It looks like Pipenv does not handle the python install itself or associated non-python libraries. With Conda I can tell it to install Python 3.6 along with FreeTDS (for mssql). Conda lets me do this in one environment.yml file and have it work cross platform. Separate homebrew or apt-get steps are no longer necessary.
That said pipenv still looks awesome. Any improvement to the python packaging world is welcome gift.