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The 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors


The 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors
By Drug Channels Institute
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The U.S. prescription market continues to expand, but the foundations of the drug channel are shifting. Legislative intervention, pricing realignment, vertical integration, and alternative payment models are accelerating a structural transition away from a rebate-driven system built on high list prices and toward a marketplace increasingly shaped by net prices.

The 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors examines the most crucial commercial, political, financial, and legal forces driving change in the industry.

The 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our seventeenth edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Widely regarded as the industry standard, this unique, encyclopedic resource is your ultimate guide to wholesale distribution’s role in the complex web of interactions within U.S. prescription drug channels. Download a free overview of the 2026-27 report.

This definitive, nonpartisan resource thoroughly updates DCI’s annual exploration of the wholesale industry’s interactions with—and services for—other participants in our healthcare system.

The report synthesizes a wealth of statistical data (including 193 data-rich exhibits), research studies, financial information, and DCI’s extensive industry experience.

These features make this report essential reading for pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospital executives, pharmacy buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and anyone else who wants to understand and benefit from this ever-changing industry.

This 2026-27 edition contains the most current available financial and industry data about the distribution of pharmaceuticals and the major companies that handle these products. The report also updates our annual analyses of the strategies, market positions, and executive compensation of the three largest companies: Cencora, Cardinal Health, and McKesson. We review each wholesaler’s business segments and underlying business profitability, based on our proprietary economic models. This information allows you to assess differences among the public wholesalers’ business organizations, strategies, and financial performance. Where appropriate, financial data have been restated based on updated disclosures.

The chart below highlights the vertical alignment for each company’s major businesses and those businesses’ diverse roles within the U.S. healthcare system. The numbers in the chart indicate the report chapter that corresponds to, explains, and analyzes each business.

The notable new material in this 2026-27 edition includes the following:

  • A new Section 3.3.4. includes updated and expanded material related to wholesalers’ investments in management services organizations (MSOs).
  • Section 6.2.4. has been expanded to cover new developments in manufacturers’ direct-to-patient channels and TrumpRx.
  • A new Section 6.3.2. evaluates the potential implications of the Inflation Reduction Act for the buy-and-bill market.
  • Section 6.3.3. has been expanded to incorporate additional details about the cell and gene therapy market as well as wholesalers’ strategies and market positions.
  • Section 7.2.2. presents revenue and profit information for Cencora’s businesses based on the new reporting structure that the company adopted during its 2026 fiscal year.
  • The Inflation Reduction Act of 2022 (IRA; P.L. 117–169) includes numerous changes to prescription drug pricing in the Medicare program. To reflect the law’s implementation, we have altered our presentation in this 2026-27 edition:
    • Our summary of key aspects of this law that affect the Medicare Part B and Part D programs now appears in a new Appendix. In previous editions, this content had appeared in Chapter 6.
    • Material highlighting drug channel implications of the IRA has been updated and integrated into the main text. In previous editions, this content had appeared in a separate section.
  • There are 193 exhibits in this 2026-27 edition, compared with the 187 exhibits in the 2025-26 edition. Most exhibits are new or fully updated from the previous year’s edition.

No other report on the market today offers the depth, insight and analysis of the 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

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THIS END USER LICENSE AGREEMENT (“Agreement”) governs your use of The 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors (“Report”) provided by HMP Omnimedia, LLC, an HMP Global Company, d/b/a Drug Channels Institute (“DCI”) under this Agreement made available to, or accessed by, you (“Purchaser”). Purchaser may cite this Report in commercial documents with full and appropriate attribution. Nothing in the license is intended to reduce, limit, or restrict any rights arising from fair use under copyright law or other applicable laws.

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TABLE OF CONTENTS

Introduction and Guide to This Report

PREFACE: INDUSTRY TRENDS AND KEY REPORT THEMES

SECTION I: WHOLESALER AND CUSTOMER INDUSTRY ANALYSIS

Chapter 1: Industry Overview

  • 1.1. Wholesale Industry Fundamentals
    • 1.1.1. Defining Drug Wholesale Distribution
    • 1.1.2. Full-Line Wholesalers
    • 1.1.3. Specialty Distributors
    • 1.1.4. Wholesalers and the Drug Supply Chain Security Act
  • 1.2. The Products That Wholesalers Sell
    • 1.2.1. Brand vs. Generic Drugs
    • 1.2.2. Route of Administration and Benefit Coverage
    • 1.2.3. Traditional vs. Specialty Drugs
  • 1.3. Overview of Wholesalers’ Channel Roles
    • 1.3.1. Physical Distribution
    • 1.3.2. Financial Intermediation
    • 1.3.3. Services for Pharmacies, Providers, and Manufacturers
    • 1.3.4. Impact on Pharmacy and Provider Reimbursement
  • 1.4. Industry Participants
    • 1.4.1. Big Three Wholesalers: Revenue and Growth Trends
    • 1.4.2. Specialty Product Distribution Market Share
    • 1.4.3. Other Wholesale Market Participants

Chapter 2: Channel Role for Retail, Mail, and Specialty Pharmacies

  • 2.1. The Pharmacy Market
    • 2.1.1. Outpatient Dispensing Formats
    • 2.1.2. Pharmacy Market Size and Structure
  • 2.2. Independent Pharmacies
    • 2.2.1. Industry Position and Wholesaler Relationships
    • 2.2.2. Wholesaler Services for Independent Pharmacies
    • 2.2.3. Franchise Programs and Marketing Groups
    • 2.2.4. PSAOs and the Wholesalers’ Role in Pharmacy-Payer Relationships
    • 2.2.5. Pharmacy Group Purchasing Organizations and Wholesaler Relationships
    • 2.2.6. Wholesaler Generic Source Programs for Smaller Pharmacies
  • 2.3. Retail Chains and Mail Pharmacies
    • 2.3.1. Wholesale Suppliers to Largest U.S. Pharmacies
    • 2.3.2. Physical Distribution Relationships Between Wholesalers and Retail Chains
    • 2.3.3. Generic Sourcing Relationships Between Wholesalers and Large Pharmacies
  • 2.4. Specialty Pharmacies
    • 2.4.1. Specialty Pharmacy Market Participants
    • 2.4.2. Wholesalers’ Specialty Pharmacies
    • 2.4.3. Wholesalers’ Role in Manufacturer-Defined Limited Specialty Networks

Chapter 3: Channel Role for Physician Offices/Clinics and Hospitals

  • 3.1. The Provider-Administered Drug Market
    • 3.1.1. Outpatient Drug Spending, Sites of Care, and Market Size
    • 3.1.2. The Buy-and-Bill System
    • 3.1.3. Group Purchasing Organizations
    • 3.1.4. Contract Management and Chargebacks
    • 3.1.5. White Bagging and Specialty Pharmacies’ Role in Buy-and-Bill Channels
  • 3.2. Provider Reimbursement in the Buy-and-Bill System
    • 3.2.1. Medicare Part B and Average Sales Price
    • 3.2.2. Commercial Health Plans
    • 3.2.3. Patient Cost Sharing
  • 3.3. Physician Offices
    • 3.3.1. Pharmaceutical Purchasing and Distributors’ Services
    • 3.3.2. Group Purchasing Organizations for Physician Practices
    • 3.3.3. Specialty Drug Dispensing by Physician Practices
    • 3.3.4. Wholesaler Investments in Physician Management Services Organizations
  • 3.4. Hospitals
    • 3.4.1. Pharmaceutical Purchasing and Wholesalers’ Services for Hospitals
    • 3.4.2. Group Purchasing Organizations for Hospitals
    • 3.4.3. Specialty Pharmacies at Hospitals and Health Systems
    • 3.4.4. Wholesalers and the 340B Drug Pricing Program

SECTION II: BUSINESS ECONOMICS AND INDUSTRY TRENDS

Chapter 4: Wholesaler Profitability

  • 4.1. Sources of Wholesaler Gross Profits and Gross Margin
  • 4.2. Components of Buy-Side Gross Margin
    • 4.2.1. Distribution Service Agreements
    • 4.2.2. Payment Discounts
    • 4.2.3. Specialty Distribution Service Agreements
    • 4.2.4. Generic Sourcing Formularies
    • 4.2.5. Provider-Administered Biosimilars
    • 4.2.6. Wholesaler Compensation and Bona Fide Service Fees
  • 4.3. Sell-Side Gross Margins and Cost-Minus Discounts
  • 4.4. Gross Margins
    • 4.4.1. Overall Gross Margins
    • 4.4.2. Estimates of Buy-Side and Sell-Side Gross Margins
  • 4.5. Gross Profits of Brand-Name, Biosimilar, and Generic Drugs
    • 4.5.1. Lifecycle Profits for Traditional Generic Drugs
    • 4.5.2. Lifecycle Profits for Provider-Administered Generic Drugs
    • 4.5.3. Private Label Generic and Biosimilar Drugs
  • 4.6. The Profit Impact of Changes in Brand-Name Drug Prices
    • 4.6.1. Wholesaler Fees and Brand-Name Drug Inflation or Deflation
    • 4.6.2. Inventory Appreciation and Revaluation
  • 4.7. Operating Expenses and Operating Profit

Chapter 5: Financial Stability and Cash Management

  • 5.1. Debt, Coverage, and Liquidity Ratios
  • 5.2. Balance Sheet Assets
  • 5.3. Cash Conversion Cycle
    • 5.3.1. Inventory Levels and Days Sales in Inventory (DSI)
    • 5.3.2. Accounts Receivable and Days Sales Outstanding (DSO)
    • 5.3.3. Accounts Payable and Days Payable Outstanding (DPO)
  • 5.4. Capital Deployment and Uses of Cash
  • 5.5. Return on Invested Capital
  • 5.6. Stock Market Performance
  • 5.7. Executive Compensation

Chapter 6: Forces of Change for Drug Distribution

  • 6.1. Industry Outlook
    • 6.1.1. The Outlook for the U.S. Pharmaceutical Market and Wholesaler Revenues
    • 6.1.2. The Outlook for Brand-Name Drug Prices and Wholesalers’ Strategic Responses
    • 6.1.3. The Outlook for Generic Drug Prices
    • 6.1.4. Update on National Opioid Settlement Payments
    • 6.1.5. Implications of Most Favored Nation Pricing and Tariffs
  • 6.2. Future Trends for Pharmacy Dispensing Channels
    • 6.2.1. Impact of Pharmacy Market Evolution and Vertical Integration
    • 6.2.2. Challenges from Specialty Prescription Growth and Wholesaler Strategic Responses
    • 6.2.3. The Growth and Profitability of Specialty Generic Drugs for Wholesalers
    • 6.2.4. Cash-Pay Prescriptions and Manufacturers’ Direct-to-Patient Channels
    • 6.2.5. Importation From Canada
  • 6.3. Future Trends for Buy-and-Bill Channels
    • 6.3.1. Hospital Vertical Integration into Physician Practices
    • 6.3.2. Implications of the Inflation Reduction Act for the Buy-and-Bill Market
    • 6.3.3. Wholesalers’ Roles in Channels for Cell and Gene Therapies
  • 6.4. The Impact of Biosimilars on Wholesalers
    • 6.4.1. 2026 Update on the Biosimilar Market
    • 6.4.2. Biosimilars Under the Pharmacy Benefit
    • 6.4.3. Biosimilars Under the Medical Benefit

SECTION III: BIG THREE WHOLESALER PROFILES

Chapter 7: Cencora

  • 7.1. Business Overview
    • 7.1.1. Company Information
    • 7.1.2. Company History
    • 7.1.3. Acquisitions and Divestitures
    • 7.1.4. Business Segments
  • 7.2. Profitability
    • 7.2.1. Overall Pharmaceutical Distribution
    • 7.2.2. Profitability by Business Sub-Segment
  • 7.3. Customers
    • 7.3.1. Largest Customers
    • 7.3.2. Walgreens Boots Alliance
    • 7.3.3. Evernorth Health Services
  • 7.4. Growth Trends
    • 7.4.1. U.S. Distribution Growth Trends
    • 7.4.2. MWI Animal Health
    • 7.4.3. Alliance Healthcare

Chapter 8: Cardinal Health

  • 8.1. Business Overview
    • 8.1.1. Company Information
    • 8.1.2. Company History
    • 8.1.3. Acquisitions and Divestitures
    • 8.1.4. Business Segments
  • 8.2. Profitability
    • 8.2.1. Overall Pharmaceutical Distribution
    • 8.2.2. Profitability by Business Sub-Segment
  • 8.3. Customers
    • 8.3.1. Largest Customers
    • 8.3.2. CVS Health
  • 8.4. Growth Trends
    • 8.4.1. U.S. Distribution Growth Trends
    • 8.4.2. Specialty Solutions

Chapter 9: McKesson Corporation

  • 9.1. Business Overview
    • 9.1.1. Company Information
    • 9.1.2. Company History
    • 9.1.3. Acquisitions and Divestitures
    • 9.1.4. Business Segments
  • 9.2. Profitability
    • 9.2.1. Overall Distribution
    • 9.2.2. Profitability by Business Sub-Segment
  • 9.3. Customers
    • 9.3.1. Largest Customers
    • 9.3.2. CVS Health
    • 9.3.3. Rite Aid
    • 9.3.4. Optum Rx
  • 9.4. Growth Trends
    • 9.4.1. U.S. Drug Distribution Growth Trends
    • 9.4.2. McKesson’s Specialty Businesses
    • 9.4.3. McKesson Europe
    • 9.4.4. McKesson Canada

Appendix: Key Provisions of the IRA For Medicare Parts B And D

Acronyms and Abbreviations

Endnotes

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LIST OF EXHIBITS

Exhibit 1: Vertical Alignment of Businesses Within Largest Wholesale Companies
Exhibit 2: Full-Line Wholesale Revenues, by Type of Customer, 2024
Exhibit 3: Full-Line Wholesalers, Inventory Levels vs. Product Sales, by Product Type, 2024
Exhibit 4: Full-Line Wholesalers, Inventory Levels and Product Sales, by Product Type, 2011 vs. 2024
Exhibit 5: Specialty Distributor Revenues, by Customer Type, 2024
Exhibit 6: Specialty Distributor Sales, by Therapeutic Area, 2024
Exhibit 7: Average Number of Manufacturers with Distribution Agreements for Specialty Distributors, 2015 to 2024
Exhibit 8: Distribution Center Operational Metrics, Full-Line Wholesalers vs. Specialty Distributors, 2024
Exhibit 9: Timeline of DSCSA Requirements for Pharmacies (Dispensers) and Wholesale Distributors, 2013 to 2027
Exhibit 10: Unbranded and Branded Generics, Share of U.S. Prescriptions, 2003 to 2025
Exhibit 11: Allowance for Doubtful Accounts at Big Three Wholesalers, by Company, 2025/2026
Exhibit 12: U.S. Drug Distribution and Related Revenues at Big Three Wholesalers, Calendar Year 2025
Exhibit 13: Market Share for U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2015 vs. 2025
Exhibit 14: U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2022 to 2026E
Exhibit 15: Prescription Dispensing Revenues from GLP-1 Products, by Dispensing Format, 2021 to 2025
Exhibit 16: Change in Quarterly U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2022 to 2026
Exhibit 17: Specialty Product Distribution Revenues, by Division and Parent Company, 2025
Exhibit 18: The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-Name Drugs
Exhibit 19: Total U.S. Pharmacy Industry Revenues, Prescriptions, and Locations, by Dispensing Format, 2025
Exhibit 20: Independent Pharmacy Purchasing Source, by Product Type
Exhibit 21: Number of Independent Pharmacy Locations, 2001 to 2025
Exhibit 22: Independent Pharmacies as a Percentage of Full-Line Wholesaler Revenues, 2015 to 2024
Exhibit 23: Independent Pharmacies, Average Per-Prescription Gross Profits and Margins, 2020 to 2024
Exhibit 24: U.S. Pharmacy Franchise and Marketing Programs, 2025/2026
Exhibit 25: U.S. Pharmacy Franchise Locations, by Company, 2015 to 2026
Exhibit 26: Customer Satisfaction with Pharmacies, by Dispensing Format and Company, 2026
Exhibit 27: Largest Pharmacy Services Administrative Organizations, by Membership and Ownership, 2026
Exhibit 28: Pharmacy Buying Groups and Primary/Preferred Wholesaler Relationships, by Number of Pharmacies, 2026
Exhibit 29: Wholesaler Generic Source Programs, Number of SKUs and Manufacturers, 2011 to 2024
Exhibit 30: Largest U.S. Pharmacies and Their Primary Wholesale Suppliers, 2026
Exhibit 31: Full-Line Wholesaler Sales to Retail Chain Warehouses, 2008 to 2024
Exhibit 32: Share of U.S. Generic Purchasing Volume, by Organization, 2026
Exhibit 33: Pharmacy Locations with Specialty Pharmacy Accreditation, by Corporate Ownership, 2025
Exhibit 34: Specialty Drug Prescription Revenues, by Dispensing Format, 2025
Exhibit 35: Prescription Revenues and Market Share from Specialty Pharmaceuticals, by Company, 2025
Exhibit 36: Specialty Pharmacy Networks, Participation Rate by Company, 2026
Exhibit 37: Alternative Channels to Specialty Pharmacies in Limited Dispensing Networks
Exhibit 38: Medical Benefit Spending on Outpatient Provider-Administered Drugs, by Drug Category and Payer, 2024
Exhibit 39: Spending for Outpatient Medical Benefit Drugs, by Site of Care and Payer, 2024
Exhibit 40: Spending for Oncology and Ophthalmology Medical Benefit Drugs, by Site of Care and Payer, 2024
Exhibit 41: Medicare Advantage Spending for Outpatient Provider-Administered Drugs, by Site of Care and Drug, 2024
Exhibit 42: Commercial Medical Benefit Spending for Outpatient Provider-Administered Drugs, by Site of Care and Drug, 2024
Exhibit 43: Total Drug Purchases by Nonfederal Hospitals and Outpatient Clinics, 2019 to 2025
Exhibit 44: Components of Change in Total Provider-Administered Drug Purchases, Nonfederal Hospitals vs. Outpatient Clinics, 2025
Exhibit 45: Buy-and-Bill System for Distribution and Reimbursement of Provider-Administered Outpatient Drugs
Exhibit 46: Primary Roles of Third-Party Payer, Distributor, and Provider in Buy-and-Bill System
Exhibit 47: Share of Commercial Plan Sponsors Receiving Specialty Drug Rebates, Pharmacy vs. Medical Benefits, 2025
Exhibit 48: Chargebacks as a Percentage of Net Sales, Full-Line Wholesalers, 2009 to 2024
Exhibit 49: Reimbursement for Provider-Administered Specialty Drugs vs. Specialty Pharmacies, by Site of Care and Therapeutic Class, 2021
Exhibit 50: White Bagging Approach for Distribution and Reimbursement of Provider-Administered Outpatient Drugs
Exhibit 51: UnitedHealthcare, White Bagging Requirements for Hospital Outpatient Providers, by Specialty Pharmacy, 2026
Exhibit 52: Drug Sourcing for Infused Oncology Therapies, by Practice Type and Source, 2019 vs. 2026
Exhibit 53: Payer Reimbursement and Patient Out-of-Pocket Obligation for Oncology Drugs, White Bagging vs. Buy-and-Bill, 2020
Exhibit 54: Share of Hospitals Permitting Pharmacy Sourcing of Infused Drugs, by Source, 2020 vs. 2022
Exhibit 55: Distribution of Medicare Part B Add-on Payments, 2021
Exhibit 56: Reimbursement Method for Provider-Administered Drugs Paid Under the Commercial Medical Benefit, by Site of Care
Exhibit 57: Reimbursement Method for Biosimilars of Provider-Administered Drugs Paid Under the Commercial Medical Benefit, 2021
Exhibit 58: Distribution of Hospitals’ Cost-to-Charge Ratio for Pharmaceuticals, 2024
Exhibit 59: Reimbursement Rate and Administration Cost for Provider-Administered Drugs Paid Under the Commercial Medical Benefit, by Site of Care, 2025
Exhibit 60: Markups for Provider-Administered Specialty Drugs for Privately Insured Individuals, by Site of Care and 340B Status, 2020/2021
Exhibit 61: Commercial Medical Benefit Cost per Claim for Reference Biologics and Their Biosimilars, by Site of Care, 2019 to 2024
Exhibit 62: Hospital Reimbursement by Commercial Payers, Avastin and Its Biosimilars, by Payer and Product, 2025
Exhibit 63: Hospitals’ Acquisition Cost and Gross Margin for Provider-Administered Oncology Biosimilars, by Product, 2020 vs. 2024
Exhibit 64: Commercial Health Plans’ Site-of-Care Programs for Provider-Administered Specialty Drugs, by Plan Type, 2025
Exhibit 65: Cigna Healthcare, Number of Specialty Drugs Subject to Site-of-Care Medical Policy, 2018 to 2026
Exhibit 66: Patient Cost Sharing for Provider-Administered Drugs
Exhibit 67: Monthly Rebate per Medicare Advantage Beneficiary, by Extra Benefit Type, 2020 to 2026
Exhibit 68: Revenue Mix at Oncology Practices, by Category
Exhibit 69: Specialty Physician Practice GPOs and Ownership, 2026
Exhibit 70: Share of Oncologists in Practices with Medically Integrated Dispensing, by Practice Setting, 2010 to 2024
Exhibit 71: Initial and Final Prescription Claim Status for Brand-Name Oral Oncology Therapies, by Site of Dispensing, 2023
Exhibit 72: Number of Private Equity Acquisitions of Physician Practices, 2013 to 2026
Exhibit 73: Management Services Organizations Acquired by Large Wholesalers, 2023 to 2026
Exhibit 74: Revenue Sources at Community Physician Practices, by Specialty, 2025
Exhibit 75: U.S. Hospitals, by Type and Ownership, 2024
Exhibit 76: Share of Community Hospitals, by Health System Affiliation, 1994 to 2024
Exhibit 77: Hospital Mergers & Acquisitions, Total Announced Transacted Revenue, 2011 to 2026
Exhibit 78: Ten Largest Integrated Delivery Networks, by Net Patient Revenues, 2024
Exhibit 79: Hospital Operating Expenses, by Type of Expense, 2025
Exhibit 80: Prescription Drug Costs as a Percentage of Hospital Expenses, 2015 to 2025
Exhibit 81: Change in Hospital Drug Expense per Adjusted Discharge, 2020 to 2026
Exhibit 82: Total Cost of Drugs and Cost-to-Charge Ratio, Top 10 Hospitals, 2024
Exhibit 83: Number and Share of Pharmacists Employed by Hospitals, 2011 to 2025
Exhibit 84: Number of Inpatient Pharmacists and Pharmacy Technicians per 100 Occupied Hospital Beds, 2019 to 2025
Exhibit 85: Largest Group Purchasing Organizations, by Membership and Total Purchasing Volume, 2026
Exhibit 86: Hospitals and Health System Pharmacy Locations with Specialty Pharmacy Accreditation, 2017 to 2025
Exhibit 87: Hospital and Clinic Share of Oral Oncology Market, 2017 to 2025
Exhibit 88: Hospitals’ Perceived Barriers to Accessing Specialty Pharmacy Networks, 2020 vs. 2022
Exhibit 89: 340B Drug Pricing Program, Purchases by Covered Entities, 2010 to 2025
Exhibit 90: 340B Contract Pharmacy Relationships with Hospitals, by Company, 2020 vs. 2026
Exhibit 91: Average 340B Prices vs. WAC and ASP, 2022 to 2025
Exhibit 92: Key Elements on a Wholesaler’s Income Statement
Exhibit 93: Sources of a Wholesaler’s Gross Margin from Brand-Name Drugs
Exhibit 94: U.S. Core Drug Distribution Gross Margin, Big Three Wholesalers, 2022 to 2026
Exhibit 95: U.S. Drug Distribution Gross Profits, Big Three Wholesalers, Total and Annual Change, 2022 to 2026
Exhibit 96: Estimated Buy-Side and Sell-Side Contributions to Wholesalers’ Gross Margin, 2026
Exhibit 97: Estimated Drug Distribution Gross Margin, by Drug and Customer Type, 2026
Exhibit 98: Revenues and Gross Profits, Big Three Wholesalers, by Type of Drug, 2026
Exhibit 99: Median Wholesaler Sell-Side Discount for Generic Drugs Sold to Retail Pharmacies, by Number of Manufacturers, 2026
Exhibit 100: Generic Drugs’ Monthly Share of Prescriptions Following Market Entry, 2005 to 2024
Exhibit 101: Path of Wholesaler Gross Profits, Brand vs. Multisource Generic Drug
Exhibit 102: Example of Channel Profits from a Provider-Administered Generic Drug
Exhibit 103: Medicare Part D and Medicaid Prescription Reimbursement for Wholesalers’ Private Label Generic Drugs, by Company, 2020 to 2024
Exhibit 104: Brand-Name Drugs, Change in Average List and Net Prices, 2014 to 2026
Exhibit 105: Illustrative Value of a Wholesaler’s Buy-Side Fees with Alternative Brand-Name Pharmaceutical Price Inflation Scenarios
Exhibit 106: Price Indices for Warehousing & Storage and Truck Transportation, 2020 to 2026
Exhibit 107: Illustrative Value of a Wholesaler’s Buy-Side Fees with Brand-Name Pharmaceutical Price Deflation
Exhibit 108: Illustrative Effect of Inventory Revaluation on a Wholesaler’s Gross Profit
Exhibit 109: Full-Line Wholesalers, Operating Expenses, by Category, 2022 to 2024
Exhibit 110: Median Annual Total Employee Compensation, by Company, 2025
Exhibit 111: Operating Profit of U.S. Business Segments as a Percentage of Revenues, Big Three Wholesalers, 2022 to 2026
Exhibit 112: Total Corporate Operating Profits as a Percentage of Total Corporate Gross Profits, Big Three Wholesalers, 2026
Exhibit 113: Total Debt Including Interest Payments, Big Three Wholesalers, 2026
Exhibit 114: Debt-to-EBITDA Ratio, Big Three Wholesalers, FY2024 to FY2026
Exhibit 115: Liquidity Ratios, Big Three Wholesalers, FY2026
Exhibit 116: Composition of Current Assets, Big Three Wholesalers, 2026
Exhibit 117: Illustrative Wholesaler Cash Conversion Cycle for Brand-Name Drugs Sold to a Pharmacy
Exhibit 118: Cash Conversion Cycle, Big Three Wholesalers, 2026
Exhibit 119: Cash Conversion Cycle, Big Three Wholesalers, 2016 to 2026
Exhibit 120: Days Sales in Inventory, Big Three Wholesalers, 2022 to 2026
Exhibit 121: Days Sales Outstanding, Big Three Wholesalers, 2022 to 2026
Exhibit 122: Percentage of Wholesalers’ Trade Accounts Receivable and DSO for Largest Customers, 2026
Exhibit 123: Days Payable Outstanding, Big Three Wholesalers, 2022 to 2026
Exhibit 124: Capital Deployment, Big Three Wholesalers, FY2022 to FY2026
Exhibit 125: Dividends and Share Repurchases as a Percentage of Operating Cash Flow, Big Three Wholesalers, FY2024 to FY2026
Exhibit 126: Return on Invested Capital, Big Three Wholesalers, 2020 to 2026
Exhibit 127: Forward Price-to-Earnings Ratio, Big Three Wholesalers vs. S&P 500, 2014 to 2026
Exhibit 128: One- and Five-Year Stock Price Performance, Big Three Wholesalers vs. Manufacturers and Overall Market
Exhibit 129: Components of CEO Compensation, Big Three Wholesalers, 2025/26
Exhibit 130: Financial Metrics Used for Annual Cash Incentive Compensation, Big Three Wholesalers, 2025/26
Exhibit 131: Financial Metrics Used for Long-Term Incentive Compensation, Big Three Wholesalers, 2025/26
Exhibit 132: U.S. Gross Manufacturer Revenues, Annual Total and Growth, 2020 to 2030
Exhibit 133: Total Value Lost to Generic and Biosimilar Launches, by Product Type, 2022 to 2030
Exhibit 134: U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2020 to 2030
Exhibit 135: Summary of List Price Reductions for Selected Brand-Name Drugs, 2025-2026
Exhibit 136: Average Year-over-Year Change in Pricing of Mature Generic Drugs, Oral vs. Injectable, 2015 to 2026
Exhibit 137: Generic Drug Approvals, FDA, 2014 to 2026
Exhibit 138: Number of Drug Shortages Active, by Dosage Form, 2014 to 2025
Exhibit 139: National Opioid Settlement Payments, by Company, 2026
Exhibit 140: Vertical Business Relationships Within the U.S. Drug Channel, 2026
Exhibit 141: Pharmacy Industry Prescription Revenues, Traditional vs. Specialty Drugs, 2020 to 2030
Exhibit 142: Top Specialty Therapy Categories, Generic Drugs as a Share of Prescriptions and Net Spending, 2025
Exhibit 143: Nonbiological Specialty Drugs, Pharmacy Acquisition Cost per Unit for Brand-Name vs. Generic Version, 2026
Exhibit 144: Dispensing Spreads for Specialty Generic Drugs at PBM-Affiliated Pharmacies, 2017 to 2021
Exhibit 145: Examples of Manufacturers’ Direct-to-Patient Websites and Dispensing Pharmacies, 2026
Exhibit 146: Physician Employment, by Practice Ownership, 2012 vs. 2024
Exhibit 147: Number of Physicians per Practice, by Practice Ownership, 2024
Exhibit 148: U.S. Physician Employment, by Specialty and Employer Type, 2022
Exhibit 149: Number of U.S. Physicians Employed by Hospitals/Health Systems, 2019 to 2026
Exhibit 150: Acquisitions of Community Oncology Practices, by Type of Acquirer, 2010 to 2024
Exhibit 151: Medicare Part B Fee-For-Service Spending on Provider-Administered Outpatient Drugs, by Location of Service, 2008 to 2024
Exhibit 152: Share of Medicare Part B Fee-For-Service Spending on Provider-Administered Outpatient Drugs, by Location of Service, 2008 to 2024
Exhibit 153: Share of Specialty Distributor Revenues, by Customer Type, 2011 to 2024
Exhibit 154: Illustrative Effect of Inflation Reduction Act on Medicare Part B Margins, 340B Hospitals vs. Community Practices
Exhibit 155: Share of CAR-T Administration, by Hospital Site of Care, 2022 to 2025
Exhibit 156: Reimbursement for CAR-T Therapies, by Site of Care and Payer
Exhibit 157: Number of U.S. Biosimilar Approvals, 2015 to 2026
Exhibit 158: Physician Perceptions of Biosimilars, by Specialty, 2023
Exhibit 159: Formulary Coverage and Pricing for Humira and Its Biosimilars, by PBM, 2026
Exhibit 160: Formulary Coverage and Pricing for Stelara and Its Biosimilars, by PBM, 2025
Exhibit 161: FDA-Approved Biosimilars, Provider-Administered Drugs, by Launch Status, 2026
Exhibit 162: Market Share of Provider-Administered Biosimilars, 2020 vs. 2026
Exhibit 163: Provider-Administered Oncology Drugs, Prices of Biosimilars vs. Reference Product, 2025
Exhibit 164: Formulary Coverage Status of Provider-Administered Drugs at U.S. Commercial Payers, Reference Products vs. Biosimilars, 2017 to 2022
Exhibit 165: Payer Formulary Coverage of Provider-Administered Oncology Biosimilars, 2022 to 2024
Exhibit 166: Cencora, Pharmaceutical Distribution Segment, Profitability Metrics, 2022 to 2026
Exhibit 167: Cencora, Estimated Revenues and Operating Profit, by Segment, FY2026E
Exhibit 168: Cencora, Largest U.S. Drug Distribution Customers, FY2026
Exhibit 169: Cencora, Revenues from Walgreens, 2016 to 2026
Exhibit 170: Cencora, Days Sales Outstanding from Walgreens and Express Scripts vs. All Other Customers, 2022 to 2026
Exhibit 171: Cencora, Revenues from Evernorth Health Services, 2017 to 2025
Exhibit 172: Evernorth Health Services, Pharmacy Dispensing Revenues vs. Pharmaceutical Purchases Through Cencora, 2014 to 2026
Exhibit 173: Cencora, U.S. Pharmaceutical Distribution and Related Businesses, Revenues and Growth, 2020:Q1 to 2026:Q2
Exhibit 174: MWI Animal Health, Revenues and Growth, 2021 to 2026
Exhibit 175: Animal Health Products Distribution Market Share, by Company and Segment, 2014 vs. 2026
Exhibit 176: Number of Pharmacies per Capita, Major European Countries, 2023
Exhibit 177: Alliance Healthcare, Revenues and Growth, 2022 to 2026
Exhibit 178: Cardinal Health, Profitability Metrics, 2022 to 2026
Exhibit 179: Cardinal Health, Estimated Revenues and Operating Profit, by Segment, FY2026
Exhibit 180: Cardinal Health, Largest U.S. Drug Distribution Customers, FY2026
Exhibit 181: Cardinal Health, Revenues from CVS Health, 2010 to 2026
Exhibit 182: Cardinal Health, Days Sales Outstanding from CVS Health and Optum Rx vs. All Other Customers, 2021 to 2026
Exhibit 183: Cardinal Health, U.S. Pharmaceutical Distribution and Related Businesses, Revenues and Growth, 2021:Q1 to 2026:Q2
Exhibit 184: McKesson, Distribution Businesses, Gross and Segment Operating Profitability Metrics, 2022 to 2026
Exhibit 185: McKesson, Estimated Revenues and Operating Profit, by Segment, FY2026
Exhibit 186: McKesson, Largest U.S. Drug Distribution Customers, FY2026
Exhibit 187: McKesson, Revenues from CVS Health, 2011 to 2026
Exhibit 188: McKesson, Days Sales Outstanding, CVS Health vs. All Other Customers, 2021 to 2026
Exhibit 189: Wholesaler Revenues from Optum Rx, 2018 to 2026
Exhibit 190: McKesson, U.S. Pharmaceutical Distribution and Related Businesses, Revenues and Growth, 2021:Q1 to 2026:Q2
Exhibit 191: McKesson Canada, Revenues and Growth, 2021 to 2026
Exhibit 192: Standard Medicare Prescription Drug Benefit, 2026
Exhibit 193: Prices for Products Selected for 2026 Medicare Drug Price Negotiation Program, by Total and Out-of-Pocket Spending

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