U.S. drug distribution revenues for Cencora, Cardinal Health and McKesson are projected to reach $933 billion in 2026 as changes in drug pricing, 340B and specialty pharmacy reshape the distribution market, according to an Oct. 14 Drug Channels analysis.
Here are 10 trends for hospital and health system leaders to know:
- Wholesaler revenue growth is projected to slow to mid-single-digit rates in 2026 after double-digit growth through 2025.
- The largest wholesalers remain financially strong. The companies maintain conservative capital structures, limited leverage and high liquidity.
- Drug distribution remains highly concentrated. Five companies are projected to account for more than 40% of U.S. drug distribution revenues.
- Drug pricing changes are challenging traditional distribution economics. More than 30 currently marketed brand-name drugs have had sharp list-price reductions.
- Alternative drug channels remain limited. Cash-pay and direct-to-patient models generally continue to rely on existing pharmacy and wholesale infrastructure.
- Wholesalers are moving deeper into provider operations. The largest wholesalers have spent more than $20 billion acquiring complete or partial stakes in physician MSOs.
- Provider-administered biosimilars are becoming an important profit source for wholesalers and specialty distributors.
- Medicare drug negotiations could affect hospital purchasing. Beginning in 2028, negotiated prices will take effect for selected Medicare Part B drugs and biologics. The analysis projects the changes could accelerate purchasing volume toward larger hospitals and health systems, including 340B organizations.
- 340B is becoming an increasingly influential distribution channel. Net drug sales through the program reached $100 billion, while more than 40 manufacturers have changed their policies for 340B discounts at external pharmacies.
- Cell and gene therapies are creating new distribution models. Wholesalers are developing services around the logistical and commercial requirements of these therapies.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
