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Pharmacy500 Hospital Practice Setting Report 2025

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MAR 2025

PRACTICE SETTING TEARDOWN

HOSPITAL /

HEALTH SYSTEM

Alexa DiLuca

Marketing Manager

Michael McEwen

Pharmacy500 Market Analyst

michael.mcewen@rxinsider.com

Gregory Cianfarani, RPh

Founder & CEO

Report Lead

Lexi Cianfarani

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.

Jeff Rackliff

Pharmacy500 Market Analyst

jeff.rackliff@rxinsider.com

Emma Cidade

Pharmacy500 Market Analyst

emma.cidade@rxinsider.com

Lexi Cianfarani

Pharmacy500 Market Analyst

lexi.cianfarani@rxinsider.com

A 2025 Breakdown of the

Hospital / Health System

Practice Setting

The objective of this report is to educate Pharmacy500

professionals, pharmacy leadership, and other stakeholders on

key trends within the hospital / health system practice setting.

The following report provides an analysis of the Pharmacy500

companies that significantly impact dispensing pharmacies within

the hospital / health system practice setting.

This report includes a detailed supply chain category and attended

conference breakdown on the hospital and health system focused

companies. Our research examines key trends within the hospital

pharmacy practice setting identified from the 2024 annual ASHP

Midyear meeting, as well as which companies are holding user

conferences for 2025. The 23 recent M&A and consolidation

activities, along with company sizes, have also been identified.

The report concludes with a snapshot of the publicly traded

Pharmacy500 companies and their stock performance for the

trailing four quarters.

Table of Contents

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

• Hospital / Health System Overview ....................4-5

• Companies by Region & Company Size ................6

• Practice Setting Crossover ........................................7

• Notable M&A & Consolidation .................................8

• Supply Chain Crossover ............................................9

• Conferences, Trade Shows & Meetings ........ 10-13

• Market Trends .................................................... 14-15

• Public Stocks ............................................................ 16

• Career Center ........................................................... 17

• References .......................................................... 18-19

• Pharmacy500 Companies ............................... 20-23

Hospital / Health System Overview

A hospital (health system) pharmacy is responsible for procuring,

preparing, dispensing, and managing medications for patients admitted

to the hospital (in-patients) and in certain cases, patients in the local

community (out-patients). The hospital pharmacy staff ensures the six

rights (the right patient, medication, indication, dose, time, and route).

Hospital pharmacies also provide services like drug therapy management,

clinical consultation, and patient education to optimize therapeutic

outcomes.

Hospital pharmacies typically consist of a team of pharmacists, pharmacy

technicians, and pharmacy interns who work closely with doctors,

nurses, and other healthcare providers. The team often includes clinical

pharmacists who specialize in particular areas (e.g., oncology, pediatrics,

or critical care) and medication safety officers who focus on minimizing

medication errors and improving patient outcomes. In-patient hospital

pharmacies are closed to the public (closed-door pharmacy), while an out-

patient pharmacy in a hospital is open to the public and operates similarly

to a retail/community pharmacy.

1. Medication Procurement and Inventory Management:

Ensuring the hospital is stocked with all necessary medications and pharmaceutical supplies.

2. Medication Dispensing:

Preparing and dispensing medications based on prescriptions written by physicians and other healthcare providers. This includes

both standard oral medications and specialized preparations like intravenous fluids, chemotherapeutic agents, and parenteral

nutrition.

3. Clinical Consultation and Drug Information:

Providing clinical expertise to healthcare providers on the safe and effective use of medications, including identifying drug

interactions, recommending alternative treatments, and adjusting doses based on patient conditions (e.g., renal function, age,

comorbidities).

4. Compounding:

Preparing customized medications, particularly when commercially available products do not meet specific patient needs (e.g.,

compounded chemotherapy drugs, pain management injections).

5. Patient Safety and Monitoring:

Ensuring that medication use is safe, effective, and tailored to the individual needs of patients. This includes checking for adverse

drug reactions (ADRs), therapeutic drug monitoring, and assessing for drug-drug interactions.

6. Education and Training:

Educating healthcare providers, patients, and caregivers about the proper use of medications, potential side effects, and the

importance of adherence to prescribed regimens.

7. Regulatory Compliance:

Ensuring that the pharmacy department follows all relevant federal and state regulations, including those related to controlled

substances, proper storage conditions, and the handling of hazardous medications.

Key Functions & Characteristics

34%

of Pharmacists work in

hospitals (approx. 115,000)

$1.5 T

Total combined expenses for

all U.S. hospitals in 2024

6,093

Hospitals in the U.S. as of 2025

920,531

Total beds in the all U.S. hospitals

271

Drug shortages as of

December 2024

PRACTICE

SETTING

SNAPSHOT

60,000

Pharmacists, student pharmacists,

and pharmacy technicians represented

by ASHP

The first hospital pharmacy was established in 1752.

References: American Hospital Association, American Journal of Hospital Pharmacy, Data USA, and ASHP

21%

NORTHEAST

MIDWEST

Companies by Region

The Pharmacy500 companies range in

sizes. There are 121 small companies

with less than 50 employees, 87

medium-sized companies with 51 to 200

employees, 69 large companies with 201

to 1,000 employees, and 60 very large

organizations with more than 1,000

employees.

WEST 16%

SOUTH

34%

1,000+ EMPLOYEES

201-1,000 EMPLOYEES

51-200 EMPLOYEES

1-50 EMPLOYEES

121

Companies by Size

INTERNATIONAL

26%

The following chart breaks down the

number of Pharmacy500 hospital / health

system companies that crossover to

additional pharmacy practice settings.

Practice Setting Crossover

187

147

126123

MANAGED CARE / PBM

NUCLEAR

LONG TERM CARE

SPECIALTY

HOME INFUSION & COMPOUNDING

COMMUNITY / RETAIL

Notable M&A & Consolidation

Q1 2025

RxStrategies, Hudson Headwaters 340B, and

RPH Innovations Merge to Form Pillr Health

Nuvem Acquires Louvir

Pharma Logistics Acquires

Rx Reverse Distributors

Avel eCare Acquires Amwell Psychiatric Care

Bluesight Acquires Protenus.

Q4 2024

CORE Higher Education Group

Merges with PeopleGrove

Amsino Acquires MedXL Inc.

Cardinal Health Acquires Both GI Alliance

& Advanced Diabetes Group

Ecolab Acquires Barclay Water Management

Kewaunee Scientific Corporation Acquires NuAire

WM Acquires Stericycle

Bluesight Acquires Sectyr

Bureau Veritas Acquires Aligned Incentives

U.S. Pharmacopeia Acquires Stratix Labs

Q3 2024

Fagron Acquires RideDose 503B

Cardinal Health Acquires Integrated

Oncology Network

Eurofins Acquires Infinity Laboratories

ASP Global Acquires RD Plastics Company

BD acquires Critical Care from

Edwards Lifesciences

Scriptology Acquires RxLive

ExactCare and Tabula Rasa HealthCare

Merge as AnewHealth

Q1 2024

Innovaccer Acquires Pharmacy Quality Solutions

Modular Devices Merges with Flow

Cleanrooms and Technical Air Products

Automation & Robotics

• Automated Dispensing Cabinets (ADCs)

• Med Carts, Computer Carts, COWs

• Pharmacy Fulfillment Robots

• Material Transport Delivery, Pneumatic Tubes

• Smart Pumps & Infusion Pumps

• Tablet & Capsule Counters

Compounding

• Closed System Drug-Transfer Devices (CSTDs)

• Sterile Compounding Automation, IV Automation

• USP <795> Non-Sterile Resources, Compliance,

Technology

• USP <797> & <800> Sterile Resources, Compliance,

Technology

Contamination Control

• Cleanrooms, Gloveboxes, Hoods, Isolators

• Cleanroom Supplies, Disposables, Sterilization

• Environmental Monitoring & Compliance

• Quality Control, Lab Testing Services

Delivery & Shipping

• Cold Chain Management & Supplies

• Courier, Delivery, Last-Mile Services

Distribution

• 340B Solutions, 340B Management Systems

• DSCSA Solutions

• GPOs, Buying Groups, COOPs

• Pharmacy Supplies

• Returns, Reverse Distribution

• Wholesalers & Distributors

Facilities

• Design, Fixtures, Engineering

• Pharmacy Refrigeration & Cold Storage

• Pharmacy Security, Medication Storage, Carousels

• Temperature Monitoring (Wireless)

• Waste Management & Destruction

Finance

• Financing, Banking, Business Loans

• Insurance (Business, Liability, Malpractice)

• Mergers, Acquisitions, Buying-Selling, Franchising

• PSAOs, Revenue Cycle Management, Reconciliation

• Worker’s Comp, Claims, PA Management, Adjudication

Manufacturing

• 503B Outsourcing Facilities, Compounding Services

• Contract Manufacturing, Drug Shortage Mitigation

• Generics, Brand Name, Biotech

• Injectables

Merchandising

• DME, Devices

• OTC Products, Vitamins, Supplements, Merchandise

Patient Care

• Adherence, Compliance, Remote Monitoring, Med Sync

• Assistance Programs, Loyalty Resources, Discount

Cards

• Diabetic Care

• Medication Therapy Management (MTM)

• Patient Communication, Outreach, Engagement

• Personalized Wellness, Point-of-Care Services

Professional Development

• Associations, Trade Organizations

• Conferences, Trade Shows, Expos, Summits

• Continuing Education, Training

• Degree Programs, Masters, Post-Secondary

• Jobs, Careers

Professional Services

• Accounting & Legal Services

• Accreditation, Certification, Compliance

• Audit Support

• Consulting (Health Systems & Infusion)

• Consulting (Retail/Community & Specialty)

• Marketing Services

• On-Site Pharmacy Management Outsourcing

• Staffing Services, Recruiting Agencies

• Telepharmacy, Remote Order Entry

Software

• Business Management, Operations, ERP

• Clinical Monitoring, Surveillance, Insights

• Controlled Substance Reporting, Ordering

• Decision Support, Point of Care Reference, Dosing, DUR

• Drug Diversion Monitoring, Diversion Prevention

• eMAR, EMR, EHR, Bedside Verification

• Error Prevention, Drug Validation

• Formulary Management

• IV Workflow Management

• Long-Term Care Operation Management

• Medication Inventory Management & Procurement

• Pharmacy Management Systems, Workflow

• Stewardship Resources (Antibiotic, Opioid...)

Unit Dose

• Outsourced Packaging & Repackaging Services

• Multi-Dose Packaging Resources, Supplies

• Single-Dose Packaging Resources, Supplies

Workflow

• IVR / Interactive Voice Response Systems

• POS / Point of Sale Systems

• Printers, Barcode Printing

• Will-Call & Kiosk Prescription Management

Pharmacy Supply Chain Categories

The following charts represent the

market presence of hospital / health-

system companies that cross into the

88 supply chain categories.

TOP FIVE SUPPLY CHAIN CATEGORIES

Compounding:

USP <797> & <800> Sterile

Resources, Compliance,

& Technology

Contamination Control:

Cleanrooms & Gloveboxes

& Hoods & Isolators

Contamination Control:

Cleanroom Supplies,

Disposables, Sterilization

Distribution:

340B Solutions & 340B

Management Systems

Software:

Medication Inventory

Management

& Procurement

Supply Chain Crossover

The following charts represent the

market presence of hospital / health-

system companies that cross into the

88 supply chain categories.

TOP FIVE SUPPLY CHAIN CATEGORIES

Compounding:

USP <797> & <800> Sterile

Resources, Compliance,

& Technology

Contamination Control:

Cleanrooms & Gloveboxes

& Hoods & Isolators

Contamination Control:

Cleanroom Supplies,

Disposables, Sterilization

Distribution:

340B Solutions & 340B

Management Systems

Software:

Medication Inventory

Management

& Procurement

Conferences, Trade Shows & Meetings

The following identifies the top 16 national

pharmacy conferences at which hospital

/ health system companies exhibited

in 2024.

152

The following Pharmacy500 hospital / health system

companies that attended one or both of the ASHP annual

conferences.

ASHP Midyear vs. Pharmacy Futures

(PHARMACY

FUTURES)

(WINTER)

ASHP Midyear

(MIDYEAR)

ASHP Pharmacy

Futures

152