Smaller Pharmacies, Bigger Impact: Inside Manufacturers’ Specialty Networks in 2025

Last week, we examined the growing concentration of specialty drug dispensing revenues among the largest pharmacies. See The Top 15 Specialty Pharmacies of 2024: How PBMs, Health Systems, and Independents Are Shaping the Market.

Today, we dive deeper. Drawing from DCI’s new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, we explore how pharmaceutical manufacturers structure their specialty pharmacy networks—and how smaller, independent pharmacies have emerged as dominant players in exclusive networks.

In DCI’s latest analysis, we find specialty pharmacies affiliated with the largest PBMs still play an outsized role in limited networks. But like a certain striped-hatted cat, smaller pharmacies unaffiliated with PBMs show up where few expect them. They dominate exclusive networks and maybe even cleaning up any messes left by Things 1, 2, and 3.

Read on for DCI’s updated profile of specialty networks—and consider why smaller players are showing the good tricks that they know.

I KNOW SOME NEW TRICKS

Due to a product's complexity and patient needs, manufacturers often limit and manage the pharmacies eligible to dispense its specialty medications.

That's right. Manufacturers have channel models. Not one, not two, but three!

They pick who can dispense it—carefully, you see.

• Open distribution? Any pharmacy will do.

• Limited dispensing network? Just a trusted few.

• Exclusive dispensing network? Only one pharmacy gets through!

Health plans and PBMs frequently narrow networks even further, requiring patients to use a preferred—and often affiliated—specialty pharmacy. As we discuss in Section 7.3 of DCI’s 2025 report, this dynamic can further limit unaffiliated pharmacies’ access, regardless of the manufacturer’s strategy.

LOOK AT MY DATA! LOOK AT MY DATA NOW!

To assess the landscape of manufacturer-defined specialty networks, DCI utilized data from IPD Analytics’ Access Hub platform, which includes Limited Distribution Drug Network Tracking. This unique resource tracks networks for a broad universe of specialty drugs. To the best of our knowledge, there is no comparable resource available for analyzing specialty pharmacy networks. To learn about this database and how you can get access, please contact Tim Powers (tpowers@ipdanalytics.com).

As of January 2025, Access hub included 382 unique specialty drugs with a manufacturer-defined limited or exclusive specialty pharmacy network. DCI analyzed the size and composition of these networks. We counted each drug only once, even if it was available in multiple forms (e.g., capsule vs. tablet), since their pharmacy networks were identical. 

OUT OF THE BOX

We tallied the data, both big and small. And here’s what we found, when we looked at them all:

• 34% of drugs have exclusive networks (only one pharmacy)

• 34% use limited networks with 2 to 4 pharmacies

• 20% include 5 to 10 pharmacies (average: 7)

• 12% have larger networks of 11 to 25 pharmacies (average: 15)

PBMS STILL DOMINATE…BUT THAT IS NOT ALL

We identified 164 unique pharmacies that were included in at least one limited or exclusive network. This list included the largest specialty pharmacies as well as numerous independent pharmacies.

The chart below shows the ten specialty pharmacies most frequently included in manufacturer-defined limited or exclusive specialty pharmacy networks.

[Click to Enlarge]

Observations:

• Specialty pharmacies associated with two of three largest things—the CVS Caremark business of CVS Health and the Express Scripts business of Cigna—have access to half of the specialty drugs in limited networks.

• Many of the largest specialty pharmacies (as ranked in last week’s post) were present in a minority of these networks.

DCI’s analysis of the 33% of products with exclusive networks (detailed in Exhibit 65 of our 2025 pharmacy/PBM report) reveals a different dynamic:

• The PBM-affiliated pharmacies had access to only one-quarter of all products with exclusive networks.

• Independent and smaller specialty pharmacies were much more prominent in manufacturers’ exclusive specialty pharmacy networks. For example, McKesson’s Biologics pharmacy accounted for 14% of the exclusive-network drugs, while PANTHERx Rare Pharmacy accounted for a further 12% of these products.

• Compared to the previous year’s report, independent pharmacies accounted for a larger share of exclusive networks. This shift occurred because a subset of drugs that had been partnered exclusively with Accredo and McKesson were no longer reported to have exclusive networks.

OH, THE PLACES SMALL PHARMACIES GO!

When manufacturers use an exclusive network, they’re seeking partners with tailored services, rare disease expertise, data-sharing capabilities, and a patient-centric approach. Independent specialty pharmacies that have invested in these areas are increasingly winning against the biggest PBM-affiliated players.

Put another way, bigger isn’t always better when it comes to specialty pharmacies. While PBM-affiliated pharmacies maintain dominance in broader networks, smaller and independent pharmacies are increasingly central to exclusive channel strategies.

As Dr. Seuss wisely asked, “Why fit in when you were born to stand out?” Solid advice for kids stuck inside on a rainy day and independent pharmacies breaking into exclusive specialty networks.