Three companies—McKesson, Cencora (formerly AmerisourceBergen), and Cardinal Health—control 98 percent of the drug wholesaler market, but they’ve demonstrated ambitions to evolve beyond their roles as pharmaceutical middlemen. In their quests for vertical integration, each company now owns a generic manufacturer, a group purchasing organization, a retail pharmacy chain, and a variety of provider groups. Oncologists have become subjects of a recent wholesaler bidding war, with the “Big Three” having spent a collective $5.7B acquiring large groups in the last two years. While there are specific interplays between wholesalers and oncologists—e.g. capturing more margin from drug administration, monetizing direct referrals, enabling value-based care contracts with accountable are organizations—this phenomenon exemplifies more broadly the progressive fragmentation of care delivery. Payers, pharmacies, retailers, and even ambulatory surgery center operators have spent billions over the last decade building care delivery businesses in pursuit of controlling greater shares of a patient’s care journey. For patients, this manifests as an overwhelming menu of siloed channels serving individual needs, in contrast to the omnichannel offerings of health systems. For providers folded into these vertically integrated organizations, the much-needed capital infusions can come at the cost of mission misalignment and inexperienced management. As best evidenced by Walgreens’ potential divestment of VillageMD, these companies can lack the strategic and operational expertise required to capitalize on the theoretical value of these transactions. Compared to retailers, the wholesalers have more experience with managing physician assets and stronger connections to their core business; however, the bidding war for physician talent could still turn out to be a bubble if enough high-profile acquisitions end up as flops.