Pharmacy500 Closed System Drug-Transfer Devices (CSTDs) Report 2025

MAR 2025

SUPPLY CHAIN TEARDOWN

Closed System

Drug-Transfer Devices

(CSTDs)

Product Displayed: EQUASHIELD®

Alexa DiLuca

Marketing Manager

Michael McEwen

Pharmacy500 Market Analyst

michael.mcewen@rxinsider.com

Gregory Cianfarani, RPh

Founder & CEO

MEET THE

MARKET INTELLIGENCE TEAM

About RXinsider

Founded in 1999, RXinsider is a pharmacist-founded marketing/

communications (MARCOM) and market intelligence (INTEL) company

focused on pharmacy operations and the companies supporting

dispensing pharmacies. Through our publications, digital platforms,

market research, and training resources, RXinsider educates pharmacy

management and industry professionals on the products, services,

and trends that impact pharmacy operations across the supply chain.

RXinsider’s Market Intelligence (INTEL) Group performs market research

on the pharmacy operations supply chain and the Pharmacy500

companies. Through our weekly reports, digital awareness, and online

training, the INTEL Group educates Pharmacy500 professionals and

pharmacy management on the products and services impacting

pharmacy operations.

Lexi Cianfarani

Pharmacy500 Market Analyst

lexi.cianfarani@rxinsider.com

Jeff Rackliff

Pharmacy500 Market Analyst

jeff.rackliff@rxinsider.com

Emma Cidade

Pharmacy500 Market Analyst

emma.cidade@rxinsider.com

Report Lead

Jeff Rackliff

A 2025 Breakdown of

Closed System Drug-

Transfer Devices (CSTDs)

The objective of this report is to educate Pharmacy500

professionals, pharmacy leadership, and other stakeholders on

key trends within the compounding supply chain as it relates to

Closed System Drug-Transfer Devices (CSTDs).

Table of Contents

• Introduction.................................................... 2-3

• CSTDs Overview & Key Features....................4

• CSTDs Company Listing..................................5

• Company Location & Practice Settings........6

• CSTDs Products............................................ 7-9

• Conferences, Trade Shows & Meetings......10

• End Users & Buyer Personas........................11

• Public Companies & Stock Performance.....12

• References........................................................13

• Pharmacy500 Companies.......................14-18

CSTDs Overview

Pharmacy Closed System Drug-Transfer Devices (CSTDs) are

specialized mechanical devices designed to prevent the escape

of hazardous drug vapors, aerosols, and liquids during drug

preparation, transfer, and administration. They are used in pharmacy

and healthcare settings to ensure the safe handling of hazardous

drugs, protecting healthcare workers, patients, and the environment

from exposure. CSTDs are a critical component of safety protocols

in pharmacy practice, ensuring a safer working environment and

minimizing risks associated with the handling of hazardous drugs.

National Institute for Occupational Safety and Health (NIOSH) definition:

Closed System Drug-Transfer Device (CSTD): a drug transfer device that

mechanically prohibits the transfer of environmental contaminants into

the system and the escape of hazardous drug or vapor concentrations

outside the system.

Closed System: a device that does not exchange unfiltered air or

contaminants with the adjacent environment.

Key Features of CSTDs

1. Closed System Design: A completely sealed system

that prevents contamination by ensuring no venting or

leakage of drug or vapor into the environment during

drug manipulation.

2. Dual Protection: Prevents:

• The escape of hazardous drug particles, vapors,

or aerosols into the environment.

• Contaminants from entering the drug vial or

container, maintaining sterility.

3. Regulatory Standards: Required under USP <800>

guidelines for the preparation and administration of

hazardous drugs to minimize occupational exposure.

4. Mechanisms of Action: Includes features like:

• Mechanically Closed Systems: Physically

block the transfer of contaminants or escape of

hazardous materials.

• Air-cleaning Closed Systems: Use filters or

membranes to clean air exchanged during drug

manipulation.

5. Applications: Used for handling hazardous

medications such as chemotherapy drugs, biologics,

and other cytotoxic agents in sterile compounding,

administration, and waste management.

6. Integration with Existing Systems: Compatible

with syringes, vials, and IV bags, and often used in

conjunction with compounding aseptic containment

isolators (CACIs) or biological safety cabinets (BSCs).

7. Benefits:

• Reduces healthcare worker exposure to

hazardous drugs.

• Maintains medication integrity and sterility.

• Enhances compliance with occupational and

environmental safety regulations.

8. Components

• Vial Adapter

• Syringe Adapter

• IV Bag / Spike Adapter

The “Pharmacy500” are 500 businesses and associations that significantly

impacted the business operations of dispensing pharmacies in the U.S. over

the previous year. The six companies listed below are the companies within

the 2025 Pharmacy500 that make up the Compounding: Closed System

Drug-Transfer Devices (CSTDs) Supply Chain Category. For Pharmacy500

criteria and details, please visit www.RXinsider.com/Pharmacy500.

Pharmacy500 CSTDs Companies

Companies by Location

The following shows the applicable practice settings for CSTDs.

Practice Setting Breakout

NUCLEAR

MANAGED CARE / PBM

HOME INFUSION / COMPOUNDING

LONG TERM CARE

SPECIALTY

HOSPITAL / HEALTH SYSTEM

COMMUNITY / RETAIL

CSTD Products

OnGuard® 2

• OnGuard® 2 is a closed system transfer device (CSTD) that

incorporates all of the current advantages of OnGuard, while

offering upgraded materials and improved usability. OnGuard

2 is designed to keep healthcare professionals safe when

handling hazardous drugs. OnGuard 2 includes a complete

portfolio of products for most handling protocol.

BD PhaSeal™ Optima System

• The BD PhaSeal™ System pioneered the category of closed-

system drug-transfer devices (CSTDs) to help protect the

pharmacists and clinicians who prepare and administer

hazardous drugs. Twenty years later, we turned to healthcare

professionals like you for feedback and guidance to optimize

its every component. The result is the BD PhaSeal™ Optima

System—a next-generation, user-tested CSTD solution that

advances hazardous drug safety.

BD Texium™ System

• The centerpiece of the Texium™ System is the Texium™ Closed

Male Luer. This is an airtight, leak-free, and drip-free closed

system drug transfer device (CSTD) and when paired with a

SmartSite™ Needle-free Connector, mechanically prohibits the

transfer of environmental contaminants into the system and the

escape of drug vapor concentrations outside the system.

BD SmartSite™ Needle-free Connector

• Allows closed system administration of medication when used

with a Texium™ closed male luer.

Halo® Closed System Transfer Device

• Halo® Closed System Transfer Device has been evaluated for

vapor and fluid containment, prevention of microbial ingress,

pressure test and drug resistance. Each Halo® component is

airtight and leak proof, intuitive and easy to use, compatible and

efficient.

EQUASHIELD®

• EQUASHIELD® is the industry leading CSTD, known for its

closed-back syringes and advanced safety measures to prevent

contamination and vapor escape in handling hazardous drugs.

ChemoLock™ Needlefree Closed System

Transfer Device (CSTD)

• The ChemoLock CSTD’s mechanically closed, needlefree

system is designed to help prohibit the escape of hazardous

drugs and vapor while maintaining the sterility of the drugs

during preparation.

ChemoClave™ Needlefree Closed System

Transfer Device (CSTD)

• Maintain a needlefree closed system to help minimize exposure

to hazardous drugs and comply with USP <800>. Familiar luer-

based CSTD, bonded to help you improve workflow efficiency

and prevent the risk of exposure due to accidental disconnects.

Arisure® Closed System Transfer Device

• The Arisure CSTD keeps you and your team safe so you can

quickly and efficiently compound the right drug and the right

dose with the least amount of disruption to your workflow.

Conferences, Trade Shows & Meetings

The following identifies the major

national pharmacy conferences

at which Pharmacy500 CSTD

companies exhibited in 2024.

The top three conferences in

2024 were ASHP Midyear, ASHP

Pharmacy Futures, and NHIA. For

the past two years, all six of the

Pharmacy500 CSTD companies

have exhibited at ASHP Midyear.

Top Three Conferences

ASHP Midyear

ASHP Pharmacy Futures

NHIA

2022

2024

2023

2022

2024

2023

2022

2024

2023

PHARMACY

FUTURES

MIDYEAR

CSTD End Users

The following roles represent the most common end users of CSTDs.

CSTD Buyer Personas

Director of Pharmacy

Independent Pharmacy Owner

Pharmacist in Charge (PIC)

Staff Pharmacist

Clinical Pharmacist

Consultant Pharmacist

Pharmacy Operations (Chain Pharmacy)

Pharmacy Technician

Director of Nursing

Nurses

Hospital CTO / CIO

Director of Pharmacy

Independent Pharmacy Owner

Pharmacist in Charge (PIC)

Staff Pharmacist

Clinical Pharmacist

Consultant Pharmacist

Pharmacy Operations (Chain Pharmacy)

Pharmacy Technician

Director of Nursing

Nurses

Hospital CTO / CIO

The following roles represent the most common buyer personas for CSTDs.

Public

Private

The following provides a breakdown of the publicly held

versus privately held Pharmacy500 CSTD companies.

Closed: March 10, 2025 at 4:00 PM ET

ICU Medical

NASDAQ: ICUI

$130.05 USD

+25.64% Past Year

NYSE: BDX

$227.45 USD

-5.03% Past Year

Public Companies & Stock Performance

References

2022 ASHP Midyear Clinical Meeting and Exhibition: Exhibitors. (2022). Jspargo.com. https://

events.jspargo.com/midyear22/Public/Exhibitors.aspx?SubCatID=2612

2022 ASHP Summer Meetings: Exhibitors. (2022). Jspargo.com. https://events.jspargo.com/

Summer22/public/Exhibitors.aspx?CatID=349

2023 ASHP Midyear Clinical Meeting and Exhibition - Event Map. (2023). Jspargo.com. https://

events.jspargo.com/midyear23/Public/EventMap.aspx

2023 ASHP Summer Meetings: Exhibitors. (2023). Jspargo.com. https://events.jspargo.com/

summer23/public/Exhibitors.aspx?CatID=349

2024 ASHP Midyear Clinical Meeting and Exhibition - Event Map. (2024). Jspargo.com. https://

events.jspargo.com/Midyear24/Public/EventMap.aspx

2024 ASHP Pharmacy Futures: Exhibitors. (2024). Jspargo.com. https://events.jspargo.com/

Futures24/Public/Exhibitors.aspx?SubCatID=2525

(2022, February 28). NHIA 2022 Program Guide [Review of NHIA 2022 Program Guide]. https://

www.eventscribe.com/upload/planner/PDFs/NHIAProgramGuide_2-28-22_lowres_34.pdf

Arisure Closed System Transfer Device. (2025, January 29). Yukon Medical. https://yukonmedical.

com/products/arisure-cstd/

BD PhaSealTM Optima System | BD. (n.d.). Www.bd.com. https://www.bd.com/en-us/products-

and-solutions/products/product-families/bd-phaseal-optima-system

‌ChemoClaveTM Needlefree Closed System Transfer Device (CSTD). (2024). Icumed.com.

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chemoclave-needlefree-closed-system-transfer-device-cstd/

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https://www.equashield.com/products/

‌Equashield LLC. (2023, September 9). EQUASHIELD: The Leading Provider of Closed System

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releases/equashield-the-leading-provider-of-closed-system-transfer-devices-celebrates-five-

years-as-the-most-used-device-in-hazardous-drug-administration-and-preparation-301922521.

html

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medicalexpo.com/prod/icu-medical/product-119492-821244.html

Disclaimer

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The Pharmacy500 is awarded to 500 pharmacy

supply chain businesses and associations

with the most significant impact on dispensing

pharmacies in the U.S. over the past year. For

Pharmacy500 selection criteria and details,

please visit www.rxinsider.com/Pharmacy500.

AAPA

Abbott | Abbott Diabetes Care

Academy of Managed Care Pharmacy (AMCP)

Accreditation Commission for Health Care

Accreditation Council for Pharmacy Education

Accu-Chart Plus Health Care Systems

Accucold

Acute Care Pharmaceuticals

AdvanceNet Health Solutions

Advasur

Agadia

Air Link International

AirCare Automation

AirClean Systems, Inc.

AIS Healthcare

Akro-Mils

Alliance for Pharmacy Compounding

Allied Pharmacy Products

Altium Packaging

American Analytics

American Associated Pharmacies (AAP)

American Association of Colleges of Pharmacy

American Association of Health System Pharmacists

(ASHP)

American BioTech Supply

American College of Apothecaries

American College of Clinical Pharmacy

American College of Veterinary Pharmacists

American HealthCare Capital

American Pharmacies, Inc.

American Pharmacists Association (APhA)

American Pharmacy Cooperative, Inc. (APCI)

American Rx Group

American Society of Consultant Pharmacists (ASCP)

Americorp Financial, LLC

Amneal Pharmaceuticals LLC

Anda Inc.

AnewHealth

ANiGENT LLC

Animal Med Express

Apexus LLC

Apothecary Products, LLC

APS - Advanced Pharmacy Solutions

ARL Bio Pharma

ARxIUM

Asembia

AssistRx

Associates of Cape Cod, Inc

AssureCare LLC

Asteres Inc.

Athenahealth

Atlas Health

Avel eCare

Aventi Health

Avery Weigh-Tronix | RxSafe/Eyecon

AvKARE, LLC

Azurity Pharmaceuticals, Inc.

Azzur Group

B Medical Systems

B. Braun Medical Inc.

BA Sciences

Baxter

Berkshire Corporation

Berry Global Inc.

BestRx (Redsail)

Beutlich Pharmaceuticals, LLC

BioCareSD

Blue Thunder Technologies Inc.

Bluesight

BluPax Pharma

Board of Certification/Accreditation, International (BOC)

Board of Pharmacy Specialties (BPS)

Bonita Pharmaceuticals

Bureau Veritas

Buy-Sellapharmacy.com

Byline Bank

CAM Commerce Solutions/Celerant Technology

Capital Inventory, Inc

Capital Wholesale Drug Company

Capsa Healthcare

CaptureRx

Cardinal Health

Care Services, LLC.

CarepathRx

CarePoint

CaryHealth

CEImpact

Cencora/AmerisourceBergen

Centor

Central Admixture Pharmacy Services, Inc. (CAPS)

Cervey

Charles River Laboratories

ChemoGLO

CINTAS Corporation

Cipla, Inc.

Civica

Clean Harbors, Inc.

Cleanetics

Cleanroom Connection

Clearway Health

Codonics

Cold Chain Technologies

ComCo Systems

CompleteRx

ConsortiEX Inc.

Containment Technologies Group, Inc.

Contec, Inc.

CORE Higher Education Group

CORMED

COSHATT

CoverMyMeds (McKesson Corporation)

CPESN USA, LLC

CPS Solutions, LLC

Crocus Medical Inc.

CuraScriptSD

Cypress Software, Inc.

D2 Solutions

Datarithm

Datascan Pharmacy, Inc.

Dexcom, Inc.

Dickson

Digital Business Solutions, Inc.

DisposeRx, Inc.

DiversifyRx

DocStation

DoseMe

DosePacker, Inc.

DosePlanner

Dr.Reddy’s Laboratories Ltd.

DrFirst

Drugstore2Door

DRX SOFTWARE LLC

Dycem Ltd

Eagle Analytical Services

Ecolab

ECRM

Elsevier

Embecta

Emporos

Endo USA

EnlivenHealth

EPIC Rx

Epic Systems Corporation

Epicor Software Corporation

EQUASHIELD

Esco

Euclid Medical Products

Eurofins Analytics

EveryDose

Everyware

EzriRx

EZSCRIPTRx

Fagron

FFF Enterprises, Inc.

FG Clean Wipes

First Databank, Inc.

First Financial Bank, Inc.

Flash Returns, LLC

FLAVORx

Flexible Pharmacy Services, PLLC

Flowsell

Follett

Franklin Eyewear

Fresenius Kabi Group

Frier Levitt

Fullscript

Genetco Inc.

GeriMed, Inc.

Germfree

Grifols

GRX Marketing

H+H System, Inc.

Hardy Diagnostics

Hayslip Rx Brokers Inc.

HealNow

Health Care Logistics, Inc.

Health Connect Partners, Inc.

HealthTrust

HealthWell Foundation

HelioMetrics

Hematology/Oncology Pharmacy Association (HOPA)

Hikma Pharmaceuticals

ICU Medical

iLocalBox

Imprivata/FairWarning

IND Consulting

Independent Pharmacy Cooperative (IPC)

InfiniTrak, LLC

InfinityLaboratories

InfoWerks

Inmar Inc.

Innovatix, LLC

Inovalon

InsightRX, Inc.

Institute for Safe Medication Practices (ISMP)

InstyMeds

Integrated Medical Systems, Inc. (IMS)

Integrity Pharmacy Consultants

Intelliguard/MEPS Real-Time, Inc.

InTemp Monitoring Solutions

Interlink AI, Inc.

International Journal of Pharmaceutical Compounding

(IJPC)

International Medical Industries

Isak Computing (SiCompounding & SiPrescribe)

ISO-MED, Inc.

IsoTech Design

Jackson Pharmacy Professionals

Jays Company

JFCRx

Jones Healthcare Group

Keycentrix, LLC

KeySource

KNAPP

Labconco

Lakeland Industries, Inc.

Legacy Pharmacy Group

Leiters Health

Liberty Software

Liebherr

LifeFile

Lincoln Savings Bank

Live Oak Bank

Loopback Analytics

LSPedia, Inc.

Lumistry

Lupin Pharmaceuticals Inc.

Managed Health Care Associates, Inc. (MHA)

Manchac Technologies

Masters Pharmaceutical (McKesson Corporation)

MatchRX

Maximum Rx Credit, Inc.

Maxor National Pharmacy Services, LLC

Maxpert Medical

MAXQ

McKesson Corporation

MedAdvisor Solutions (Adheris Health)

Medi-Dose, Inc./EPS, Inc.

Medical Packaging Inc., LLC

Medicine-On-Time

Medigi

Medility Inc.

Medisca Inc.

Meditech

Medivant Healthcare

MediZap

MedMe Health

MedSafety Solutions

Medtel Communications (Lumistry)

MedXL Inc.

Merative

Mesmerize

Micro Merchant Systems, Inc.

MIDAS Healthcare Solutions

Mideast Delivery Solutions

Migali Scientific

Mobile MediClaim, Inc.

Moderna, Inc.

Modular Cleanrooms, Inc.

Modular Devices

Modular Pharmacy Solutions, LLC

Morris & Dickson

N3PR

NarcX

National Association of Boards of Pharmacy (NABP)

National Association of Chain Drug Stores (NACDS)

National Association of Specialty Pharmacy (NASP)

National Community Pharmacists Association (NCPA)

National Council for Prescription Drug Programs (NCPDP)

National Home Infusion Association (NHIA)

National Pharmaceutical Returns, Inc.

National Pharmacy Purchasing Association (NPPA)

National Pharmacy Technician Association (NPTA)

Nephron Pharmaceuticals Corporation

Net-Rx (an MHA Solution)

Nimble

Nordic Cold Chain Solutions

Noritsu Pharmacy Automation

NuAire, Inc.

Nuvem

Omega Pharmacy Group

Omnicell

OmniSYS (XiFin Pharmacy Solutions)

Optum, Inc.

Oracle Health/Cerner

OrderInsite, LLC

OurPharma LLC

Outcomes

Owen Mumford

P&C Pharma

PAAS National LLC

Paladin Data Corporation

Paragon Ventures

Parasol Medical, LLC

Parata Systems (BD)

ParcelShield

Patient Access Network Foundation

PCCA

PDM Healthcare

PDR/ConnectiveRx

Pentapack

PEPID, LLC

Perfex Corporation

Pestle

Pevco

phactMI

Pharma Logistics, LLC

Pharma Source Direct

Pharmacists Mutual Insurance Company

PharmaComplete

Pharmacy Automation Supplies

Pharmacy Brokers

Pharmacy Consulting Broker Services

Pharmacy First

Pharmacy Podcast Network

Pharmacy Quality Alliance (PQA)

Pharmacy Quality Solutions (PQS)

Pharmacy Stars, LLC

Pharmacy Technician Certification Board (PTCB)

Pharmacy Times (MJH Life Sciences)

Pharmacy-Lite Packaging

PharmaForce

PharmaLink Inc.

Pharmapod

PharmaPoint, LLC

Pharmathek

PharmCon

PharmEcology (WM)

Pharmetric Laboratory

PharmID, Inc.

Pharmsource, LLC

PharmWaste Technologies, Inc.

PHC Corporation of North America

Phox Health, Inc

Pillr Health

Pine Pharmaceuticals

PK Telehealth (TCE Group)

Plenful

PointClickCare

Powerpak (Postgraduate Healthcare Education)

PPOk

PreciseRX

Precision Dose, Inc.

Premier

Prescryptive Health, Inc.

Primex Inc.

Prompt Praxis Laboratories

ProPharma Cleanrooms

ProxsysRx

PRS Pharmacy Services

Prudential Cleanroom Services

Pure Microbiology, LLC

Pyrls (Cosmas Health, Inc)

Q.I. Medical Inc

QleanAir Scandinavia

QRx Solutions

QuicksortRx, Inc.

QuidelOrtho Corporation

QuVa Pharma

R.C. Smith

R.J. Hedges & Associates

R&S Northeast LLC

RD Plastics Company, Inc.

Real Value Rx

Redsail Technologies, LLC

Rees Scientific

Relay Robotics, Inc.

Retail Designs Inc.

Retail Management Solutions, LLC

Return Solutions, Inc.

Revelation Pharma

RevSpring, Inc.

Roemer Industries

RPh on the Go

Rx Advisors

RX Destroyer

Rx relief

Rx Return Services, LLC.

Rx Reverse Distributors, Inc.

Rx Systems, Inc.

Rx2Go

RxConnexion

RxDispense

RXinnovate Consulting

RXinsider

RxLive, Inc.

RxMile

RxOwnership (McKesson)

RxPreferred

RxRise

RxScan

RXshelving.com (Surplus Equipment Company)

SafeChain Solutions, LLC

Safecor Health

Samson Medical Technologies, LLC

Sanford Guide

SCA Pharma

ScriptPro LLC

SDS Rx

SensoScientific, Inc.

ServRx, Inc.

Shamrock Labels

Sharps Medical Waste Services

Shepard Medical Products

Shields Health Solutions

Skyline Pharmaceuticals

SmartCells (SATECH, Inc.)

SmartSense (Digi International)

Smith Drug Company

So-Low Environmental Equipment Co.

SoftWriters, Inc

Soliant Health

Source Communications LLP

South Pointe Wholesale, Inc.

SpecializedRx Products, LLC

Specialty Medical Staffing

Spectrum Pharmacy Products

Speed Script

SpendMend

Sphinx Strategies

SpotSee

SRS Pharmacy Systems

STACK, LLC

STAQ Pharma, Inc.

STChealth

Stericycle, Inc. (WM)

Stratix Labs Corporation

SuiteRx, LLC

Suncrest Solutions

SUNRx

SureCost, LLC

Surescripts

Swisslog Healthcare

Sykes & Company, P.A.

TailorMed

TEAM Technologies, Inc.

Teknipure

TelNet-Rx

Tension Packaging & Automation

Terso Solutions, Inc.

Texwipe (ITW)

The Baker Company

The Compliance Team, Inc.

The Craneware Group

The Medicine Shoppe Pharmacy

The Relief Products

Thermo Fisher Scientific, Inc.

ThoroughCare, Inc.

TICKERWORKS

TopRx, LLC

Total Pharmacy Supply, Inc.

Total-Shield PLUS (McGowan Industries, Inc.)

TouchPoint Medical

TraceLink, Inc.

TrackTraceRx, Inc.

Trane Technologies

TransferMyRx

Travis CleanAir, Inc.

TRC Healthcare

Trilogy MedWaste, Inc.

TruMed Systems, Inc.

Turbare Manufacturing

U.S. Micro-Solutions, Inc.

UGO

Unidoses

United Pharmacy Network (UPN)

UNITED Staffing Network, Inc.

United States Pharmacopeia (USP)

UNIWEB, Inc.

Updox by EverHealth

Value Drug Company

Veltek Associates, Inc.

Veracity Group, Inc.

Veridikal

Verity Solutions

Vileda Professional

Virtue Technologies

Visante

VIVID (Scientific Industries, Inc.)

Vizient, Inc.

VMI Care

VPL, Inc.

WeInfuse, LLC

Well-Served Pharmacy Community (WSPC)

Wellgistics

Wellpartner

Wells Pharma

West Pharmaceutical Services, Inc.

Winfield Laboratories Inc

Wolters Kluwer

Workflow Services

WorkingBuildings

Yardi Systems, Inc.

Yukon Medical, LLC

Yuyama USA, Inc.

Zebra Technologies Corp.

340B Health

340BDirect | Procuity

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Product Displayed: EQUASHIELD®