A new competitive landscape is emerging in pharmacy. Organizations that treat pharmacy services as a strategic asset rather than downstream function will break away from the pack. Here are 10 predictions that we believe will reshape pharmacy specifically and healthcare broadly in 2026 and beyond. We also lay out the strategic implications for leaders to act on.
1. Transparent PBMs spark a new era of competition
Momentum around transparent pharmacy benefit managers (PBMs) will accelerate. Although most large health plans will remain in legacy contracts, a wave of net-cost performance growth and carve-outs will emerge in 2026, capturing the attention of forward-thinking payers. Platforms using application programming interfaces (APIs) and data analytics vendors will lead the way in separating administrative and dispensing functions, laying the groundwork for a structurally different PBM model. Of course, regulatory scrutiny will continue to grow.
Market implications: Private equity and strategic capital will gravitate to specialist PBMs, API infrastructures, and support services that remove friction from switching and enable cleaner, more auditable negotiations.
2. 340B turbulence spurs market uncertainty
Proposed regulatory changes, rebate-based pilot programs, changes, manufacturer restrictions, and new compliance standards are already reshaping how health systems manage 340B economics. The One Big Beautiful Bill Act adds another layer of complexity due to a predicted drop in Medicaid enrollment. As a result, health systems may see Medicaid patient volume decline, putting their 340B eligibility at risk. This sits alongside new operational complexity, as covered entities adapt to manufacturer platforms and variable reimbursement. Payers are also watching carefully as health systems actively redesign outpatient pharmacy strategies.
Market implications: For many organizations, exposure to 340B changes is the single biggest swing factor in their financial outlook for 2026 and beyond. Growth continues in compliance, “340B-as-a-service,” and governance platforms supported by artificial intelligence (AI). Merger and acquisition activity among vendors will help participants gain visibility and resilience. Manufacturers invest in contracting tools built for rebate-first dynamics.
3. Health systems step into expanding pharmacy deserts
The retail pharmacy landscape looks drastically different from a decade ago. Rite Aid is gone. Walgreens and CVS are closing stores. Independent pharmacies are dwindling, and grocers are questioning their own role in the space as margins shrink and reimbursement contracts. What remains is a widening map of pharmacy deserts — urban and rural alike — and a growing gap in medication access and continuity of care. Health systems will step up even more in 2026, seeing both an obligation and opportunity. They’ll eye pharmacy-only sites with smaller, leaner footprints and hub-and-spoke or mail-service fulfillment. These models focus on clinical impact and medication access, not retail goods. By leveraging integrated data and payer alignment, health systems can deliver pharmacy services locally where legacy models fail.
Market implications: Expect health-system–backed retail footprints, co-located infusion or urgent care nodes, and new joint ventures with grocers or real estate players seeking stable anchor tenants. Sanford Health and Lewis Drug is an example of this evolution.
4. GLP-1s redefine the boundaries of metabolic care
Breakthroughs in clinical research and data collection, expanding indications into neuroprotection and cardiometabolic prevention, amplified patient demand, and late-stage oral indication trials will push GLP-1 utilization to new levels in 2026. But coverage will remain uneven, creating a paradox: rapid clinical expansion paired with system-wide affordability strain. Digital engagement tools will become more prevalent in hopes of maximizing value and managing costs.
Market implications: Expect explosive growth in manufacturing capacity, cold-chain logistics, and physician-direct distribution models. Pressure mounts for new economic frameworks — subscription pricing, outcomes-based reimbursement, or payer carve-outs — to keep the system solvent as demand races ahead of affordability.
5. Pharmaceutical companies grow their direct-to-consumer channels
Direct-to-consumer channels will shift from small pilots to branded storefronts that are scaled for specific chronic conditions and specialty areas. Still, don’t expect the middleman to become obsolete in 2026 since these models still require a valid prescription and often interface with a patient’s health plan. Instead, the platforms will shine a light on what’s possible: seamless digital access, richer adherence insights, and branded patient experiences. With a direct line of sight into patient behaviors, drugmakers can deploy engagement, support, and even fulfillment offerings, with data loops that improve outcomes and loyalty. For payers and PBMs, this means new competitive dynamics and more informed patients, but not disintermediation. Market implications: The digital buildout by pharmaceutical companies is driving M&A in last-mile logistics, adherence analytics, customer relationship management, and patient support programs. The biggest impact in 2026 will be a wave of innovation and transparency that exposes long-standing frictions and creates pressure for the larger system to adapt.
6. Infusion care prepares for growth wave beyond 2026
Payers are pushing high-cost infusions out of hospitals, driving growth in community- and home-based infusion. National networks will continue their expansion in 2026, shaping a more connected and accessible ecosystem. Meanwhile, a second wave of technology-enabled entrants is orchestrating the logistics of home infusion — managing scheduling, nurse dispatch, payer integration, and vitals monitoring through unified digital platforms. Advances in biologic stability, cold-chain handling, and remote patient monitoring are increasing both the safety and clinical viability of home-based infusion.
Market implications: Expect infusion network roll-ups, remote-nursing platforms, and home-based orchestration platforms to dominate private-equity and growth-stage pipelines. The players who can make home infusion predictable, billable, and safe at scale will define the next decade of specialty care delivery.
7. Biosimilars tip the scale as prices drop, and new dynamics emerge
With more than 40 biosimilars competing across specialties, 2026 will mark a dramatic step-down in unit pricing. Formularies are being rebuilt around net cost and supply reliability, shifting leverage toward distributors and group purchasing organizations (GPOs) while challenging legacy rebate economics. Hospitals and health systems are adapting to a proliferation of stock keeping units and procurement volatility. As adoption of biosimilars expands, real value will flow to players with the scale and precision to contract, forecast, and distribute efficiently, ushering in new rules for pharmacy economics, even if the system isn’t fully rewritten yet.
Market implications: Expect acceleration in biosimilar supply-chain platforms, AI-driven contracting and forecasting tools, and white-label commercialization networks. The next generation of pharmacy economics will be written organizations that can spur integration across multiple players.
8. Pharmacy becomes a data business
New Centers for Medicare and Medicaid Services interoperability and prior authorization rules are forcing payers and PBMs to open up formulary and claims data via APIs, breaking down long-standing information silos. This is enabling data-driven companies to optimize formularies, streamline prior authorization, and support smarter adherence interventions. For many organizations, future profit centers will focus on converting data into actionable insights; those that standardize, integrate, and interpret these new streams of information will be poised to shape pharmacy’s next decade.
Market implications: Strong growth is expected in AI data orchestration platforms, API-first prior authorization automation, and pharmacy data marketplaces. The most successful players are creating tools that improve coordination, transparency, and decision support across the pharmacy value chain.
9. The great pharmacy value chain land grab
Margin collapse will fuel a rewiring of the value chain around data, distribution, and demand integration. The result is a land grab with wholesalers moving downstream into last-mile fulfillment and specialty pharmacy; payers and health systems buying or building specialty, infusion, and pharmacy assets to control total cost of care; private equity betting that regional transparency players can scale into viable national competitors. Also, manufacturers will quietly acquire data, distribution, and patient-access capabilities to protect margin and own the consumer relationship.
Market implications: PBMs, payers, wholesalers, and providers continue to integrate more deeply across the value chain. Expect a surge of mid-market M&A in PBMs, specialty pharmacies, and technology-enabled logistics platforms. Premium valuations will accrue to players who unify access, economics, and execution in one ecosystem.
10. Pharmacists accelerate path to becoming frontline clinicians and redefine their clinical role
The scope of practice and role of the pharmacist continue to expand in 2026 as they assume greater roles in chronic disease management, medication-to-bed transitions, preventive screenings in areas like hypertension and diabetes, and pain management. Across dozens of states, new protocols and scope expansions will support these roles and be enabled by advanced digital tools and workflow integration into system-wide care pathways. Retail pharmacists are well positioned to manage more complex therapies, drive clinical protocols, and are increasingly relied upon to address primary care shortages and elevate longitudinal care, but must balance business model challenges with expanded activity and responsibility.
Market implications: Enablement platforms, AI-driven documentation, and clinical workflow solutions targeting pharmacists will be hot investment themes. Major players will target infrastructure to help pharmacists operate at the top of their license within collaborative care team models, pointing toward a future where pharmacy becomes a primary touchpoint for ongoing patient health.
Kim Babbin, Dale Brown, Zhe Yu, Irene Wei, Sean Mcauliffe and Reilly Baggs contributed to this article.