The Top 15 Specialty Pharmacies of 2016

In 2016, specialty drugs became an even bigger part of the pharmacy industry. We estimate that in 2016, retail, mail, long-term care, and specialty pharmacies dispensed about $115 billion in specialty pharmaceuticals. Specialty drugs accounted for 28% of the pharmacy industry’s prescription dispensing revenues.

Below is our exclusive list of the 15 largest pharmacies, ranked by estimated revenues from dispensing specialty pharmaceuticals. This year’s expanded list includes specialty pharmacies owned by pharmacy benefit managers (PBMs), health plans, retail chains, and wholesalers. A further five pharmacies are independent companies—for now.

Lace up and get ready to slug it out with our latest update on the booming specialty market.

As I describe in The Top 15 Pharmacies of 2016, PBM-owned and insurer-owned central-fill mail pharmacies with substantial specialty operations constitute six of the of the industry's largest 15 pharmacies.

To complement that broader list, here are the top pharmacies based on specialty drug dispensing revenues. The table appears in Chapter 3 of our new 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. We discuss many of the individual companies in subsections of the report’s Section 3.3.

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Note that the market share figures above are not comparable with our previous reports, due to the inclusion of long-term care pharmacies. (See Exhibit 39 of the new report for restated specialty prescription revenue figures from 2011 to 2016.) Many companies do not report specialty prescription revenues, so we have therefore used various methods and sources to estimate the data. Since last year’s report, we have also refined our estimates for some companies on the list.

The growth of specialty drugs continues to draw many new competitors into the market. Pharmacies that compete to dispense specialty therapies are owned by a diverse set of organizations: pharmacy benefit managers, health plans, retail chains, pharmaceutical wholesalers, hospital systems, and physician practices. There are also many independent specialty pharmacies.

Despite this diversity, market share for dispensing specialty drugs remains highly concentrated. This dominance is due partly to network strategies used by manufacturers and payers:

• For most recently-launched specialty drugs, manufacturers limit and manage the specialty pharmacies eligible to dispense these expensive medications.

• PBMs and health plans typically further limit the number of specialty pharmacies by requiring patients to use the specialty pharmacy that the plan or PBM owns and operates.

Consequently, the two largest PBMs—Express Scripts and CVS Health—remain the largest participants in the specialty pharmacy market. The top five companies account for about two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.

Smaller specialty pharmacies, physician offices, and health systems often struggle to access specialty medications within these networks. But as healthcare management guru Robert Balboa, Sr., reminded us: The world ain't all sunshine and rainbows. Check out his words of wisdom for pharmacies looking to expand in the specialty market. (Click here if you can't see the video.)