M&A activity snapshot
Specialty pharmacy and home infusion deals follow the drug market, and that market keeps growing. In 2025, U.S. pharmacies collectively dispensed an estimated $293.4 billion in specialty pharmaceuticals—a 9.6% increase over the revised 2024 figure. Drug Channels counts more than 1,900 dispensing locations with specialty pharmacy accreditation.
Home infusion is a smaller, more fragmented layer. NHIA's most recent industry sizing, from 2020, estimated a $19 billion industry made up of over 900 providers serving 3.2 million patients annually. That figure is now several years old, and NHIA has not published an updated public market size.
Who is buying
PBM-owned pharmacies dominate specialty dispensing. In 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs, and all three belong to organizations that also own a PBM. Independent buyers compete for the remaining share and for limited-distribution drug access.
Large independents are the main strategic buyers in home infusion. Option Care Health is the nation's largest independent provider of home and alternate site infusion services, with over 8,000 team members, including more than 5,000 clinicians. It reported Q2 2026 net revenue of $1,442 million.
Payers are buying into health-system specialty pharmacy. Cigna's Evernorth invested $3.5 billion in Shields, which helps hospitals build and run their own specialty pharmacies. Shields became one of five standalone businesses created from pharmacy behemoth Walgreens after Sycamore Partners' acquisition. It partners with more than 80 health systems comprising more than 1,000 hospitals and care sites.
Private equity backs the fastest-growing independents. Drug Channels names PANTHERx Rare, Senderra Specialty Pharmacy, and Soleo Health as independents that have all received substantial PE investment.
What buyers look for
Payer and manufacturer access come first. Drug Channels notes that some smaller, independent specialty pharmacies also remain well-represented in manufacturers' exclusive specialty pharmacy networks. A seller's limited-distribution drug contracts, payer network status, and specialty accreditation are core diligence items.
Therapy mix is the second test. Buyers separate chronic, recurring specialty therapies from short-course acute infusions, and they review revenue concentration by drug. A single drug facing biosimilar entry or a Medicare price negotiation can move a target's earnings quickly.
Reimbursement mechanics are the third. Medicare's home infusion therapy benefit, effective January 1, 2021, pays for professional services tied to certain pump-administered drugs. Buyers check whether a target is enrolled as a qualified supplier and how much nursing it provides in-house.
Health-system competition is rising. The number of accredited specialty pharmacies operated by hospitals and health systems has expanded quickly, from 106 locations in 2017 to 553 locations in 2025. Drug Channels links that growth to the 340B Drug Pricing Program.
What makes a strong company
A specialty pharmacy or infusion business that commands a premium typically shows:
- Access to limited-distribution drugs and placement in manufacturer specialty networks.
- In-network status with major commercial payers and documented reimbursement rates.
- A chronic-therapy mix that produces recurring referrals, with no single drug dominating revenue.
- Employed or tightly managed infusion nursing and, where relevant, ambulatory infusion suites.
- Specialty pharmacy accreditation and clean state board of pharmacy inspection records.
- Reimbursement reporting that shows margins net of pharmacy price concessions.
Valuation and deal structure
Reliable infusion- or specialty-pharmacy-specific multiples are not published by the major lower-middle-market data providers. The closest proxy is GF Data's 7.7x for healthcare services in its 2026 mid-year read, which it cautioned rests on a small sample. Large strategic deals are priced on different terms. Shields, for example, brought in slightly below $700 million in revenue over the last twelve months, up from $212 million in 2021, before Evernorth's $3.5 billion investment.
Structure can be creative. Evernorth's investment in the form of preferred stock does not give Evernorth a controlling stake in Shields. Minority and preferred structures let strategics gain access to a channel without a full acquisition.
DIR reform changed how buyers read a pharmacy's margins. From contract year 2024, Part D plans must include all pharmacy price concessions in the negotiated price at the point of sale. CMS cited data that these concessions grew 107,400 percent between 2010 and 2020.
340B is the open regulatory risk. HRSA's first rebate pilot was vacated and remanded to the agency in February 2026. A revised pilot launches January 1, 2027, running for at least one year. Buyers of pharmacies with 340B contract-pharmacy revenue should model a rebate-based scenario.
Outlook
Expect steady buyer interest through 2027. Specialty drug spend is still growing, and the drug pipeline keeps shifting toward specialty products dispensed outside hospitals. Health systems and payers will keep competing with independents for the same specialty and infusion assets.
The main risks are policy and drug-specific. Changes to 340B, PBM reimbursement rules, and biosimilar entry on high-revenue drugs can each shift a target's earnings. Owners with diversified therapy mix, strong payer access, and clean reimbursement reporting are best placed to hold value through those changes.
Own a specialty pharmacy or infusion business and want a starting point before you talk to buyers? Run the valuation tool or read the Healthcare Services M&A overview. See also: how family offices source direct deals.