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Pharmacy500 Market Threats Report 2025

JUN 2025

PHARMACY500 MARKET REPORT

MARKET THREATS

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.

Alexa DiLuca

Marketing Manager

Gregory Cianfarani, RPh

Founder & CEO

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

Table of Contents

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

• Executive Snapshot..........................................4

• Pharmacy500 Companies Analyzed.............5

• Market Threat Type Breakout..................... 6-7

• Market Threat Breakout Analysis.............8-17

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

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

A 2025 Breakdown of Pharmacy500

Market Threats

The objective of this report is to educate Pharmacy500

professionals, pharmacy leadership, and other stakeholders

on key trends and identified market risks analyzed from the

publicly traded companies within Pharmacy500. Approximately

1,300+ market threats were gathered from 43 publicly traded

Pharmacy500 companies.

EXECUTIVE SNAPSHOT

PHARMACY500

MARKET THREATS

1,300+

Total market threats identified

across 43 public companies.

Source: Fortune500

Source: RXinsider

of the 43 companies analyzed

are international.

Source: RXinsider

of the 43 companies have

1,000+ employees.

Source: RXinsider

most common market

threat category is

Operational & Company

Risks.

of the 43 companies

analyzed are in the

Fortune500.

49 of the Pharmacy500 are publicly traded companies.

Top 10 Fortune500

companies (McKesson

& Cencora).

Source: Fortune500

Pharmacy500 Companies Analyzed

Abbott

Akro-Mils

Amneal Pharmaceuticals LLC

Baxter

Berry Global Inc.

Byline Bank

Cardinal Health

Cencora / AmerisourceBergen

Charles River Laboratories

CINTAS Corporation

Cipla, Inc.

Clean Harbors, Inc.

Dexcom

Digi International

Dr. Reddy’s Laboratories Ltd.

Ecolab

Embecta

Endo USA

Eurofins Analytics

Fresenius Kabi Group

Grifols

Hikma Pharmaceuticals

ICU Medical

Lakeland Industries, Inc.

Live Oak Bank

Lupin Pharmaceuticals Inc.

McKesson Corporation

Moderna, Inc.

Omnicell

Optum

Oracle Health

Premier

QleanAir Scandinavia

QuidelOrtho Corporation

Scientific Industries, Inc.

The Craneware Group

Thermo Fisher Scientific, Inc.

Trane Technologies

West Pharmaceutical Services, Inc.

Waste Management, Inc.

Wolters Kluwer

Zebra Technologies Corp.

The following 43 companies are Pharmacy500 companies that were

analyzed to identify key market threats and trends within the pharmacy

supply chain. These 43 companies are included because they are publicly

traded with available annual reports.

The “Pharmacy500” are 500 businesses and associations that significantly

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

over the previous year. For Pharmacy500 criteria and details, please visit

www.RXinsider.com/the-pharmacy500.

246

Litigation / Regulatory

Risks

214

Industry / Economic

Risks

Source: RXinsider

557

Company / Operational

Risks

140

General Risks

Financial Risks

Technology

Risks

Market Threat Type Breakout

The following represents the number of market risks identified within

each threat category. These risks have been directly sourced from the

annual reports of all the listed companies.

While some threats may reasonably fit into multiple categories, we

have classified each risk based on how it was specifically categorized

in the respective annual report.

The analysis covers five primary market threat categories: Industry

/ Economic, Company / Operational, Litigation / Regulatory, General

Risk, Financial, and Technology. Of these, Company and Operational

risks accounted for the largest share, with a total of 557 identified

risks.

Market Threat Types

Company / Operational

These risks stem from internal processes, personnel, supply chains, or unique business model aspects.

Operational risks summarize the risks and uncertainties a company faces in conducting its daily business

activities, procedures, and systems.

Industry / Economic

Industry and economic risks refer to broader trends or conditions that could negatively affect a

company’s operations and performance. These can be driven by cyclical industry trends, evolving

market dynamics, and shifts in customer preferences. Economic factors, such as inflation, interest

rates, GDP growth or contraction, and global economic volatility, can materially affect a company’s

profitability and strategic outlook.

General Risk

General risks are broad, non-specific risks that do not neatly fall under other categories. They usually

include unforeseen circumstances or unpredictable externalities. Additionally, general risks often involve

reputational damage, public perception issues, or unforeseen regulatory shifts at a macro level that can

disrupt the status quo and present substantial operational and financial challenges.

Litigation / Regulatory

This covers exposure to legal actions, regulatory investigations, or penalties that could materially affect

financial performance. These risks can emerge from contractual disagreements, intellectual property

challenges, product liability claims, or labor disputes. Regulatory risks encompass potential changes in

laws, industry standards, and government policies that require a company to modify its operations or

face financial or reputational penalties.

Financial

Financial risks are associated with a company’s financial operations, stability, and overall exposure to

market conditions. These include risks from interest rate fluctuations, foreign currency volatility, credit

risks (from counterparties or customers), liquidity issues, or disruptions in capital markets.

Technology

Technology risks involve the reliance on systems and digital infrastructure to support business

activities. This includes exposure to cyberattacks, data breaches, and system outages that can lead

to operational disruptions and reputational harm. As technology evolves rapidly, companies must also

contend with the obsolescence of existing systems, escalating costs of digital transformation, and

challenges in integrating new technologies with legacy infrastructure.

Top 10 Notable Market Threats

Disclaimer: The following is a consolidation of the most frequently

mentioned and notable market threats from the annual reports and are not

presented in any particular order.

1. Industry and Market Consolidation

Industry and market consolidation pose a significant risk to the pharmaceutical distribution, retail, and

logistics sectors. Consolidation increases market concentration among both suppliers and buyers,

reshaping competitive dynamics and potentially leading to margin pressures and weakened negotiating

positions. Companies express deep concerns about these structural shifts, which also amplify existing

competitive threats in the healthcare landscape.

CORE

THEMES

Increased bargaining

power of customers

Market concentration

among suppliers

or buyers

Loss of business to

vertically integrated

competitors

Key Risk Drivers:

• Vertical integration among large players,

reducing reliance on intermediaries

• Consolidation among PBMs and distributors,

boosting their negotiating power

• Emerging competitors leveraging digital health,

AI, and telemedicine

• Pressure to reduce drug prices and improve

value-based outcomes

• Patent expirations impacting revenues

Strategic Implications:

• Margin compression due to intensified price

competition and customer power

• Need for innovation in digital, data-driven, and

patient-centric services

• Acquisition costs for capabilities to remain

competitive

2. Operational Disruption and Third-Party Risk

Operational disruption and third-party/vendor risk threaten the stability and continuity of pharmacy and

healthcare operations. As many companies increasingly rely on outsourced services and third-party

vendors for functions such as distribution, billing, and IT, they face shared liabilities and new compliance

challenges. Any breakdown in these systems can have far-reaching consequences for service reliability,

patient safety, and brand reputation.

CORE

THEMES

IT system failure

Cybersecurity

incidents

Supply chain

disruptions

Key Risk Drivers:

• Vendor breaches that compromise protected

health or financial data

• Logistics failures leading to service disruptions

• Compliance gaps or contractual weaknesses

with partners

• Regulatory constraints on outsourcing and data

handling

• Operational dependencies that amplify third-

party failures

Strategic Implications:

• Loss of customer trust and potential contract

terminations

• Regulatory penalties or investigations linked to

third-party lapses

• Increased burden of due diligence and vendor

monitoring

Natural disasters and

climate-related events

Third-party and

outsourcing

vulnerabilities

CORE

THEMES

Allegations of

antitrust, false claims,

and public nuisance

violations

Government audits

and investigations

Litigation, including

class actions,

intellectual property

disputes, and opioid

lawsuits

Key Risk Drivers:

• Ongoing and emerging government scrutiny

(FDA, DEA, HHS, DOJ)

• Complex and changing regulatory frameworks

(HIPAA, FCPA, state laws)

• Allegations of healthcare fraud, false claims, or

negligence

• Rising litigation in opioid distribution and public

nuisance claims

• Unpredictable legal outcomes that can escalate

exposure

Strategic Implications:

• Loss of licenses or access to key federal

programs (e.g., Medicare/Medicaid)

• Substantial legal and compliance costs that

strain margins

• Long-term reputational damage, eroding

customer and stakeholder trust

• Increased need for rigorous compliance and

risk management frameworks

Data privacy,

cybersecurity, and

HIPAA compliance

Healthcare fraud

and abuse

3. Compliance, Regulatory Scrutiny, and

Litigation Exposure

The evolving and complex regulatory environment in the healthcare and pharmaceutical industries

exposes companies to heightened legal, compliance, and litigation risks. Enforcement agencies and

shifting legal frameworks increase the potential for investigations, audits, and litigation. This scrutiny can

lead to significant financial burdens, reputational damage, and operational disruptions.

CORE

THEMES

4. Cybersecurity and Data Protection

Data is the lifeblood of healthcare operations, encompassing clinical, financial, and personal information.

In an environment where cyber threats are rapidly evolving and adversarial tactics are becoming more

sophisticated, companies face critical risks to their data integrity, service continuity, and compliance

posture.

AI-driven cyber threats

and advanced

phishing campaigns

Breaches of sensitive

patient and

employee data

Key Risk Drivers:

• Escalating ransomware incidents impacting

hospitals, payers, and distributors

• Compliance obligations under HIPAA, GDPR,

and similar frameworks

• Vulnerabilities within vendor ecosystems

• Emerging adversarial AI-based cyber threats

Strategic Implications:

• Regulatory fines and potential class-action

lawsuits for data breaches

• Erosion of trust with patients, customers, and

regulatory bodies

• Rising costs for IT security investments and

insurance premiums

• Need for continuous risk assessments and

vendor security reviews

Weak security

protocols in third-party

vendor networks

Ransomware attacks

on healthcare

systems and supply

chain players

CORE

THEMES

5. Strategic Growth Challenges

Achieving and sustaining strategic growth remains a persistent challenge in the healthcare sector,

intersecting with innovation, M&A activity, and talent retention. While mergers, acquisitions, and

divestitures are central to long-term strategies, they introduce significant financial, legal, and operational

risks that can derail growth initiatives if not managed effectively.

Technology

investments failing

to yield ROI

Risks associated with

business combinations

Key Risk Drivers:

• Overpayment for acquisitions or failure to

realize anticipated synergies

• Culture and leadership misalignments

undermining integration efforts

• Regulatory delays and scrutiny that can stall or

block deals

• Challenges in aligning operations, systems, and

compliance frameworks post-merger

Strategic Implications:

• Missed growth targets, disappointing

stakeholders and investors

• Talent attrition, particularly among acquired

leadership and key teams

• Reversal of deals or costly legal settlements if

integration falters

• Diminished ROI on technology investments and

growth initiatives

Difficulty in retaining

talent and executing

growth strategies

Unsuccessful

integration of

acquisitions

CORE

THEMES

6. Technology and Innovation Risk

As the healthcare sector rapidly embraces digital transformation, technology and innovation risks are

at the forefront of operational and strategic concerns. Companies face growing uncertainty around

software reliability, platform modernization, and the deployment of healthcare technology. Any failures

in these areas can disrupt patient care, compromise data integrity, and weaken competitive positioning.

Challenges in product

development and

deployment

Obsolescence of

existing platforms

Key Risk Drivers:

• IT outages that disrupt logistics, EHR

integrations, and billing workflows

• Subpar software performance in critical clinical

decision-making tools

• Vulnerabilities in legacy systems unable to

support fast-paced growth

• Incompatibilities between acquired systems

post-merger, complicating integration efforts

Strategic Implications:

• Legal exposure from clinical or financial harm

caused by technology failures

• Delays or failures in system migrations,

impacting service delivery and innovation

cycles

• Customer attrition due to poor technology

performance and reliability concerns

Unreliable data

systems or analytics

AI and automation

misalignment

CORE

THEMES

7. Reputation Damage and Product Integrity

Reputation damage is a significant and multifaceted risk in the healthcare and pharmaceutical industries,

often arising from legal, operational, and ethical failures. At the heart of this challenge is product integrity,

which underpins trust across the supply chain and patient care landscape. Any lapse in product quality,

safety, or compliance can quickly escalate into adverse publicity, stakeholder distrust, and long-term

brand erosion.

Product integrity

failures, including

recalls and

counterfeit supply

Lawsuits or product

failures tarnishing

corporate image

Key Risk Drivers:

• Drug recalls stemming from contamination,

expiration, or efficacy issues

• Errors in packaging, labeling, or dosage delivery

• Failures in temperature-controlled logistics

leading to product degradation

• Distribution of counterfeit or unauthorized

medications

• Legal and compliance failures that amplify

reputational vulnerabilities

Strategic Implications:

• Regulatory backlash and intensified oversight

• Loss of product exclusivity or market share,

undermining competitive advantage

• Significant financial and operational costs tied

to product recalls, legal settlements, and brand

rehabilitation

• Erosion of stakeholder and customer trust,

which can take years to rebuild

Negative perceptions of

environmental, social, and

governance (ESG) and

diversity, equity, and

inclusion (DEI)

practices

Adverse publicity and

brand erosion

CORE

THEMES

8. Human Capital and Labor Constraints

Human capital and labor constraints represent a significant risk across the healthcare, logistics, and

technology sectors. As these industries grapple with ongoing workforce challenges—exacerbated by

post-pandemic disruptions—the ability to recruit, retain, and engage skilled professionals has become

mission-critical. Workforce instability can directly impact operational excellence, compliance, and

innovation.

Leadership

succession and

organizational

continuity

Labor shortages in

critical functions

Key Risk Drivers:

• Challenges in hiring and retaining qualified

personnel in competitive markets

• High turnover in compliance-sensitive or

regulated roles

• Legal and reputational exposure tied to DEI

practices and workplace equity

• Leadership gaps and succession challenges

disrupting stability

Strategic Implications:

• Talent shortages can slow innovation, strain

operations, and jeopardize compliance efforts

• Culture erosion during organizational

transformation or post-M&A integration,

undermining morale and performance

• Rising labor costs tied to competitive wages,

training investments, and retention incentives

• Legal and reputational risks if workforce-

related issues escalate into public or regulatory

scrutiny

Employee misconduct

and DEI-related

scrutiny

Inability to attract or

retain key talent

9. Environmental and Climate Risks

Environmental and climate risks are emerging as critical challenges that affect both operational continuity

and long-term sustainability in the healthcare and logistics sectors. These risks are driven by extreme

weather events, climate change impacts on supply chains, and the growing regulatory and stakeholder

pressures to meet sustainability commitments.

Key Risk Drivers:

• Extreme weather disrupting distribution centers

and logistics networks

• Losses of heat-sensitive inventory, especially in

pharmaceutical supply chains

• Regulatory mandates for carbon disclosures,

emissions reductions, and environmental

reporting

• Growing scrutiny from investors, customers,

and other stakeholders regarding sustainability

performance

Strategic Implications:

• Increased operating and compliance costs as

companies adapt to stricter regulations and

rising ESG expectations

• Supply chain interruptions that can delay

product delivery and impact service reliability

• Reputational risks if ESG performance is

perceived as weak or lacking transparency

• Need for climate resilience and sustainable

operations to remain competitive and meet

evolving market expectations

CORE

THEMES

Rising environmental

compliance and

sustainability

demands

Severe weather events

and climate-driven

disruptions

Heightened investor

and customer scrutiny

of ESG policies

10. Financial Uncertainty

Financial uncertainty is a significant and pervasive risk in the healthcare and logistics sectors, driven

by macroeconomic volatility, inflationary pressures, and shifting reimbursement environments. These

challenges have a direct impact on financial performance, operating margins, and overall sustainability.

Key Risk Drivers:

• Inflation and interest rate hikes driving up

capital and operating costs

• Reimbursement rate fluctuations undermining

revenue predictability

• Overreliance on a few large customers or

payers, making financial performance more

vulnerable to payer decisions

• Tax challenges linked to mergers, acquisitions,

or divestitures, potentially introducing

unexpected financial burdens

• Volatile capital markets impacting investment,

expansion, and refinancing strategies

Strategic Implications:

• Margin compression and profitability pressures

requiring disciplined cost management

• Funding constraints that could delay innovation

and growth initiatives

• Heightened financial planning complexity amid

shifting regulatory and market conditions

• Necessity to diversify revenue streams and

manage payer risk to stabilize performance

CORE

THEMES

Negative effects on

operating results and

margins

Adverse impacts on

financial condition

Cost increases and

exposure to

macroeconomic

volatility

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kluwer-2024-annual-report-cd216d4be7?v=7a259453

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zbra-20241231.htm#i6d8a8d5580f441a5b161bf1107019de2_16

Disclaimer

This content has been prepared by RXinsider and is based

on secondary market research and analysis of public

information available or provided to RXinsider, including but

not limited to internal data and other references believed to

be true. While every effort is made to ensure the accuracy

and completeness of the information contained, RXinsider

takes no responsibility and assumes no liability for any error/

omission or accuracy of the information.

Recipients of this material should rely on their own judgments

and conclusions from relevant sources. The information

disclosed in this report is provided for general informational

and educational purposes only and is not a substitute

for professional advice. All information in this report is

provided in good faith, however, we make no representation

or warranty of any kind, express or implied, regarding the

accuracy, adequacy, validity, availability, or completeness of

any information. Under no circumstance shall we have any

liability to you for any loss or damage of any kind incurred as

a result of the use of our report.

The information and analysis herein do not constitute advice

of any kind, are not intended to be used for investment

purposes, and neither RXinsider nor any of its subsidiaries or

their respective officers, directors, shareholders, employees

or agents accept any responsibility or liability with respect

to the use of or reliance on any information or analysis

contained in this document.

This work is copyrighted by RXinsider and may not be

published, transmitted, broadcast, copied, reproduced, or

reprinted in whole or in part without the explicit written

permission of RXinsider.

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

Coldkeepers

ComCo Systems

CompleteRx

ConsortiEX Inc.

Containment Technologies Group, Inc.

Contec, Inc.

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