Top 10 CROs to Watch in 2023

The global contract research organization (CRO) services market, estimated to be US$68.3 billion in 2022, is projected to grow at a compound annual growth rate (CAGR) of 11.0% to reach US$115.1 billion in 2027. Key drivers include the growing investment in pharmaceutical research and development (R&D), the number of clinical trials, drugs, and biologics market despite the COVID-19 pandemic, demand for specialized testing services among end users, and the need for novel clinical trial designs for complex cell and gene therapies. The high cost of in-house drug development has also resulted in biopharma companies increasingly choosing to outsource to CROs. In 2021, North America was the largest market worldwide.

Market Dynamics

An analysis of the global CRO services market highlighted the trend of major pharmaceutical companies improving R&D efficiencies through increased R&D spending and collaborative R&D efforts. The list of CROs featured here are poised to deliver research services outsourced by biopharma companies. There has been growth in the drugs and biologics market, opening up more opportunities for CROs to provide more modern services. A significant challenge for the market is the shortage of skilled professionals for clinical trials, especially clinical trial associates (CTAs) and clinical research associates (CRAs). Vial, one of the CROs featured on this list, has developed its technology platform with this in mind and has proven to empower its CRAs with streamlined productivity-enabling workflows and full visibility to all sites at every level for improved performance. Below is a list (in no particular order) of the top 10 CROs to watch in 2023.

Charles River Laboratories International, Inc.

Among the top and largest CROs is Charles River Laboratories, a full-service, non-clinical CRO based in the US. It began operations in 1947 and today has over 110 locations in over 20 countries. Traded on the New York Stock Exchange, it had a total revenue of $3.5 billion in 2021. For the nine months ending Sept 24, 2022, revenue was $2.9 billion, an increase of 9.1% from $2.6 billion in the first nine months of 2021. Charles River Laboratories has completed acquisitions (which contributed 1.7% to consolidated third-quarter revenue growth) to expand its portfolio and broaden its geographic footprint, as well as divestitures in Japan and Sweden which purportedly had the opposite effect and reduced reported revenue growth by 2.1%.

The CRO’s strategy focuses on having an integrated early-stage portfolio, a comprehensive biopharmaceutical manufacturing portfolio, deep scientific expertise, a commitment to animal welfare, superior quality and client support, offering a flexible and customized environment to provide the right solutions, and being a large, global partner. Charles River Laboratories believes that the evolving large biopharma R&D business model will increasingly benefit from its products and services, integrated offerings, and expertise. Signs of success – Charles River Laboratories has entered into strategic commercial relationships with leading global biopharma companies, expanded existing preferred provider agreements with other leading global biopharma companies, and broadened and extended relationships with other research institutions.

CMIC Holdings Co., Ltd.

Among the top CROs in Japan, CMIC Co., Ltd. is a CRO with global reach founded in 1985. Seven years later, it commenced business as the first CRO in Japan. In 2002, CMIC was listed on the Japan Securities Dealers Association Quotation (JASDAQ) Market and subsequently listed on the Second Section of the Tokyo Stock Exchange in 2004. The following year, CMIC was listed on the First Section of the Tokyo Stock Exchange. CMIC offers pharmaceutical solutions, which include its CRO, contract development and manufacturing organization (CDMO), and Market Solutions businesses; and healthcare solutions which include its site support solutions and healthcare revolution businesses. The CMIC Group Network comprises 26 companies with 62 sites worldwide – in Asia, Australia, and the US supported by 7,735 employees.

Compared to FY2021, revenue in FY2022 grew by 26.4% to ¥108,461 million (approx. US$799 million). By business segment, the CRO’s business grew by 15.2% to ¥40,285 million (approx. US$297 million) over the same period. The CRO’s business focus areas include:

  • providing enhanced development support for advanced therapies such as biologics and regenerative medicine
  • digital applications such as decentralized clinical trials (DCTs) and real-world data (RWD)
  • proactively take on nucleic acid medicine projects and global clinical studies (clinical trials in Asia, Japan-US bioanalysis business)
  • business expansion in the US and Asia.


ICON was founded in Dublin, Ireland, in 1990 and is a global provider of drug and device development and commercialization services with a presence in Europe, the US, South America, the Middle East, and Africa. ICON services span the lifecycle of product development and commercialization, serving small local trials as well as large global programs. As of September 30, 2022, ICON employed approximately 41,150 employees in 113 locations in 53 countries. ICON’s year-to-date 2022 revenue (first three quarters) was $5,779.4 million, up 60.6% on prior year adjusted revenue or 65.1% on a constant currency basis.

In 2021, ICON completed the acquisition of PRA, with the combined Group retaining the name ICON. To develop the CRO’s expertise in patient recruitment, ICON established a global clinical research network Accellacare to help patients access innovative treatments and give ICON customers the option of DCTs. ICON is also focused on improving site selection through the use of leading technology to identify patients, assessment of sites based on real data, and the development of capabilities for electronic medical record (EMR) interrogation. In 2020, ICON established a new company, Oncacare Limited, which operates as a specialized oncology site network in the US and EMEA regions to accelerate recruitment and retain patients for oncology trials. ICON deploys digital solutions, including pre-screening, eConsent, learning management, and document tracking and management.

Vial Health Technology Inc.

Founded in 2020, Vial is a global, full-service CRO powered by technology delivering “faster, better, and cheaper clinical trial results.” Vial is on a mission to disrupt the clinical trials industry with next-generation clinical trial management and tech-enabled CRO services. By mid-2022, Vial raised more than $100 million+ in total venture funding and, in November 2022, announced that venture firm General Catalyst has led a $67 million Series B fund of financing for Vial.

Vial’s mission is to raise the clinical research industry to the next level — to be less reliant on pathways and processes which are now defunct — and to mirror the speed and progress that its biopharma partners demand of their innovations in healthcare. Vial has built a team of ClinOps executives from leading CROs and Silicon Valley technology leaders to achieve its mission. To successfully deliver a higher-quality CRO experience, Vial is reimagining the very nature of clinical trials and distinguishing itself by leveraging its technology platform to deliver dramatically faster and more efficient trials for sponsors. The Vial technology platform replaces paper sources in trials, supports productivity-enabling workflows, and is HIPAA, GDPR, and CFR P11 compliant.

Reimagining Clinical Trials. The Vial technology platform integrates trial onboarding, patient enrollment, site communication, and data collection processes into one connected system:

  • Vial Site Startup App enables sites to seamlessly onboard to trials, as evidenced by 90% of sites being onboarded in under 30 days.
  • Vial Technology
    • Vial eSource allows real-time, intuitive data capture with conditional logic and validation built-in, is easy to use, and reduces protocol deviations for sites. eSource enables the shift to Centralized Monitoring and lower-cost geographies resulting in up to 50% cost savings
    • Vial EDC: From the CRA and project manager (PM) perspective, running a complex global trial from the Vial dashboard is made easier as it allows full visibility into all sites at every level and ensures process adherence.
    • Vial eSource Builder has dramatically reduced build times with an approx. 40% reduction in timeline compared to legacy eCRF (electronic case report form) translations and builds; a one-day turnaround of initial, pre-quality assurance build; and two weeks end-to-end build flow timeline.
    • Centralized monitoring has resulted in approx. 20% cost reduction
    • Automation of CRAs/PMs has resulted in approx. 10% cost reduction
  • Fixed-price agreements with no change orders. Vial offers sponsors flat-rate pricing, zero change orders, risk-share on commitments, and accountability on commitments.


Founded in 1982, IQVIA is a leading global provider of advanced analytics, technology solutions, and clinical research services to the combined industries of health information technologies and clinical research. Today, IQVIA is among the top and largest CROs and has approximately 85,000 employees in operations in over 100 countries. Compared to the first nine months of 2021, IQVIA revenue for the same period in 2022 was $10,671 million, an increase of 4.2% on a reported basis and 8.1% at constant currency.

One of the ways IQVIA brings value to its clients is by combining its proprietary information assets with advanced analytics, transformative technology, and domain expertise. IQVIA reports that its collection of healthcare information includes more than 1.2 billion comprehensive, longitudinal, non-identified patient records. Core capabilities include

  • having a healthcare-specific global IT infrastructure
  • providing analytics-driven clinical development
  • cultivating a robust real-world solutions ecosystem
  • developing a growing set of proprietary clinical and commercial applications

IQVIA identified key trends affecting their end markets: growth and innovation in the life sciences industry; growth in R&D; increased complexity in R&D; financial pressures driving the need for increased efficiency; and evolving need to integrate and structure expanding sources of data. IQVIA’s growth strategy includes:

  • continuously innovating by leveraging its information, advanced analytics, transformative technology, and domain expertise
  • building upon client relationships and leveraging its global presence
  • expanding offerings to a broader healthcare marketplace
  • expanding portfolio through strategic acquisition


Labcorp is a leading global life sciences company with diagnostics and drug development capabilities that allow them to provide insights and accelerate innovations in healthcare. It has over 75,000 employees and serves clients in more than 100 countries. Labcorp reported revenue of $16.1 billion in 2021. In the first nine months of 2022, revenue was $11.20 billion, a decrease of 7.1% compared to the first nine months of 2021. Revenue for the third quarter was $3.61 billion, a decrease of (11.2%) from $4.06 billion in the third quarter of 2021. The Clinical Development business grew 8.0% on a CAGR basis from Q2 2019 to Q2 2022.

While the CRO industry has been characterized by increasing mergers and acquisitions (M&As), with 50 M&A deals completed among CROs in 2021, Labcorp announced in July 2022 a planned spin-off of its Clinical Development business. The NewCo will operate as a CRO providing Phase I-IV clinical trial management, market access, and tech solutions to biopharma companies. The rationale for the spin-off is that Labcorp’s laboratory business and clinical development business target different markets and have different capital structure requirements and equipment needs.


Parexel is a global CRO providing clinical development capabilities and integrated consulting expertise, with global study locations in the US, UK, and Germany. One of the largest CROs, Parexel, supports the development of innovative new medicines to improve the health of patients. To expand access to patient populations and increase diversity in clinical trials, Parexel launched its Community Alliance Network in 2022. In collaboration with CVS Health and Javara, the novel program integrates clinical research into the community healthcare setting.

In November 2021, Parexel announced the completion of its acquisition by EQT IX fund and funds managed by the Private Equity business within Goldman Sachs Asset Management for $8.5 billion, with both parties committed to supporting Parexel’s Patients-First focus, track record of clinical excellence and dedication to quality. The newly-appointed Board of Directors brings vast experience across life sciences, digital transformation, and innovation. The Parexel leadership team and our more than 18,000 colleagues around the world remain united in our Patients-First focus and mission of advancing world health, and we’re excited about this next phase of the journey,” said Jamie Macdonald, CEO of Parexel.


PPD was established as a one-person consulting firm in 1985 and has since conducted clinical trials in more than 100 countries. Today, PPD has over 30,000 employees globally and is a leading global CRO providing comprehensive, integrated drug development, laboratory, and lifecycle management services. For the nine months ending September 30, 2021, PPD revenue increased 36.1% to $4,514.6 million compared to the nine months ending September 30, 2020. Of total revenue, the Clinical Development Services share was $3,688.2 million, and Laboratory Services was $826.4 million. In December of the same year, PPD was acquired by Thermo Fisher Scientific for $17.4 billion.

PPD’s competitive strengths include providing differentiated clinical development services and comprehensive laboratory services, having a large and growing diversified customer base, and being an experienced, highly technical organization with a culture of excellence and industry-leading retention. Key elements of the PPD growth strategy include further strengthening its offerings in existing and new markets, expanding therapeutic expertise in existing and novel areas, increasing the use of its innovative site network and patient enrollment platform, capitalizing on its laboratory segment, and investing in innovation.

Syneos Health

Formed through a merger between INC Research and inVentiv Health, Syneos Health is a global biopharmaceutical solutions organization that includes a CRO and a Contract Commercial Organization (CCO). Its business model was designed to accelerate customer success by strategically blending clinical development, medical affairs, and commercial capabilities. Syneos Health has a team of over 29,000 supporting operations in more than 110 countries. For the first nine months of 2022, revenue was $4,033.2 million, an increase of 5.0% on a reported basis and 7.2% on a constant currency basis for the same period in 2021. Corresponding figures for the Clinical Solutions segment revenue was $3,047.3 million, increasing 2.5% on a reported basis and 4.8% on a constant currency basis.

In October 2022, Syneos Health announced its expanded partnership with Datavant to develop advanced analytics and AI-driven technologies to increase the efficiency of clinical trials, and improve the experience for patients, sites, and biopharma customers. The collaboration with Datavant also seeks to further empower health economics and outcomes research (HEOR), medical affairs, market access, and commercial analytics for clients. Emphasis is placed on evidence continuity across the product lifecycle – including late-phase studies, RWD sources for clinical development, HEOR, and commercial analytics – towards creating an integrated evidence-generation plan.

WuXi AppTec

WuXi PharmaTech was founded in China in 2000, and upon acquiring US-based AppTec Laboratory Services in 2008, WuXi AppTec was formed. Today, it is a global company with 45,000 employees and operations in Asia, Europe, and North America, providing R&D and manufacturing services to global pharmaceutical, biotech, and medical device industries. These services include CRDMO (Contract Research, Development, and Manufacturing Organization), biology discovery, preclinical testing and clinical research services, and cell and gene therapies CTDMO (Contract Testing, Development, and Manufacturing Organization). WuXi AppTec’s open-access platform connects more than 5,900 customers from over 30 countries to realize its vision: “Every drug can be made, and every disease can be treated.”

For the first nine months of 2022, the CRO’s revenue grew 71.9% year-over-year to RMB28,395 million (approximately US$4.04 billion). During the same period, revenue from the top 20 global pharmaceutical companies grew by 175% to RMB12,918 million (approx. US$1.83 Billion). By region, revenue from customers based in

  • US grew 110% to RMB18,991 million (approx. US$2.7 billion)
  • Europe grew by 21% to RMB2,897 million (approx. US$412 million)
  • China grew by 30% to RMB5,318 million (approx. US$757 million)
  • other regions grew by 22% to RMB1,188 million (approx. US$169 million.

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