Analysis

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.

Click here to see the original post from March 2025.

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Three’s still company in the world of pharmacy benefit managers.

For 2024, nearly 80% of all equivalent prescription claims were processed by three familiar companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. The names haven’t changed, but shifting relationships and contract shakeups have altered the plot, with Express Scripts stepping into a new lead role.

Below, we break down the latest market share data from Drug Channels Institute (DCI), explore the developments driving these changes, and examine what they signal for the future of the PBM landscape.

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.

Click here to see the original post from March 2025.

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Next week, Drug Channels Institute (DCI) will release our 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 16th edition of our popular and comprehensive examination of the entire U.S. drug pricing, reimbursement, and dispensing system.

For 2024, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $683 billion, up 9% from the 2023 figure. GLP-1 agonist drugs remained the most significant driver of prescription revenue at retail pharmacies, accounting for more than 80% of dispensing revenue growth for 2024.

The table below—one of 268 in our new report—cues up DCI's first look at the 15 largest organizations that battled for those revenues. For a sneak peek at the complete report, click here to download our free 30-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits).

Today’s guest post comes from Sean Wagner, VP of Client Partnerships and Carolyn Zele, Advisor, Solution Consulting at MMIT.

Sean and Carolyn argue that planning for a successful drug launch must begin early—often well before Phase III. In this article, they present a six-step framework to help manufacturers align clinical development with payer expectations, patient needs, and real-world access dynamics.

To learn more, view their latest webinar: Meet the Expert: Developing Your Commercial Strategy in Phases II-III.

Read on for Sean and Carolyn’s insights.

The 340B Drug Pricing Program has emerged as a growing source of profits for pharmacies and pharmacy benefit managers (PBMs).

Drug Channels Institute’s latest exclusive analysis of the 2025 market reveals a highly concentrated market structure increasingly dominated by a handful of major players:

• About 32,000 pharmacy locations—nearly 60% of the entire U.S. pharmacy industry—function as contract pharmacies for the hospitals and federal grantees that participate in the 340B program.

• The 340B contract pharmacy has become increasingly concentrated with five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via Optum Rx), Walgreens, and Walmart.

The 2025 market data below illustrate just how far the 340B program’s operations have diverged from its original intent. As Senator Bill Cassidy recently noted, the 340B program “was never meant to be part of an earnings call. It was meant to be part of patient care.”

For more on what the 340B program’s growth means for pharmacies, join Adam J. Fein, Ph.D., and Antonio Ciaccia on June 20 for a new live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption.

Today’s guest post comes from Logan Melchione, VP of Patient Affordability at Paysign.

Logan explores how maximizers have reshaped the patient affordability landscape and pressured pharmaceutical manufacturers to adapt their copay strategies. In this guest post, she outlines her perspective on the limitations of traditional copay solutions, describes Paysign’s data-driven approach to first-fill identification of maximizer impact, and shares how the company reports saving millions while improving patient access.

To request an analysis of your program’s maximizer exposure risk and learn more about Paysign solutions, email affordability@paysign.com or visit paysign.com/rx.

Read on for Logan’s insights.

It’s time for Drug Channels’ annual look at pharmacist salaries and employment.

There was more bad news, as employment in retail pharmacies and drugstores dropped by 8,500 positions in 2024, following a drop of 4,800 positions in 2023. Employment in mass merchants and supermarkets with pharmacies increased. Meanwhile, employment at hospitals surged to a new high, growing by nearly 7,000 positions in 2024.

Average salaries hit $137,000, but varied widely across practice settings. However, salary growth did not keep pace with overall inflation.

Downsizing by the larger pharmacy chains, combined with Rite Aid’s liquidation, means that 2025 looks even grimmer for retail pharmacists. Full salary and employment data below for your enjoyment or sorrow. Click here to share your thoughts on the pharmacist job market with the Drug Channels LinkedIn community.

Jump to:

Today’s guest post comes from Aaron Crittenden, President of Rx Marketplace at GoodRx.

Aaron introduces us to GoodRx Community Link, a new offering from GoodRx that allows independent pharmacies to contract directly with GoodRx.

Summer unofficially began over the weekend. To mark the occasion, here are a few hot items, freshly seared on the Drug Channels grill:

• Reactions from the Drug Channels community to the Most Favored Nation (MFN) pricing policy

• A reality check on whether plan sponsors truly want rebate reform

• What plan sponsors should know about the evolving profit models of pharmacy benefit managers (PBMs)

Plus: A special moment for DCI on Capitol Hill.

P.S. Join my 63,000+ LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the DCI community.

What’s Next for Retail Pharmacy: Data, Debate, and Disruption.

Don’t miss DCI’s June 20, 2025, webinar, featuring Dr. Adam J. Fein and Antonio Ciaccia. We’ll unpack the good, the bad, and the ugly of the pharmacy industry—and explore what it means for you. This dynamic session will blend expert insights and real-time debate. Join us!

The Inflation Reduction Act (IRA) is triggering increases in Medicare beneficiaries’ spending on their Part B drugs.

Though CMS touts that the IRA’s inflation-based coinsurance adjustments will "lower out-of-pocket costs," the results have been more complicated. Below, we update and expand on our previous analysis.

We find that a growing number of Part B drugs now have inflation-adjusted coinsurance rates that are rising, not falling. In many cases, the rate dips temporarily before snapping back to the standard 20%.

Even more troubling, these fluctuations have led to unexpected increases in patients’ out-of-pocket expenses—even when a drug’s price was declining.

These unpredictable coinsurance shifts are another example of the IRA’s unintended consequences. Rather than enjoying stable or reduced costs, some seniors are finding themselves on a financial rollercoaster.

What’s Next for Retail Pharmacy: Data, Debate, and Disruption.

Don’t miss DCI’s next webinar on June 20, 2025 (12:00–1:30 p.m. ET), featuring Dr. Adam J. Fein and Antonio Ciaccia. We’ll unpack the good, the bad, and the ugly of the pharmacy industry—and explore what it means for you. This dynamic session will blend expert insights and real-time debate. Hope you can join us!

Dr. Adam J. Fein, president of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s new live video webinar:

What’s Next for Retail Pharmacy:
Data, Debate, and Disruption

This event will be broadcast live on:
Friday, June 20, 2025
12:00 p.m. to 1:30 p.m. ET

Dr. Fein will be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors. Adam and Antonio will share their unique insights on the pharmacy market and engage in a dynamic, real-time debate you won’t want to miss!

The webinar will be broadcast live from the Drug Channels studio in beautiful downtown Philadelphia and the 46brooklyn studio in fabulous Columbus, Ohio. It is part of The Drug Channels 2025 Video Webinar Series.

WHAT YOU WILL LEARN

Join industry experts Adam and Antonio for an exclusive deep dive and discussion into the latest trends, data, and strategies shaping the retail pharmacy industry. Drawing from their organizations’ respective research, they will provide invaluable insights to help you and your team stay informed about this rapidly changing marketplace.

Topics will include:

• The competitive landscape of retail pharmacy, with exclusive market data from DCI and 46brooklyn

• Key economic trends among leading PBMs and their impact on the market

• PBMs’ controversial effect on pharmacy and how they’re shaping the industry

• The medications driving pharmacy profits and the ones bringing financial pain

• The benefits and shortcomings of state and federal PBM regulations, including a debate over the new Arkansas law

• Exclusive insights into the latest state transparency reports

• The complex roles of pharmaceutical wholesalers in pharmacies’ supply chain

• The risks and rewards of acquisition cost pharmacy reimbursement

• The pros and cons of the 340B Drug Pricing Program for retail pharmacies

• How hospital-owned pharmacies are changing the game

• The outlook for shakeout and consolidation

• Actionable takeaways for pharmaceutical manufacturers and pharmacy leaders

• Emerging controversies, challenges, and threats to watch in the industry

And much more!

As always, Adam and Antonio will clearly distinguish their opinions and interpretations from the objective facts and data.

What’s more, this 90-minute video webinar will feature a live discussion and debate between Adam and Antonio. Watch these two experts challenge conventional wisdom—and each other—in an unprecedented throwdown.

Register now to stay informed and get ahead of the curve on the pharmacy industry!

PRICING OPTIONS

Take advantage of this exclusive educational opportunity for just $420 per viewing device. Once you register, you'll receive a unique Zoom access link within 24 hours—making it easy to add the event to your calendar and ensure you don’t miss out.

Special Discounts For Teams!

We understand that many professionals are working remotely, so we’re offering substantial savings for multiple registrations from the same organization:

• Register multiple devices for as low as $295 each—a 30% discount!
• Unlimited attendees can watch together at a single physical location (one registered device required).

Important Reminder: Each device at a single physical location must have its own registration. The webinar may not be recorded, streamed, broadcast, or shared across different locations, devices, or sites.

Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)

What’s Next for Retail Pharmacy: Data, Debate, and Disruption

Please contact Paula Fein (paula@drugchannels.net) if you have any questions. If you purchase access for multiple devices, we will contact you for a list of your participants and their email addresses. Or, download this spreadsheet and email your registrants’ information to dcisupport@hmpglobal.com.

Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Need to pay via check or ACH? Click here to request an invoice.

IMPORTANT THINGS TO KNOW

• Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.
• We will use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.
• Every registrant will receive an email from Zoom with links to download Adam and Antonio’s slides.
• The day after the event, every registrant—whether they attended the live event or not—will receive an email from Zoom with information on how to access a video replay of the live event and download all slides.
• This event is part of The Drug Channels 2025 Video Webinar Series. If you already purchased access to the 2025 Drug Channels Video Webinar Series, then you should have received an email from Zoom with a link to access the June 20, 2025, event.
• Organizations that purchased corporate access for The Drug Channels 2025 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.
• Each registration for a DCI webinar is valid for a single device at a single physical location. Each device at a physical location requires its own registration. Attendees are not permitted to record, stream, share, or project a DCI webinar to other sites or locations. Purchasers who violate this limitation by recording, streaming, sharing, or projecting a DCI webinar to other sites, devices, or locations will be liable for the full cost of all locations that viewed the webinar. DCI reserves the right to prohibit purchasers who violate our terms from attending future DCI webinars.
• Unfortunately, we are unable to offer refunds.