The specialty pharmacy market is nothing short of dynamic as payers increase vertical integration, health systems push for access, and regulatory activity continues to emerge and develop. HIRC’s report, Specialty Pharmacy Providers: Market Landscape Trends and Strategic Imperatives, examines recent market trends, key players, and specialty pharmacy provider (SPP) strategic imperatives. The report addresses the following questions: 

• What notable market trends are impacting the specialty pharmacy channel? 
• What are the latest trends in specialty drug dispensing and distribution (e.g., limited distribution, white bagging)? 
• How has the market evolved in regards to specialty pharmacy market share and the number accredited specialty pharmacies operating in the U.S.? 
• What is the status and impact of the health system-owned specialty pharmacy sector? 
• What do SPPs describe as their most urgent strategic imperatives for 2025 and how does this vary by ownership type (e.g., PBM-owned vs. independent)? 
• How common is it for various SPP services to be provided as a core service vs. at an additional cost to manufacturers and payers? 

Key Finding: Market share continues to be dominated by a few large vertically integrated specialty pharmacies. Many SPPs outside of the "big three" continue to experience access challenges and margin compression, and are thus seeking creative means of growing their businesses and increasing efficiencies. 

The Unfolding Regulatory Environment is Identified by SPPs as the Top Most Impactful Market Trend for 2025. SPPs report several market trends impacting their industry and businesses in 2025. Topping the list is the rapidly evolving legislative and policy landscape, with the IRA, 340B, new drug pricing laws, and PBM regulations top of mind for SPP decision-makers. This is followed by margin pressures and the increase in gene therapy, rare disease medications, and biosimilars - the latter presenting both challenges and opportunities to SPPs depending on their ownership type and capabilities. 

The full report examines the complete list of market trends in detail, in addition to how specialty pharmacies are responding and positioning themselves. 

PBM/Health Plan-owned SPPs Maintain Advantage in Limited Distribution Drug Access. A large proportion of specialty drugs are launched with a limited network, and networks may be increasingly limited (smaller) or even exclusive to support complex rare disease or gene therapies. PBM and health plan-owned specialty pharmacies report access to a greater number of limited distribution drugs on average, followed by health system-owned specialty pharmacies. 

While some leading independent SPPs have a defined focus in oncology or rare disease dispensing which are often under limited distribution, others have elected to focus on higher volume, more open distribution therapeutic areas such as inflammation & immunology and HIV/AIDS. The full report reviews trends in limited distribution networks as well as SPP perspectives on which manufacturers are most willing of offer access into LDD networks. 

Detailed Profiles of Select Industry-Leading Specialty Pharmacies Provided. The full report includes in-depth profiles of the following listing of industry-leading specialty pharmacies in market share: 

Dispensing trends, service offerings, and strategic imperatives are also segmented by the following three SPP ownership types: 

• PBM/Health Plan-owned Specialty Pharmacies (n=9) 
• Independent/Other Specialty Pharmacies (Other includes retail, wholesaler-owned, etc.) (n=13) 
• Health System-owned Specialty Pharmacies (n=19) 

Research Methodology and Report Availability. In March & April, HIRC surveyed 41 specialty pharmacy provider executives, representing a variety of ownership types. In addition to extensive secondary research, online surveys and follow-up telephone interviews were used to gather information. The report, Specialty Pharmacy Providers: Market Landscape Trends and Strategic Imperatives, is part of the Specialty Pharmaceuticals Service, and is now available to subscribers at www.hirc.com.