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The 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

By Adam J. Fein, Ph.D.
(downloadable 388 page PDF file; Released October 2024)

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Since the previous edition of this report, pharmacy and healthcare provider markets continued to experience strong post-pandemic growth. At the same time, U.S. distribution and dispensing channels for prescription drugs are undergoing significant evolution and consolidation as conventional business models are challenged by the evolving economics of pharmaceuticals.

During this period of volatility, pharmaceutical wholesalers are expanding their industry position and strengthening their economic fundamentals. The 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors delves into the most crucial commercial, political, financial, and legal forces driving industry change.

The 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our fifteenth edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Click here to download a free overview of the 2024-25 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 is researched and written by Adam. J. Fein, Ph.D., one of the world’s leading experts on the drug distribution industry and the author of the influential Drug Channels website. The report synthesizes a wealth of statistical data (including 178 data-packed exhibits), research studies, financial information, and Dr. Fein’s extensive experience.

That’s what makes 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 who wants to understand and benefit from this ever-changing industry.

Our 2024-25 edition contains the most current financial and industry data. As always, we have updated all market and industry data with the most current information available. 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 upon 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 notable new material in this 2024-25 edition includes the following:

  • Section 3.3.1. includes new data on the economics and profit of community oncology practices.
  • Section 3.4.1. includes new data on the hospital market and the role of prescription drug costs on hospitals’ expenses.
  • Section 4.6.1. includes new material on the impact of a reduction in brand-name list prices on wholesalers’ buy-side payments from manufacturers.
  • Section 6.1.4. includes new data about the wholesalers’ payments under the comprehensive National Opioid Settlement.
  • A new Section 6.2.4. examines the impact of direct-to-pharmacy models and direct-to-patient channels.
  • Section 6.5. has been revised to reflect the ongoing implementation of the Inflation Reduction Act of 2022. In Subsection 6.5.1., we update and expand our review of key provisions of the law that relate to prescription drugs. In Subsection 6.5.2., we analyze the IRA’s likely consequences for wholesalers and the overall pharmaceutical business. We have altered our analyses of certain issues compared with the previous edition of this report.
  • Section 8.2. updates our financial analyses and model based on the new reporting segments introduced by Cardinal Health.
  • We have removed the stand-alone section that addressed the distribution of COVID-19 vaccines and therapeutics. Material that addresses COVID-19 and its impact on the wholesale channel has been integrated into our analyses throughout the report.
  • We provide updated, expanded, and reorganized data about the following markets:
    • Pharmacy franchise programs and marketing groups (Section 2.2.3.)
    • Pharmacy services administrative organizations (Section 2.2.4.)
    • Group purchasing organizations for small pharmacies (Section 2.2.5.)
    • Group purchasing organizations for physician practices (Section 3.3.2.)
  • There are 178 exhibits in this 2024-25 edition, compared with 163 in the 2023-24 edition.

No other report on the market today offers the depth, insight and analysis of the 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Effective August 30, 2023, AmerisourceBergen changed its name to Cencora and began trading under the ticker symbol COR on the New York Stock Exchange. Beginning with this 2024-25 edition, we exclusively use the name Cencora.

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THIS END USER LICENSE AGREEMENT (“Agreement”) governs your use of The 2024-25 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. License terms, purchaser’s name/email, and a unique transaction ID will be added to the secure PDF file upon checkout. We offer three License Options:

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The 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is protected by copyright law. Unauthorized reproduction or distribution of this report, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent of the law. This report may be cited in commercial documents with full and appropriate attribution. Nothing in this 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. Specialty vs. Traditional 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 Market Shares
    • 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 the Pharmacy-PBM Relationship
    • 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 (GPOs)
    • 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
    • 3.1.1. 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. GPOs for Physician Practices
    • 3.3.3. Specialty Drug Dispensing by Physician Practices
  • 3.4. Hospitals
    • 3.4.1. Pharmaceutical Purchasing and Wholesalers’ Services for Hospitals
    • 3.4.2. Hospital GPOs
    • 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, 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 Drugs
  • 4.6. The Profit Impact of Brand-Name Drug Price Inflation
    • 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
    • 5.3.2. Accounts Receivable and Days Sales Outstanding
    • 5.3.3. Accounts Payable and Days Payable Outstanding
  • 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
  • 6.2. Future Trends for Pharmacy Dispensing Channels
    • 6.2.1. Impact of Pharmacy Market Evolution
    • 6.2.2. Specialty Prescription Growth and Wholesaler Strategic Responses
    • 6.2.3. The Growth of Specialty Generic Drugs
    • 6.2.4. Emergence of Direct-to-Pharmacy Models and Direct-to-Patient Channels
    • Importation From Canada
  • 6.3. Future Trends for Buy-and-Bill Channels
    • 6.3.1. Hospital Vertical Integration into Physician Practices
    • 6.3.2. Physician Practice Acquisitions by Corporate Entities, Private Equity Firms, and Wholesalers
    • 6.3.3. Wholesalers’ Roles in Channels for Cell and Gene Therapies
  • 6.4. The Impact of Biosimilars on Wholesalers
    • 6.4.1. 2024 Update on the Biosimilar Market
    • 6.4.2. Biosimilars Under the Pharmacy Benefit
    • 6.4.3. Biosimilars Under the Medical Benefit
  • 6.5. The Inflation Reduction Act of 2022
    • 6.5.1. Key Provisions of the IRA for Medicare Parts B and D
    • 6.5.2. Wholesale Industry Implications of the Inflation Reduction Act

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. Top 10 Largest Customers
    • 7.3.2. Walgreens Boots Alliance
    • 7.3.3. Express Scripts/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. Top 10 Largest Customers
    • 8.3.2. CVS Health
    • 8.3.3. Optum Rx
  • 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. The 10 Largest Customers
    • 9.3.2. CVS Health
    • 9.3.3. Rite Aid
  • 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

Acronyms and Abbreviations

Endnotes

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LIST OF EXHIBITS

Exhibit 1: Full-Line Wholesale Revenues, by Type of Customer, 2022
Exhibit 2: Full-Line Wholesalers, Inventory Levels vs. Product Sales, by Product Type, 2022
Exhibit 3: Full-Line Wholesalers, Inventory Levels and Product Sales, by Product Type, 2011 vs. 2022
Exhibit 4: Specialty Distributor Revenues, by Customer Type, 2022
Exhibit 5: Specialty Distributor Sales, by Therapeutic Area, 2022
Exhibit 6: Average Number of Manufacturers with Distribution Agreements for Specialty Distributors, 2015 to 2022
Exhibit 7: Distribution Center Operational Metrics, Full-Line Wholesalers vs. Specialty Distributors, 2022
Exhibit 8: Timeline of DSCSA Requirements for Pharmacies (Dispensers) and Wholesale Distributors, 2013 to 2026
Exhibit 9: Unbranded and Branded Generics, Share of U.S. Prescriptions, 2003 to 2023
Exhibit 10: Allowance for Doubtful Accounts at Big Three Wholesalers, by Company, 2023/2024
Exhibit 11: U.S. Drug Distribution and Related Revenues at Big Three Wholesalers, Calendar Year 2023
Exhibit 12: Big Three Wholesalers, Market Share for U.S. Drug Distribution and Related Revenues, 2012 vs. 2023
Exhibit 13: U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2020 to 2024E
Exhibit 14: Quarterly Revenues from GLP-1 Products, By Company, 2022 to 2024
Exhibit 15: Change in Quarterly U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2020 to 2024
Exhibit 16: Specialty Product Distribution Revenues, by Division and Parent Company, 2023
Exhibit 17: The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-Name Drugs
Exhibit 18: Total U.S. Pharmacy Industry Revenues, Prescriptions, and Locations, by Dispensing Format, 2023
Exhibit 19: Independent Pharmacy Purchasing Source, by Product Type
Exhibit 20: Number of Independent Pharmacy Locations, 2001 to 2023
Exhibit 21: Independent Pharmacies as a Percentage of Full-Line Wholesaler Revenues, 2014 to 2023E
Exhibit 22: Independent Pharmacies, Average Per-Prescription Gross Profits and Margins, 2018 to 2022
Exhibit 23: U.S. Pharmacy Franchise and Marketing Programs, 2023/2024
Exhibit 24: U.S. Pharmacy Franchise Locations, by Company, 2015 to 2024
Exhibit 25: Customer Satisfaction with Pharmacies, by Dispensing Format and Company, 2024
Exhibit 26: Largest Pharmacy Services Administrative Organizations, by Membership and Ownership, 2024
Exhibit 27: Pharmacy Buying Groups and Primary/Preferred Wholesaler Relationships, by Number of Pharmacies, 2024
Exhibit 28: Wholesaler Generic Source Programs, Number of SKUs and Manufacturers, 2011 to 2022
Exhibit 29: Largest U.S. Pharmacies and Their Primary Wholesale Suppliers, 2024
Exhibit 30: Full-Line Wholesaler Sales to Retail Chain Warehouses, 2007 to 2022
Exhibit 31: Share of U.S. Generic Purchasing Volume, by Organization, 2023
Exhibit 32: Pharmacy Locations with Specialty Pharmacy Accreditation, by Corporate Ownership, 2023
Exhibit 33: Specialty Drug Prescription Revenues, by Dispensing Format, 2023
Exhibit 34: Prescription Revenues and Market Share from Specialty Pharmaceuticals, by Company, 2023
Exhibit 35: Manufacturer-Defined Specialty Pharmacy Networks, Participation Rate by Company, 2024
Exhibit 36: Alternative Channels to Specialty Pharmacies in Limited Dispensing Networks
Exhibit 37: Medical Benefit Spending on Outpatient Provider-Administered Drugs, by Drug Category and Payer, 2022
Exhibit 38: Spending for Outpatient Medical Benefit Drugs, by Site of Care and Payer, 2022
Exhibit 39: Medicare Advantage Spending for Outpatient Provider-Administered Drugs, by Site of Care and Drug, 2022
Exhibit 40: Commercial Medical Benefit Spending for Outpatient Provider-Administered Drugs, by Site of Care and Drug, 2022
Exhibit 41: Total Drug Purchases by Nonfederal Hospitals and Outpatient Clinics, 2017 to 2023
Exhibit 42: Components of Change in Total Provider-Administered Drug Purchases, Nonfederal Hospitals vs. Outpatient Clinics, 2023
Exhibit 43: Buy-and-Bill System for Distribution and Reimbursement of Provider-Administered Outpatient Drugs
Exhibit 44: Primary Roles of Third-Party Payer, Distributor, and Provider in Buy-and-Bill System
Exhibit 45: Share of Commercial Plan Sponsors Receiving Specialty Drug Rebates, Pharmacy vs. Medical Benefits, 2023
Exhibit 46: Chargebacks as a Percentage of Net Sales, Full-Line Wholesalers, 2009 to 2022
Exhibit 47: Reimbursement for Provider-Administered Specialty Drugs vs. Specialty Pharmacies, by Site of Care and Therapeutic Class, 2021
Exhibit 48: White Bagging Approach for Distribution and Reimbursement of Provider-Administered Outpatient Drugs
Exhibit 49: UnitedHealthcare, White Bagging Requirements for Hospital Outpatient Providers, by Specialty Pharmacy, 2024
Exhibit 50: Drug Sourcing for Infused Oncology Therapies, by Practice Type and Source, 2019 vs. 2024
Exhibit 51: Payer Reimbursement and Patient Out-of-Pocket Obligation for Oncology Drugs, White Bagging vs. Buy-and-Bill, 2020
Exhibit 52: Share of Hospitals Permitting Pharmacy Sourcing of Infused Drugs, by Source, 2020 vs. 2022
Exhibit 53: Distribution of Medicare Part B Add-on Payments, 2021
Exhibit 54: Reimbursement Method for Provider-Administered Drugs Paid Under the Commercial Medical Benefit, by Site of Care
Exhibit 55: Reimbursement Method for Biosimilars of Provider-Administered Drugs Paid Under the Commercial Medical Benefit, 2021
Exhibit 56: Reimbursement Rate and Administration Cost for Provider-Administered Drugs Paid Under the Commercial Medical Benefit, by Site of Care, 2023
Exhibit 57: Markups for Provider Administered Specialty Drugs for Privately Insured Individuals, by Site of Care and 340B Status, 2020/2021
Exhibit 58: Commercial Medical Benefit Cost per Claim for Reference Biologics and Their Biosimilars, by Site of Care, 2019 vs. 2022
Exhibit 59: Site-of-Care Management Programs for Provider-Administered Drugs, Commercial Health Plans, 2017 to 2022
Exhibit 60: Cigna Healthcare, Number of Specialty Drugs Subject to Site-of-Care Medical Policy, 2018 to 2024
Exhibit 61: Patient Cost Sharing for Provider-Administered Drugs, 2021
Exhibit 62: Medicare Part B Coinsurance Adjustments, 2023:Q2 to 2024:Q3
Exhibit 63: Revenue Mix at Oncology Practices, by Category, 2023
Exhibit 64: Specialty Physician Practice GPOs and Ownership, 2024
Exhibit 65: Share of Oncologists in Practices with Medically Integrated Dispensing, by Practice Setting, 2010 to 2022
Exhibit 66: U.S. Hospitals, by Type and Ownership, 2022
Exhibit 67: Share of Community Hospitals, by Health System Affiliation, 1992 to 2022
Exhibit 68: Hospital Mergers & Acquisitions, Total Announced Transacted Revenue, 2011 to 2024
Exhibit 69: Ten Largest Integrated Delivery Networks, by Net Patient Revenues, 2024
Exhibit 70: Hospital Operating Expenses, by Type of Expense, 2023
Exhibit 71: Prescription Drug Costs as a Percentage of Hospital Expenses, 2014 to 2023
Exhibit 72: Change in Hospital Drug Expense per Adjusted Discharge, 2020 to 2024
Exhibit 73: Ten Hospitals with Largest Pharmacy Expenses, 2022
Exhibit 74: Number and Share of Pharmacists Employed by Hospitals, 2011 to 2023
Exhibit 75: Number of Inpatient Pharmacists and Pharmacy Technicians per 100 Occupied Hospital Beds, 2003 to 2023
Exhibit 76: Largest Group Purchasing Organizations, by Membership and Total Purchasing Volume, 2024
Exhibit 77: Hospitals with a Specialty Pharmacy, by Number of Staffed Beds, 2015 to 2023E
Exhibit 78: Hospital and Clinic Share of Oral Oncology Market, 2017 to 2023
Exhibit 79: Hospitals’ Perceived Barriers to Accessing Specialty Pharmacy Networks, 2020 vs. 2022
Exhibit 80: Initial and Final Prescription Claim Status for Brand-Name Oral Oncology Therapies, by Site of Dispensing, 2023
Exhibit 81: 340B Drug Pricing Program, Purchases by Covered Entities, 2015 to 2023
Exhibit 82: 340B Contract Pharmacy Relationships with Hospitals, by Company, 2024
Exhibit 83: Key Elements on a Wholesaler’s Income Statement
Exhibit 84: Sources of a Wholesaler’s Gross Margin from Brand-Name Drugs
Exhibit 85: U.S. Drug Distribution Gross Margin, Big Three Wholesalers, 2020 to 2024
Exhibit 86: U.S. Drug Distribution Gross Profits, Big Three Wholesalers, Total and Annual Change, 2020 to 2024
Exhibit 87: Estimated Buy-Side and Sell-Side Contributions to Wholesalers’ Gross Margin, 2024
Exhibit 88: Estimated Drug Distribution Gross Margin, by Drug and Customer Type, 2024
Exhibit 89: Big Three Wholesalers, Revenues and Gross Profits, by Type of Drug, 2024
Exhibit 90: Median Wholesaler Sell-Side Discount for Generic Drugs Sold to Retail Pharmacies, by Number of Manufacturers, 2024
Exhibit 91: Path of Wholesaler Gross Profits, Brand vs. Multi-Source Generic Drug
Exhibit 92: Brand-Name Drugs, Change in Average List and Net Prices, 2014 to 2024
Exhibit 93: Illustrative Value of a Wholesaler’s Buy-Side Fees with Alternative Brand-Name Pharmaceutical Price Inflation Scenarios
Exhibit 94: Price Indices for Warehousing & Storage and Truck Transportation, 2019 to 2024
Exhibit 95: Illustrative Value of a Wholesaler’s Buy-Side Fees with Brand-Name Pharmaceutical Price Deflation
Exhibit 96: Illustrative Effect of Inventory Revaluation on a Wholesaler’s Gross Profit
Exhibit 97: Full-Line Wholesalers, Operating Expenses, by Category, 2021
Exhibit 98: Median Annual Total Employee Compensation, by Company, 2023
Exhibit 99: Big Three Wholesalers, Drug Distribution Operating Profit as a Percentage of Revenues, 2019 to 2023
Exhibit 100: Big Three Wholesalers, Total Corporate Operating Profits as a Percentage of Total Gross Profits, 2024
Exhibit 101: Big Three Wholesalers, Total Debt Including Interest Payments, 2024
Exhibit 102: Big Three Wholesalers, Debt-to-EBITDA Ratio, FY2022 to FY2024
Exhibit 103: Big Three Wholesalers, Liquidity Ratios, FY2024
Exhibit 104: Big Three Wholesalers, Composition of Current Assets, 2024
Exhibit 105: Illustrative Wholesaler Cash Conversion Cycle for Brand-Name Drugs Sold to a Pharmacy
Exhibit 106: Big Three Wholesalers, Cash Conversion Cycle, 2024
Exhibit 107: Big Three Wholesalers, Cash Conversion Cycle, 2013 to 2024
Exhibit 108: Big Three Wholesalers, Days Sales in Inventory, 2020 to 2024
Exhibit 109: Big Three Wholesalers, Days Sales Outstanding, 2019 to 2023
Exhibit 110: Percentage of Wholesalers’ Trade Accounts Receivable and DSO for Largest Customers, 2024
Exhibit 111: Big Three Wholesalers, Days Payable Outstanding, 2020 to 2024
Exhibit 112: Big Three Wholesalers, Capital Deployment, FY2020 to FY2024
Exhibit 113: Big Three Wholesalers, Dividends and Share Repurchases as a Percentage of Operating Cash Flow, FY2022 to FY2024
Exhibit 114: Big Three Wholesalers, Return on Invested Capital, 2016 to 2024
Exhibit 115: Forward Price-to-Earnings Ratio, Big Three Wholesalers vs. S&P 500, 2014 to 2024
Exhibit 116: One- and Five-Year Stock Price Performance, Big Three Wholesalers vs. Manufacturers and Overall Market
Exhibit 117: Components of CEO Compensation, Big Three Wholesalers, 2023/24
Exhibit 118: Financial Metrics Used for Annual Cash Incentive Compensation, Big Three Wholesalers, 2023/24
Exhibit 119: Financial Metrics Used for Long-Term Incentive Compensation, Big Three Wholesalers, 2023/24
Exhibit 120: U.S. Gross Manufacturer Revenues, Annual Total and Growth, 2018 to 2028
Exhibit 121: Total Value Lost to Generic and Biosimilar Launches, by Product Type, 2018 to 2028
Exhibit 122: U.S. Drug Distribution and Related Revenues, Big Three Wholesalers, 2018 to 2028
Exhibit 123: Summary of List Price Reductions for Insulin Products, January 2024
Exhibit 124: Average Year-over-Year Change in Pricing of Mature Generic Drugs, Oral vs. Injectable, 2015 to 2024
Exhibit 125: Generic Drug Approvals, FDA, 2014 to 2024
Exhibit 126: National Opioid Settlement Payments, By Company, 2024
Exhibit 127: Pharmacy Industry Prescription Revenues, Traditional vs. Specialty Drugs, 2018 to 2028
Exhibit 128: Top Specialty Therapy Categories, Generic Drugs as a Share of Prescriptions and Net Spending, 2023
Exhibit 129: Nonbiological Specialty Drugs, Pharmacy Acquisition Cost per Unit for Brand-Name vs. Generic Version, 2024
Exhibit 130: Physician Employment, by Practice Ownership, 2012 vs. 2022
Exhibit 131: Number of Physicians per Practice, by Practice Ownership, 2022
Exhibit 132: U.S. Physician Employment, by Specialty and Employer Type, 2022
Exhibit 133: Number of U.S. Physicians Employed by Hospitals/Health Systems, 2019 to 2024
Exhibit 134: Acquisitions of Community Oncology Practices, by Type of Acquirer, 2010 to 2022
Exhibit 135: Medicare Part B Fee-For-Service Spending on Provider-Administered Outpatient Drugs, by Location of Service, 2008 to 2022
Exhibit 136: Share of Medicare Part B Fee-For-Service Spending on Provider-Administered Outpatient Drugs, by Location of Service, 2008 to 2021
Exhibit 137: Share of Specialty Distributor Revenues, by Customer Type, 2011 to 2022
Exhibit 138: Vertical Business Relationships Among Insurers, PBMs, Specialty Pharmacies, and Providers, 2024
Exhibit 139: Number of Private Equity Acquisitions of Physician Practices, 2013 to 2024
Exhibit 140: Certified CAR-T Centers, by Products, 2019 vs. 2022
Exhibit 141: Number of U.S. Biosimilar Approvals, 2015 to 2024
Exhibit 142: Humira and Its Biosimilars, Price and PBM Formulary Coverage, 2024
Exhibit 143: Insulin Glargine, Share of New-to-Brand Prescriptions, 2023
Exhibit 144: FDA-Approved Biosimilars, Provider-Administered Drugs, 2024
Exhibit 145: Market Share of Provider-Administered Biosimilars, 2020 vs. 2024
Exhibit 146: Provider-Administered Oncology Drugs, Prices of Biosimilars vs. Reference Product, 2024
Exhibit 147: Formulary Coverage Status of Provider-Administered Drugs at U.S. Commercial Payers, Reference Products vs. Biosimilars, 2017 to 2022
Exhibit 148: Physician Perceptions of Biosimilars, by Specialty, 2023
Exhibit 149: Standard Medicare Prescription Drug Benefit, 2024 vs. 2025
Exhibit 150: Illustrative Effect of Inflation Reduction Act on Medicare Part B margins, 340B Hospitals vs. Community Practices
Exhibit 151: Cencora, Pharmaceutical Distribution Segment, Profitability Metrics, 2020 to 2024
Exhibit 152: Cencora, Estimated Revenues and Operating Profit, by Segment, FY2024E
Exhibit 153: Cencora, Top 10 U.S. Drug Distribution Customers, FY2024
Exhibit 154: Cencora, Revenues from Walgreens Boots Alliance, 2014 to 2024
Exhibit 155: Cencora, Days Sales Outstanding from Walgreens and Express Scripts vs. All Other Customers, 2020 to 2024
Exhibit 156: Cencora, Revenues from Express Scripts, 2014 to 2024
Exhibit 157: Express Scripts, Pharmacy Dispensing Revenues vs. Pharmaceutical Purchases Through Cencora, 2014 to 2024
Exhibit 158: Cencora, U.S. Pharmaceutical Distribution, Revenues and Growth, 2020:Q1 to 2024:Q2
Exhibit 159: MWI Animal Health, Revenues and Growth, 2020 to 2024
Exhibit 160: Animal Health Products Distribution Market Share, by Company and Segment, 2014 vs. 2023
Exhibit 161: Number of Pharmacies, Major European Countries, 2022
Exhibit 162: Alliance Healthcare, Revenues and Growth, 2020 to 2024
Exhibit 163: Cardinal Health, Profitability Metrics, 2020 to 2024
Exhibit 164: Cardinal Health, Top 10 U.S. Drug Distribution Customers, FY2024
Exhibit 165: Cardinal Health, Estimated Revenues and Operating Profit, by Segment, FY2024
Exhibit 166: Cardinal Health, Revenues from CVS Health, 2010 to 2024
Exhibit 167: Cardinal Health, Days Sales Outstanding from CVS Health and Optum Rx vs. All Other Customers, 2020 to 2024
Exhibit 168: Cardinal Health, Revenues from Optum Rx, 2016 to 2024
Exhibit 169: Cardinal Health, U.S. Pharmaceutical Distribution, Revenues and Growth, 2020:Q1 to 2024:Q2
Exhibit 170: McKesson, Distribution Businesses, Gross and Segment Operating Profitability Metrics, 2020 to 2024
Exhibit 171: McKesson, Estimated Revenues and Operating Profit, by Segment, FY2024
Exhibit 172: McKesson, Top 10 U.S. Drug Distribution Customers, FY2024
Exhibit 173: McKesson, Revenues from CVS Health, 2011 to 2024
Exhibit 174: McKesson, Days Sales Outstanding, CVS Health vs. All Other Customers, 2020 to 2024
Exhibit 175: McKesson, Revenues from Rite Aid, 2020 to 2024
Exhibit 176: Rite Aid, Retail Pharmacy Prescription Revenues, 2018 to 2029
Exhibit 177: McKesson, U.S. Pharmaceutical Distribution, Revenues and Growth, 2020:Q1 to 2024:Q2
Exhibit 178: McKesson Canada, Revenues and Growth, 2020 to 2024

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