Analysis

This week, we’re rerunning some popular posts while we prepare for tomorrow’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Adam J. Fein, Ph.D.

Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.

For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.

However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.

Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.

Posted by Drug Channels Institute, an HMP Global company on Thursday, June 11, 2026

Labels: Hospitals, PBMs, Specialty Drugs

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Adam J. Fein, Ph.D.

It's time for Drug Channels Institute’s (DCI) annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. As you can see below, we have updated and revised our infamous illustration of the major vertical business relationships within the largest companies.

These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical integration strategies. Scrutiny of these companies’ actions continues to grow.

For all the details behind these companies’ operations, check out DCI’s new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, June 10, 2026

Labels: Channel Management, Group Purchasing Organizations (GPOs), PBMs, Pharmacy, Specialty Drugs, Wholesalers

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from March 2026.

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By Adam J. Fein, Ph.D.

Three is still the magic number for pharmacy benefit managers (PBMs).

For 2025, 80% of all equivalent prescription claims were processed by three companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. Express Scripts continued to pull ahead of its peers, while CVS Caremark’s claim volume declined for the second year.

Independent PBMs continued to gain business from these larger PBMs, showing fragmentation at the margins. Many smaller PBMs still rely on their larger competitors for claims processing, network management, and rebate negotiation. So even if a plan sponsor chooses an alternative PBM, the Big Three can still win with behind-the scenes economics.

Below, we draw on DCI's new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers to break down the latest market share data for the largest companies.

The Big Three PBMs’ dominance persists, but they face growing regulatory and competitive constraints. The largest PBMs are restructuring their businesses in response to client demands, legislative changes, and legal pressures. The emerging Net Pricing Drug Channel will accelerate these shifts, forcing changes in how PBMs generate profits, structure contracts, and justify their role in the drug channel.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, June 9, 2026

Labels: Group Purchasing Organizations (GPOs), Industry Trends, PBMs

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from March 2026.

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By Adam J. Fein, Ph.D.

Next week, the Drug Channels Institute (DCI) will release our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This 17th edition provides our most comprehensive and up-to-date examination of the U.S. drug pricing, reimbursement, and dispensing system.

For 2025, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $751 billion in 2025, up 10% from the 2024 figure.

GLP-1 agonist drugs have become the dominant driver of revenue growth. Over the past five years, increases in dispensing revenues from GLP-1 products accounted for about 60% of retail pharmacies’ total revenue growth.

The table below—one of 270 in our new report—racks up DCI's first look at the 15 largest organizations that competed for a share of those dollars. For a sneak peek at the complete report, click here to download our free 32-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits).

Posted by Drug Channels Institute, an HMP Global company on Monday, June 8, 2026

Labels: Trends, PBMs, Pharmacy, Specialty Drugs

Today’s guest post comes from Stephen Hom, Co-Founder, EVP & Chief Operating Officer of RIS Rx.

Drawing on RIS Rx’s proprietary data and case studies, Stephen highlights patterns that can undermine patient support program effectiveness. He argues that a more data-driven approach can help manufacturers identify hidden risks, improve program performance, and ensure that affordability resources reach the patients they are intended to support.

Request a complimentary analysis from RIS Rx.

Read on for Stephen’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, June 5, 2026

Labels: Sponsored Post, Guest Post

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

It’s time for Drug Channels Institute’s latest exclusive analysis of the 340B contract pharmacy market, which continues to boom along with the overall program’s expansion.

However, our 2026 analysis finds that the contract pharmacy market is now entering a more mature phase characterized by consolidation, slower growth, and increasing dominance by the industry’s largest participants.

Below, we characterize the state of the marketplace:

• Nearly two-thirds of the entire U.S. pharmacy industry participates as contract pharmacies for the 340B hospitals and federal grantees.

• The number of 340B pharmacy locations declined for the third year, due largely to the retail pharmacy shakeout and manufacturers’ 340B policies.

• Meanwhile, the total number of unique contract pharmacy/covered entity relationships continues to expand. Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna, CVS Health, UnitedHealth Group, Walgreens, and Walmart—now account for a record 77% of all relationships.

The 340B program was originally designed as a narrow policy solution to address an unintended consequence of Medicaid’s best-price provision while supporting core safety-net providers. The 2026 market data illustrate just how dramatically the program’s current operations and economic incentives have diverged from that original intent.

Read on for our latest analysis of this ever-expanding profit pool for pharmacies and PBMs. For a deep dive on what the 340B program’s growth means for drug channel participants, join Adam J. Fein, Ph.D., and Tyler Novotny on June 12 for a new live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, June 2, 2026

Labels: 340B, Pharmacy, PBMs, Hospitals, Channel Management

Today’s guest post comes from Angie Franks, Chief Executive Officer at Kalderos.

As Angie explains, the industry still lacks the transparency needed to effectively manage where discounts occur and how funds move across stakeholders. She argues that improving visibility and coordination across the ecosystem is essential to building a more sustainable and accountable model for both innovation and patient support.

To learn more, register for Kalderos’ free webinar on June 23, 2026:
GTN Oversight: A New Standard of Transparency Is Here.

Read on for Angie’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, May 29, 2026

Labels: Sponsored Post, Guest Post

By Adam J. Fein, Ph.D.

Summer unofficially kicked off last weekend. So fire up the grill and enjoy these noteworthy delicacies, seared to perfection on the Drug Channels barbeque:

• Why Optum Rx Is Accelerating Its Transparency Strategy

• The Most Important 340B Paper You’ll Ever Read

• Blue Shield of California’s PBM Unbundling Plan Meets Reality

• Prior Authorization: Administrative Complexity = Delayed Care

Plus: The Drug Channels Institute team takes on Las Vegas—with stickers!

P.S. Join my 70,000+ LinkedIn followers for links to interesting industry news, along with unfiltered commentary from the DCI community.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Don't miss DCI’s upcoming webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, May 27, 2026

Labels: PBMs, Benefit Design, 340B

Here at Drug Channels, we’ve been closely tracking the evolution of the pharmacy benefit management (PBM) industry for many years.

The short video below—excerpted from DCI’s recent PBM Industry Update 2026: Trends, Challenges, and What’s Ahead video webinar—reviews the shifting market positions of the largest PBMs and explains why vertical integration continues to reshape the industry’s competitive dynamics.

I also discuss the proliferation of smaller PBMs, many of which still depend on the largest PBMs for claims processing, pharmacy networks, rebate negotiation, and other core services. However, the market is entering what we believe will be a significant shakeout phase.

The growing administrative complexity of state and federal regulation will disproportionately burden smaller PBMs that lack the scale, capital, and integrated infrastructure of the largest organizations. Over the next five years, we expect many smaller PBMs to disappear through acquisition, consolidation, or business failure.

Meanwhile, vertical integration will continue to create strategic and financial advantages for the largest healthcare organizations—along with new opportunities to shift profits, manage risk, and coordinate services across multiple parts of the healthcare system.

What do you think?

Can’t see the video? Click here to watch the PBM clip.

ADDITIONAL BACKGROUND AND ANALYSIS

For more on the PBM industry, see these articles and reports:

• Watch the full webinar replay and download the complete slide deck.

• The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments

• Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update

• The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

Cathy Kelly at The Pink Sheet also wrote an article about the webinar: PBM Regulation May Bolster Big Three Market Position Versus Smaller Competitors.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Don't miss DCI’s next live video webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, May 20, 2026

Labels: PBMs, Industry Trends, Video, Mergers and Acquisitions

Today’s guest post comes from Peter Darch, SVP of Strategy and Operations at PHIL Inc.

Peter explains that growing pressure on drug pricing is exposing structural inefficiencies in gross-to-net (GTN) across traditional distribution channels. He argues that single-channel ecosystems can better coordinate affordability, coverage, and dispensing, improving both patient outcomes and brand performance.

Click here to learn more about PHIL’s technology solution for brands.

Read on for Peter’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, May 15, 2026

Labels: Sponsored Post, Guest Post