes nonphysician providers with specialty pharmacies, such as the AIDS Healthcare Foundation (AHF). AHF provides outpatient medical care for those affected by HIV or living with AIDS. It also operates one of the country’s largest specialty pharmacies as a federal grantee under the Ryan White HIV/AIDS program, so AHF qualifies as a 340B covered entity.
- Location data do not correspond with the market share of specialty prescriptions or specialty dispensing revenues. As we show in our list of the top 15 specialty pharmacies, 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.
Not everything that counts can be counted, and not everything that can be counted counts. But as our obsessive enumeration shows, the specialty boom is reshaping pharmacy market competition in favor of scale, integration, and control. Ah ah ah ah ah!
COMMENTS FOR COUNTS
Before you question The Count’s arithmetic, a few notes on how we built this tally:
- Our analyses are based on data we have independently gathered from the accreditation organizations.
- We analyzed pharmacy locations, not the number of companies. Many specialty pharmacy businesses have multiple locations, each of which is counted separately.
- Some pharmacies seek accreditation from more than one organization. We accounted for potential double-counting when computing the total number of unique pharmacy locations with specialty pharmacy accreditation. We have identified these locations based on the pharmacy’s address.
- The data exclude locations with provisional, conditional, and expected accreditation.
- Some community pharmacy locations are accredited if they are “spokes” associated with a specialty pharmacy services hub within a retail chain. We excluded the individual spoke locations from our analysis to maintain comparability when counting the number of accredited specialty pharmacies.
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