The Honolulu healthcare market continues to be driven by the insurer powerhouse, Hawaii Medical Service Association (Blue Cross and Blue Shield of Hawaii). This payer drives reform without significant competition, reimbursing primary care providers a capitated rate under the carrier’s M?hie 2020 initiative in a market that heavily favors generic drugs, thereby hindering pharma’s ability to make significant revenue off branded and specialty products. Honolulu’s large health systems have expanded their primary and urgent care footprints despite the drastic interruption to services created by the novel coronavirus pandemic. The Queen’s Health Systems, Hawaii Pacific Health and Kaiser Permanente Hawaii have all undergone mass vaccination efforts as part of a broader overall initiative to return the community to a sense of normalcy. Oncology services are poised to receive a significant upgrade as the Hoola project, which involves the creation of the state’s only Early Phase Clinical Research Center, is slated for completion later in 2021.