Analysis

By Bryce Platt, PharmD

The United States has almost 8,000 fewer retail pharmacies than it did in 2018, and more than 2,000 closed in 2025 alone. Rite Aid has liquidated. Walgreens is working through a multi-year plan to shutter hundreds of stores. CVS has trimmed hundreds more.

Yet total U.S. prescription dispensing revenues for all dispensing formats reached a record $751 billion in 2025, up 10% from 2024.

Record closures and record revenue in the same year may seem contradictory, but national totals obscure very different effects on the community. The impact of the retail pharmacy shakeout on patient access has become geographically K-shaped: dense markets can absorb pharmacy closures with little loss of patient access, while rural communities can lose their only nearby pharmacy.

The economic pressures on pharmacies are similar across the country. The access consequences of a closure are not. Below, we examine what is driving the shakeout and why geography determines which communities can absorb them.

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October 5-7, 2026 | Chicago, IL
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Today's guest post comes from Scott Filosi, Chief Commercial Officer at Valeris.

Scott explores how patient access organizations can move beyond simply tracking the patient journey to using real-time insights to improve it. He argues that connecting commercial strategy, market access, payer intelligence, and patient services can speed access to therapy, improve decision-making, and enhance the patient experience.

To learn more, download Valeris’ white paper: The Unified Ecosystem: How Valeris Integrates Intelligence and Execution for Better Patient Outcomes.

Read on for Scott's insights.

By Adam J. Fein, Ph.D. and Greis Kapexhiu

In late June, the boffins at the Centers for Medicare & Medicaid Services (CMS) released the latest projections for U.S. spending on healthcare. (See links below.) These data provide the latest official, nonpartisan look at the future of U.S. healthcare spending.

Notably, overall U.S. spending on drugs dispensed by retail and mail pharmacies will remain about 9% of overall healthcare spending.

However, the new forecasts reflect the reality that the Congressional Budget Office (CBO) finally acknowledged last week: The Inflation Reduction Act’s (IRA) Part D provisions will cost much more than CBO had initially estimated.

Below, we outline the factors that led to the dramatic revision to Medicare spending, along with insights on the shrinking role of private insurance and consumer out-of-pocket spending.

Taxpayers—primarily via Medicare and Medicaid—now account for a majority of U.S. prescription drug spending, outstripping the share financed via employer-sponsored insurance.

Like it or not, everyone in the drug channel should prepare to deal with the government programs as increasingly important transaction partners—along with the biggest vertically integrated insurers, PBMs, specialty pharmacies, and healthcare services that administer these programs.

Today's guest post comes from Jen Norton, President, Market Access & Value at EVERSANA.

Jen examines why fragmented ownership across development, regulatory, pricing, distribution, and field functions undermines access at launch. She argues that naming a single accountable owner for the access outcome can close "access debt" earlier, reduce pre-launch friction, and turn coverage into real patient access.

Learn more about EVERSANA's approach to access.

Read on for Jen's insights.

By Bryce Platt, PharmD

Summer's in full swing, but the drug channel didn't take a break.

What better way to spend the summer than reading about new pharmacy resources in the Drug Channels News Roundup?

In this issue:

• The New Biosimilar Launch Playbook

• Factors Adding to Part D Cost Trends

• Rural vs. Non-rural 340B Hospitals

• The Employer 340B Playbook

Extra: Who are the Villains in the Drug Channel?

P.S. Join my nearly 40,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

Today's guest post comes from Chip Parkinson, CEO at Gifthealth.

Chip discusses how Direct-to-Patient (DTP) models can transform the manufacturer access model for prescription therapies. He argues that a tech-plus-touch, end-to-end approach can improve patient access, protect manufacturer economics, and increase brand trust and loyalty.

Learn more about Gifthealth.

Read on for Chip's insights.

By Adam J. Fein, Ph.D.

Every year, Drug Channels reviews drug pricing trends at the largest pharmaceutical manufacturers. This year's disclosures provide early evidence that the economics of the U.S. drug channel—and the strategies manufacturers use to secure market access—are beginning to change.

We review the following eight companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data in the appendix.

Our review found:

• Brand-name drug list prices continued to rise modestly, while mandatory and voluntary rebates, discounts, and fees reduced net prices at seven of the eight manufacturers.

• The average gross-to-net price difference was –5.5%, reflecting an average list price increase of 3.7% and an average net price decline of 1.8%.

• For the three manufacturers that disclosed these data, rebates, discounts, and other fees reduced the selling prices of brand-name drugs to less than half of their list prices.

Sanofi's latest and historical disclosures provide one of the clearest illustrations yet of the drug channel's changing economics. Since 2020, the company's estimated U.S. biopharmaceutical sales have grown far faster than rebate payments. As a result, the share of its gross sales returned to payers as rebates declined from 51% to 39%.

Taken together, this year's manufacturer disclosures suggest that the gross-to-net bubble is growing more slowly—and even deflating in parts of the market. Meanwhile, the Net Pricing Drug Channel (NPDC) is becoming visible in manufacturers’ pricing disclosures and financial statements.

Today's guest post comes from Divya Iyer, SVP, Head of Revenue, Pharma Direct at GoodRx.

Divya examines why direct-to-consumer strategies shouldn't default to mail-order as the endpoint for every program. She argues that preserving patient choice between retail pickup and home delivery can reduce friction, improve therapy initiation, and strengthen the overall patient experience.

To learn more about GoodRx's Pharma Direct solution, visit GoodRx Pharma Direct.

Read on for Divya's insights.

By Adam J. Fein, Ph.D.

The 340B Drug Pricing Program continues to redefine the meaning of "skyrocketing."

• For 2025, discounted purchases under the 340B program reached an astounding $100 billion—23% higher than in 2024.

• The gross-to-net difference between list prices and discounted 340B purchases—a proxy for funds available to covered entities—also grew, to $79.5 billion (+$12.0 billion).

• Hospitals again accounted for 87% of 340B purchases.

• 340B purchases are now more than 70% larger than Medicaid’s net prescription drug spending. The program now accounts for nearly one-fifth of the total U.S. gross-to-net bubble.

During DCI’s June webinar, I predicted that the 340B program would move from an era of expansion and opacity to one of transparency and accountability.

But given the latest growth figures, I worry that reform of this undermanaged, out-of-control program may never happen. Has the program become too big to reform?

Read on for our full analysis—and consider whether 340B will ever face its true day of reckoning.

Click here to share your thoughts on the latest 340B data with the Drug Channels community on LinkedIn.