As reimbursement pressure and 340B restrictions tighten across healthcare, more health systems are turning to in-house specialty pharmacies as a direct revenue play — and they’re building infrastructure to match.
Health systems and hospitals have emerged as the fastest-growing direct participants in the specialty pharmacy market, and changes in manufacturers’ 340B contract pharmacy policies have accelerated their investments in in-house specialty pharmacy operations, according to Drug Channels’ 2026 economic report. Health systems have seen an increase from 106 accredited specialty pharmacy locations in 2017 to 553 in 2025 — and manufacturers’ 340B contract pharmacy restrictions have been a key driver of that expansion.
Charlottesville, Va.-based UVA Health, for instance, opened its 40,000-square-foot central pharmacy services center earlier this year — a $17 million facility serving as a hub for nine retail pharmacy locations and its specialty and home delivery operations. Morgantown, W.Va.-based WVU Medicine converted a former Mylan pharmaceutical plant into a 25,000-square-foot centralized hub in 2025, reporting $620,000 in drug shortage savings, and has proposed consolidating specialty, home infusion and mail-order operations at the same site.
Falls Church, Va.-based Inova Health opened a 72,000-square-foot facility in August 2025, combining specialty, retail and mail-order operations under one roof with robotic filling and a large call center. Indianapolis-based Eskenazi Health opened a $10 million, 32,000-square-foot central fulfillment center in 2025, designed to fill 60% of the health system’s prescriptions over the next five years.
Chicago-based Lurie Children’s Hospital plans to open its first outpatient specialty pharmacy later this year as part of its new Outpatient and Infusion Center in Schaumburg, Ill., designed to serve pediatric patients with complex conditions through integrated care coordination. And Norfolk, Va.-based Sentara Health is insourcing its entire specialty pharmacy program from an outsourced managed service, reflecting a broader push by systems to own the revenue and patient relationships that specialty pharmacies generate rather than cede them to outside operators.
The strategic logic is consistent: specialty pharmacy is one of the few areas where pharmacy can function as a true revenue center. At MercyOne in Des Moines, leadership identified expanding retail pharmacy infrastructure as a top priority heading into 2026 — capturing prescriptions physicians write for their own patients and citing it as a critical positive margin in a challenging environment. At Winston-Salem, N.C.-based Novant Health, the director of pharmacy business warned that the margin for error has disappeared, and that many systems continue to lose significant revenue through preventable leakage driven by underinvestment in pharmacy revenue integrity.
PBMs are taking note and are moving to own that market. Cigna’s Evernorth fully acquired CarepathRx — a specialty pharmacy and infusion services operator supporting hundreds of hospitals — in March 2026, following a minority investment it made in 2023. The financial stakes are also rising. A federal court blocked the HRSA rebate pilot days before its Jan. 1 launch, but HRSA is developing a revised framework, keeping policy uncertainty intact. Meanwhile, Eli Lilly cut off 340B pricing for noncompliant hospitals after a June 8 claims-data deadline passed, making in-house specialty operations an increasingly critical hedge.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.