Specialty pharmacy is losing some of its sizzle. Go-go growth and a vibrant M&A market look like distant memories. Fewer new specialty pharmacies are starting up, the two biggest companies have been acquired, and market share continues to concentrate with the PBM-owned specialty pharmacies. There were 10 specialty pharmacy transactions in 2019, compared with 20 transactions in 2016. The slowdown is due partly to a decline in activity by serial acquirers. Many of these companies have slowed acquisition activity (e.g., Walgreens) or been acquired themselves (e.g., Diplomat Pharmacy). The challenges facing smaller pharmacies over the past few years have also limited the supply of viable acquisition targets of sufficient scale.