Pharmacy benefit manager-affiliated specialty pharmacies continue to dominate the market, with the top three companies accounting for two-thirds of prescription revenues in 2025, according to an April 21 Drug Channels report.
Here are five things to know:
1. The market remains highly concentrated: The report analyzed the top 15 specialty pharmacies by dispensing revenue and found concentration persists despite growth in accredited locations, which exceeded more than 1,900 in 2025, up 3% year over year and more than five times higher than in 2015.
2. Specialty drug spending continues to rise: Specialty pharmacies collectively dispensed $293.4 billion in drugs in 2025, a 9.6% increase from the previous year.
3. PBM-owned entities dominate revenue: Pharmacies tied to PBMs and major insurers continue to control a significant share of specialty drug-dispensing revenue.
4. Hospitals are gaining ground: Health systems expanded from 106 accredited specialty pharmacy locations in 2017 to 553 in 2025, now representing 28% of sites.
5. Independents face scale challenges: Independent pharmacies remain the largest category by number of locations but account for a smaller share of total revenue as vertical integration drives consolidation.
The top 15 specialty pharmacies by dispensing revenue were:
- CVS Specialty
- Accredo/Freedom Fertility
- Optum Specialty Pharmacy
- Walgreens Specialty Pharmacy/Walgreens stores
- Onco360 Oncology Pharmacy/CareMed Specialty Pharmacy
- PANTHERx Rare Pharmacy
- CenterWell Specialty Pharmacy
- BioPlus Specialty Pharmacy/Paragon Healthcare
- Acaria Health/Foundation Care
- Walmart Specialty Pharmacy/Walmart stores
- Senderra Specialty Pharmacy
- Biologics
- Lumicera Health Services
- AHF Pharmacy
- Soleo Health
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