Key Takeaways:
· Specialty drugs now represent more than half of total pharmaceutical spending in the United States.
· The challenge extends beyond the number of new drugs entering the market to the unique requirements associated with each therapy.
· Technology investments continue to shape the future of specialty pharmaceutical distribution, with distributors prioritizing automation, compliance, and operational efficiency.
Specialty pharmaceuticals continue to command a growing share of U.S. drug spending, reinforcing their central role in the healthcare system and placing new demands on distribution infrastructure. According to the 17th edition of Specialty Pharmaceutical Distribution: Facts, Figures, and Trends, specialty drugs now represent more than half of total pharmaceutical spending in the United States.
“It’s clear that specialty pharma continues to grow and now represents more than half of total pharmaceutical spending in the U.S., reinforcing its central role in our healthcare system,” says Perry Fri, President, HDA Research Foundation.
The updated data are based upon a survey of HDA-member specialty distributors conducted between January and April 2025. This report also includes updated IQVIA pharmaceutical sales figures for 2020–2024. New to the process this year, the Foundation conducted secondary research and in-depth interviews with specialty pharmaceutical manufacturers and distributors to examine the implications of changes to the specialty pharmaceutical pipeline.
What Defines Specialty Pharmaceutical Distribution
Specialty pharmaceuticals are typically high-cost therapies used to treat chronic, complex, or rare diseases. These products frequently demand unique handling, storage, and administration requirements.
“They typically require long-term use and specialized clinical oversight and infrastructure,” says Fri.
While many distributors are capable of handling specialty drugs, Perry notes that specialty pharmaceutical distributors distinguish themselves through their exclusive focus on these products and related services.
“Their customer base is primarily independent practices and specialist physician offices, physician- and hospital-owned clinics, specialty pharmacies, home healthcare providers, and some hospital pharmacies,” he says.
Scale, Reach, and Performance
According to IQVIA, specialty medicine sales rose 12% from 2023 to $417 billion in 2024, surpassing traditional drugs for the third consecutive year. Rising specialty drug spending was led by the immunology and oncology therapeutic areas, which together accounted for 70% of total growth.
“The benchmark study shows the expanding footprint and efficiency of specialty distributors,” says Fri.
Collectively, they now serve nearly 33,000 unique provider locations, fill approximately 4,900 orders each day, and maintain a fill rate above 99%.
Rising Complexity Drives Early Planning
Beyond growth, the 2025 report takes a deeper look at the increasing complexity of specialty distribution. The challenge extends beyond the number of new drugs entering the market to the unique requirements associated with each therapy.
“It’s not just the number of new drugs,” says Fri. “It’s the uniqueness of each new drug in terms of how it’s handled, stored, how it’s administered, the points of care, and more.”
With more complexity required, it comes to no surprise that interviews with industry stakeholders revealed strong demand for earlier and more customized launch planning—often beginning as early as Phase II of drug development.
“One of the best statements I heard during the advisory board discussions was that every new product launch means building a unique new supply chain,” says Fri. “We’re not just dumping products into an existing supply chain.”
Cold Chain Becomes the Norm
As specialty therapies become more advanced, cold chain requirements are increasingly common across the category.
“The bulk of specialty medicines typically need some sort of special handling,” Fri explains. “In different temperature ranges, most require cold chain or specialized handling.”
These requirements are driving investments in cold chain and cryogenic capacity, as well as expanded monitoring systems to maintain product integrity.
Preparing for Growth Through Investment
With the volume of advanced and ultra-specialty therapies expected to continue rising, distributors are actively investing in infrastructure and workforce development.
“They’re investing,” says Fri. “Cold chain capacity gaps do exist, and distributors are working to expand infrastructure, including facilities, equipment, and monitoring systems.”
He emphasized that labor is just as critical as physical infrastructure. “Don’t underestimate the need for specialized labor. The unique storing, handling, and transportation of these products are going to require a highly trained workforce.”
Narrow Launches, Broader Access Over Time
The report also notes that while distribution networks may remain narrow at launch, patient access ultimately depends on broader provider participation as therapies mature.
“The initial indications for a medicine may be very focused on a particular disease or therapy type,” says Fri. “Over time, manufacturers may learn they can expand that to other patients.”
As those expansions occur, distributors and wholesalers play a key role in reaching additional provider categories and patient populations.
What Manufacturers Look for in Distribution Partners
While manufacturers evaluate a range of performance metrics when selecting distribution partners, Fri says the most important factors tend to align with reliability and reach.
“The metrics that matter most tend to align with the manufacturer’s need for competence, consistency, and reach,” he says. “That means, can the distributor reliably ensure product availability and reach the intended patient population?”
Maintaining appropriate inventory levels, he adds, is fundamental to meeting those expectations.
Sustainability Gains Momentum
Sustainability is emerging as a growing area of focus in specialty distribution, particularly around cold chain packaging. While maintaining temperature control remains non-negotiable, distributors are taking steps to reduce waste where possible. But Fri notes that sustainability is an ongoing discussion- and it’s tricky as it’s expensive and limited. But companies are making smart choices in how they invest.
“Our survey data indicates that distributors are trying to take tangible steps,” says Fri. “Seventy-five percent reported reusing their insulated boxes, and 50 percent reported reusing their ice packs.”
He notes that sustainability requirements in Europe may eventually influence expectations and reporting standards in the U.S. “It’ll be interesting to see how any of that reporting from a European standpoint bleeds into relationships and requirements here.”
Technology as an Efficiency Enabler
Technology investments continue to shape the future of specialty pharmaceutical distribution, with distributors prioritizing automation, compliance, and operational efficiency.
“Specialty distributors are increasingly prioritizing their technology investments because those investments can directly strengthen internal operations and external partner relationships,” says Fri.
Beyond efficiency, technology plays a critical role in maintaining consistent, high-quality communication with providers and manufacturers. It reinforces collaboration and reliability across the supply chain.
