Health system infusion strategy: closing the gap between a $20 billion market and untapped program potential

The U.S. home infusion therapy market is approaching $20 billion and growing at 7-8% annually.¹ More than 60% of drugs currently in development are infusion-delivered therapies. ² For health systems, the opportunity to build or expand infusion programs is significant and continuing to grow.

Yet according to the Pharmacy Outlook 2026 survey, adoption has not kept pace with the market opportunity.

The Pharmacy Outlook 2026, a proprietary benchmarking survey of more than 100 health system pharmacy leaders conducted by Accelerate Pharmacy Solutions, found that 82% of respondents manage 25% or fewer of their infusion patients at home. Nearly two out of three do not have a home infusion program at all. Meanwhile, health systems that have built home infusion programs report an average of $20 million in annual revenue from those services.

The gap between market potential and program adoption is not driven by a lack of awareness. Most pharmacy leaders recognize the opportunity. The challenge is operational: standing up or scaling an infusion program when the barriers are real and institutional resources are already committed elsewhere.

Several converging market developments are creating both urgency and competitive risk for health systems without a defined infusion strategy.

Major national home infusion providers have scaled back operations, creating gaps in patient access and referral continuity. Commercial payer site-of-care programs continue to expand, increasing the share of infusions delivered in ambulatory and home settings rather than hospital outpatient departments. Private equity-backed infusion centers are growing their presence in markets traditionally served by health systems, adding competitive pressure for specialty infusion volume. The pipeline of infusible specialty medications continues to grow, with industry analysts projecting that specialty drugs will account for more than half of all drug spending within the next few years.³

Health systems lacking a clear infusion strategy for home, infusion suites, and centers are finding it harder to keep infusion volume and revenue amid shifting markets. Organizations investing in diversified infusion infrastructure now will be better positioned as the competitive landscape continues to evolve.

The Pharmacy Outlook data points to three operational challenges that consistently prevent health systems from capturing available infusion revenue.

Infusion referrals often fall through operational gaps before treatment begins. When intake workflows are fragmented and routing to the appropriate site of care is inconsistent, the consequences are measurable: delayed time-to-therapy, increased denial risk, and lost revenue that is difficult to recover after the fact. The Pharmacy Outlook found that complex payer requirements are the top revenue cycle challenge reported by health systems, followed by lack of visibility into rebilling opportunities and denials due to coding errors. Most organizations focus revenue cycle attention on billing and collections, but in infusion, the upstream process matters more. Referral intake, prior authorization, payer-specific documentation, and site-of-care routing decisions are where revenue is protected or lost.

Health systems evaluating ambulatory or home infusion expansion frequently cite accreditation as a barrier. Developing clinical protocols, establishing quality programs, and meeting regulatory standards require specialized expertise that most organizations do not have in-house. As a result, infusion program development is often deprioritized, even when the financial case supports investment. In practice, organizations that pursue accreditation with a structured approach and specialized guidance can navigate the process more efficiently. Accreditation is a critical step toward payer access and the quality infrastructure required to sustain a program over time.

In many health systems, no single team owns infusion services end-to-end. Pharmacy, nursing, revenue cycle, and managed care each manage a portion of the workflow without visibility into the whole. This fragmentation makes it difficult to identify where revenue is being lost or where process improvements would have the greatest financial impact. As commercial payer site-of-care policies continue to redirect treatments out of hospital outpatient departments, the cost of operating without enterprise-level visibility into infusion performance is increasing.

Health systems that have successfully built or expanded infusion programs tend to share several operational characteristics. They begin with a data-driven assessment of their market opportunity, including referral leakage analysis, before committing capital or operational resources. They address referral capture and patient navigation early in the process rather than focusing exclusively on downstream billing optimization. They establish a disciplined site-of-care routing approach that accounts for clinical need, payer requirements, and financial impact. And they treat infusion as a cross-functional service line spanning home, ambulatory, and hospital-based settings rather than managing it as a pharmacy-only initiative.

The Pharmacy Outlook data indicates that adoption is accelerating. One in four health systems without a home infusion program today report that they are likely to launch one within three years, with integrated delivery networks leading in adoption rates.

For organizations evaluating their options, a comprehensive assessment of the infusion opportunity specific to the local market, patient population, and payer mix is typically the most productive starting point. Quantifying the opportunity in concrete financial terms is often what shifts the internal conversation from exploration to execution.