Analysis

Last week, President Trump signed yet another executive order, this time promising to make healthcare pricing more transparent.

While this marks another federal push for disclosure, states have already been quite active in this space. Since 2017, 24 states have passed 38 laws targeting healthcare transparency, with a strong focus on unraveling the complex economics of pharmacy benefit managers (PBMs).

But has all this legislation actually provided clarity—or just more red tape?

Below, I analyze four state reports on manufacturers’ rebate and fee payments to PBMs. The findings are dispiriting: mandated disclosures have yielded little actionable, reliable data. Lawmakers got to pat themselves on the back for “transparency,” but the data tell a different story. Federal efforts haven’t been much better.

Should we continue down the path of government-mandated reporting, or should plan sponsors be left to negotiate their own deals? I’ll explore these questions and more during DCI’s upcoming live video webinar, PBM Industry Update: Trends, Challenges, and What's Ahead on April 4, 2025. Click here to learn more and sign up.

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:

PBM Industry Update: Trends, Challenges, and What's Ahead
This event will be broadcast live on
Friday, April 4, 2025, from 12:00 p.m. to 1:30 p.m. ET

This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2025 Video Webinar Series.

WHAT YOU WILL LEARN

Join industry expert Adam J. Fein, Ph.D., for an exclusive deep dive into the latest trends, data, and strategies shaping the pharmacy benefit management (PBM) industry. Drawing from the brand-new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, Dr. Fein will provide invaluable insights to help you and your team stay informed about this rapidly evolving market.

Dr. Fein will share his expert analysis on critical industry developments, including:

• The competitive landscape of major PBMs, with exclusive market share data from DCI

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

• PBMs’ expanding role in specialty pharmacy and how it’s reshaping the industry

• Exclusive insights into the Federal Trade Commission’s interim reports and the future of its investigation

• The evolving role of independent PBMs and their market positioning

• How health-system-owned PBMs are changing the game

• Fresh data on plan sponsors’ perspectives on their PBM partners

• Key takeaways from PBMs’ 2025 commercial formularies

• The latest shifts in PBM compensation models

• The risks and rewards of PBM-affiliated private-label products and GPOs

• Legislative and business implications of the 340B Drug Pricing Program

• State and federal PBM regulations: What’s ahead?

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

And much more!

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.

This 90-minute video webinar will feature a dedicated Q&A session, where attendees can unmute and engage directly with Dr. Fein. Don't miss this unique opportunity to gain actionable insights and have your burning questions answered in real time!

Register now to stay informed and ahead of the curve on the PBM 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 GROUPS!

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).

Please contact Paula Fein (paula@drugchannels.net) to register a group for one fixed price.

Important Reminder: Each device at a single physical location must have its own registration. The webinar may not be recorded, streamed, 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.)

Today’s guest post comes from Scott Genone, Chief Product Officer at CareMetx.

Scott shares key findings from CareMetx’s recent survey of over 100 industry leaders. He explains how such advanced technologies as AI and machine learning will reshape patient services and improve the experience for both patients and healthcare providers.

To view the full survey results, download The 2025 Patient Services Report: Provider Engagement is Make or Break for Success.

Read on for Scott’s insights.

On March 18, 2025, Drug Channels Institute will release The 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our sixteenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. This unique, encyclopedic resource is your ultimate guide to the complex web of interactions within U.S. prescription drug channels.

12 chapters, 500+ pages, 268 exhibits, nearly 1,200 endnotes: There is nothing else available that comes close to this valuable resource.

We are providing you with the opportunity to preorder this thoroughly updated, revised, and expanded 2025 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before March 18.

• Review pricing/license options and place a preorder

• Download a free 30-page pre-publication overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits)

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to contact us if you would like to pay by corporate check or ACH.

Email Paula Fein (paula@drugchannels.net) if you’d like to bundle the report purchase with access to DCI’s video webinars.

Special preorder and launch pricing discounts will be valid through March 31, 2025.

Read on for more details.

Winter—or at least February—is almost over. Celebrate the imminent return of spring with our selection of noteworthy news from around the drug channel. In this issue:

• How Part D plan sponsors responded to pharmacy DIR changes

• Troubling new data on copay accumulators in marketplace plans

• DCI’s latest vertical integration visualization

• How the IRA will hurt physician practices

Plus, cartoon cats explain the 340B Drug Pricing Program.

P.S. Join my more than 60,000 LinkedIn followers for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Today's guest post comes from Thomas Luby, Sr. Vice President, Business Development at PHIL.

Thomas discusses the challenges brands face as they manage gross-to-net (GTN) performance while simultaneously enhancing patient access and adherence. He lists the key performance indicators that can help brands improve GTN.

To learn more, watch PHIL’s free on-demand webinar: Four Patient Access Barriers to Address for High-Impact Programs.

Read on for Thomas's insights.

Abracadabra! Small pharmacies have ghosted Medicare Part D’s preferred networks—no farewell party, no breakup text, just a quiet exit.

A few months ago , DCI highlighted how the largest pharmacy chains are participating as preferred cost sharing pharmacies in the 2025 stand-alone prescription drug plan (PDP) networks. Today, we update our exclusive analysis of how smaller pharmacies are participating via their pharmacy services administrative organizations (PSAOs).

As you will see below, the largest PSAOs have almost fully abandoned PDPs’ preferred networks in 2025. Plans from Humana, WellCare, and UnitedHealthcare will again not have any independent pharmacies participating via PSAOs as preferred pharmacies.

Thanks to the Inflation Reduction Act (IRA), the PDP market is vanishing. Looks like the presence of smaller pharmacies in preferred networks will not be far behind.

Today’s guest post comes from Angie Franks, CEO at Kalderos

Angie describes the compliance challenges that stakeholders face in managing the complex interactions of the 340B Drug Pricing Program, the Medicaid Drug Rebate Program, and IRA’s Maximum Fair Price and inflation rebate provisions. She explains how clean, comprehensive claims data can resolve these issues.

To learn more, register for Kaldreros’ March 4 free webinar: Taking Action Amidst 340B Uncertainty With Truzo.

Read on for Angie’s insights.

Valentine’s Day is almost here! So, it’s time for our romantic review of plan sponsors’ sweetheart: the accumulators and maximizers that divert manufacturers’ copay support payments away from patients—and toward plans and PBMs.

As of late 2024, more than 40% of commercially insured lives were in plans that utilize a copay accumulator or a maximizer. Thanks to a potent combination of payer savings and PBM profits, maximizers are now more beloved than copay accumulators. Check out the data below.

DCI estimates that that plans and their vendors receive about $6.5 billion of manufacturers’ copayment support funds. Given the money at stake, plans will keep wooing this money away from patients. Will legislators let this love continue to bloom? Read on and let me know what you think.

Today’s guest post comes from Richard Faris, Chief Strategy & Growth Officer at PANTHERx Rare Pharmacy.

Richard outlines the key factors for commercialization success when a manufacturer launches treatments for rare and orphan diseases. He explains the key considerations for choosing a specialty pharmacy network design, selecting the right pharmacy partners, and establishing patient services HUBs.

To learn more, download PANTHERx’s latest white paper and SP decision-support resource: Selecting the Right Specialty Pharmacy Partner for a Successful Launch.

Read on for Richard’s insights.