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In recent years, policymakers and stakeholders have begun to question how health plans and PBMs have consolidated power across the drug supply chain by controlling formularies, reimbursement, and patient access. But a new player is quietly expanding its reach: drug wholesalers.
According to a new analysis from Drug Channels Institute, the buy-and-bill market, where physicians purchase and administer drugs directly in their offices, is emerging as the next frontier for vertical integration. The nation's three largest wholesalers, Cencora (AmerisourceBergen), Cardinal Health, and McKesson, are no longer simply distributing medicine. They're partnering with or buying private equity–backed management groups that run oncology, ophthalmology, urology, and gastroenterology practices.
As Drug Channels notes, "the Big Three wholesalers have become dominant players in acquiring or partnering with private-equity-backed MSOs. Together, they've spent over $16 billion to acquire complete or partial ownership in eight transactions with disclosed values."
Why does this matter for policymakers and regulators? Because this expansion moves wholesalers closer to the point of care, blurring traditional lines of oversight. The same entities that supply and finance specialty drugs are now taking ownership stakes in the very practices that prescribe and administer them.
This trend mirrors the vertical integration long seen among PBMs and health plans, but with even fewer policy safeguards in place, as wholesalers adopt similar strategies to stay competitive. Oversight of physician-practice acquisitions and this type of consolidation, particularly at the wholesaler level, remains largely unexamined.
As drug pricing, site-of-care reform, and market competition rise on the policy agenda, the growing role of wholesalers deserves closer scrutiny. From distribution hubs to direct care, the wholesalers' move upstream represents a powerful and thus far, overlooked shift in who controls access and economics across the drug channel.
Read more here: https://www.drugchannels.net/2025/10/the-future-of-buy-and-bill-market.html
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