What to Know
- Major wholesalers are expanding into practice management, reshaping buy-and-bill economics through vertical integration.
- Recent MSO acquisitions by Cencora, Cardinal Health, and McKesson signal a structural shift in market access, competition, and control.
- Wholesaler-owned MSOs can influence contracting, reimbursement navigation, payer leverage, and practice-level inventory decisions.
- Physicians need independent partners—like Remedy GPO—to preserve purchasing power, transparency, and clinical autonomy.
- The future of buy-and-bill will be defined by consolidation, scale, and new hybrid market-access models.
The New Reality: Wholesalers Are Moving Upstream
The buy-and-bill ecosystem is undergoing its most dramatic shift in a decade. Historically, pharmaceutical wholesalers served as distributors: moving product, securing channel inventory, and providing basic access support.
Today, they are rapidly integrating upstream into physician practices through large-scale acquisitions of management services organizations (MSOs).
These new structures allow wholesalers to influence:
- Product access
- Contracting
- Pricing dynamics
- Payer engagement
- Clinical operations that affect utilization
This vertical expansion is not subtle. It is strategic, aggressive, and reshaping the balance of power in specialty care.
Recent Multi-Billion-Dollar Acquisitions
The top three wholesalers have invested heavily to secure direct control over the physician-facing side of the supply chain in recent years:
- Cencora (formerly AmerisourceBergen) — expanded its footprint with MSO acquisitions that embed distribution strategy directly into practice operations.
- Cardinal Health — strengthened its specialty solutions infrastructure to influence medical benefit drug use at the point of care.
- McKesson — deepened ties with oncology, rheumatology, and ophthalmology practices through integrated service platforms.
These moves position wholesalers not just as distributors but as operators, payer negotiators, and market-access drivers.
What Vertical Integration Means for Buy-and-Bill Practices
Vertical integration alters incentives across the specialty landscape and reshapes specialty drug economics, directly affecting independent practices.
While wholesalers aim for efficiency, the consolidation introduces new challenges for independent practices and provider networks.
1. Expanded Control Over Market Access
Wholesalers that own MSOs hold greater influence over:
- Which products are stocked
- Contracting pathways
- Utilization management workflows
- Cost containment or margin protection strategies
This control can shape a practice’s treatment patterns, often aligning them with wholesaler profit priorities rather than clinical autonomy.
2. Contracting Becomes Less Transparent
Traditional buy-and-bill operates on:
- Clear unit pricing
- Rebates
- Predictable ASP-linked margins
With vertically integrated structures, however, contracting may become:
- More opaque
- Bundled into broader service agreements
- Influenced by MSO-specific utilization pathways
- Providers may gain convenience, but often lose visibility, negotiation leverage, and independent choice.
3. Reimbursement Navigation Shifts
Wholesaler-owned MSOs can take over:
- Benefit verification
- Prior authorization
- Denial management
- White-bagging vs. brown-bagging decisions
This gives wholesalers the ability to influence reimbursement outcomes and steer practice reliance toward their integrated services.
4. Inventory and Cash Flow Dynamics Change
As wholesalers gain control of inventory decisions:
- Days-on-hand may decrease
- Contracted items may shift
- Practice-level cash flow becomes tighter
- Drug mix may align with wholesaler-owned data models
These shifts create structural pressures that can threaten the stability of smaller or independent specialty practices.
Limited visibility into pricing, restricted autonomy over biosimilar adoption, and tighter inventory controls reduce a practice’s ability to optimize buy-and-bill margins.
As operational leverage shifts toward the wholesaler, independent practices may struggle to maintain predictable revenue cycles, sustain competitive purchasing power, or respond to reimbursement volatility.
In many cases, this dynamic accelerates consolidation, forcing practices into vertically integrated MSO arrangements they may not have otherwise chosen.
Why Remedy GPO Matters in a Consolidated Market
Amid accelerating market-access consolidation, practices are seeking partners that preserve autonomy without sacrificing access or efficiency.
Remedy GPO fills this gap by offering an independent, physician-aligned structure that protects clinical decision-making while maximizing buy-and-bill performance.
How Remedy GPO Supports Practices
In this environment, practices require a counterbalance, an independent ally that protects their autonomy while strengthening their economic position.
That’s where Remedy GPO steps in, offering clarity and independence through:
- Transparent contracting with clear pricing and predictable economics.
- Vendor-agnostic advocacy that protects practices from wholesaler-driven utilization pressures.
- Strengthened negotiating power through aggregated volume and market expertise.
- Operational support that enhances reimbursement success without embedding control into practice ownership.
- Market access insights that help practices navigate wholesaler consolidation, payer policies, and emerging reimbursement models.
In short, Remedy GPO ensures physicians stay in control, even as wholesalers reshape the field.
The Future: Hybrid Access Models Will Define the Modern Buy-and-Bill Ecosystem
As wholesalers continue to acquire MSOs, the ecosystem will evolve into hybrid models where:
- Distribution
- Reimbursement technology
- Data analytics
- Practice management
- Payer negotiation
…operate under consolidated umbrellas.
This structure favors large organizations but poses significant risks for independent practices that rely on fair contracting, transparent pricing, and genuine clinical autonomy.
In this environment, independent GPOs become essential counterweights that restore balance across the market.
Remedy GPO’s expertise and vendor-agnostic neutrality position it as a vital safeguard for provider practices navigating consolidation pressures.
Strategic Takeaways for Today’s Buy-and-Bill Landscape
Vertical integration is accelerating, and the major wholesalers are setting new rules for market access, pricing, and operational control in the buy-and-bill space.
Independent practices need equally strong partners to maintain transparency, negotiate competitively, and protect clinical choice.
Remedy GPO remains committed to defending provider interests and giving practices the purchasing power and clarity they need to thrive in a rapidly consolidating market.
FAQ: Vertical Integration & Buy-and-Bill
1. What is vertical integration in buy-and-bill?
Vertical integration occurs when wholesalers acquire or operate MSOs, giving them direct influence over practice management, reimbursement workflows, and product access.
2. How do wholesaler MSO acquisitions affect physician practices?
When wholesalers acquire MSOs, they shift control upstream, influencing contracting, drug utilization, reimbursement navigation, and operational decision-making.
3. Why are Cencora, Cardinal Health, and McKesson acquiring MSOs?
The major wholesalers are investing heavily in acquiring MSOs to control more of the supply chain—distribution, data, practice operations, and payer interactions —creating a vertically integrated market-access ecosystem that strongly favors them.
4. What risks does vertical integration pose for providers?
Vertical integration poses significant risks to independent providers by reducing transparency, diminishing negotiation power, tightening inventory control, and potentially restricting clinical autonomy.
5. How can practices protect independence in a consolidated market?
The best way for independent practices to protect themselves is by partnering with independent organizations like Remedy GPO, which provide transparent contracting, unbiased advocacy, and operational support.
6. Why is Remedy GPO’s independence important?
It ensures practices maintain control over pricing decisions, product selection, and clinical workflows, without being influenced by wholesalers.
