Analysis

Today’s guest post comes from Allison Bridges, SVP Client Success at PHIL Inc. and Cindy Eckert, Founder and CEO of Sprout Pharmaceuticals

Allison and Cindy argue that many direct-to-patient (DTP) programs remain constrained by one-size-fits-all models that limit both patient experience and commercial performance. As patients increasingly expect convenience, choice, and price transparency, they suggest that manufacturers must evolve beyond static DTP channels toward more flexible, hybrid access models.

Click here to learn more about PHIL’s DTP 2.0 platform, PHIL Direct.

Read on for Allison and Cindy’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, February 27, 2026

Labels: Sponsored Post, Guest Post

By Adam J. Fein, Ph.D.

Despite the recent storm, winter—or at least February—is almost over. Before we thaw out, here’s a brisk tour of the forces reshaping the drug channel. In this issue:

• Mark Cuban’s $0.02 on the FTC-ESI settlement

• What patients want from health insurance

• Why the QALY paradox could block MFN

• How 340B drives hospital vertical integration

Plus: Meet the expanding Drug Channels Institute team!

P.S. Join my more than 68,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, February 24, 2026

Labels: PBMs, 340B, Buy-and-Bill, Benefit Design, Net Pricing Drug Channel

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

Scott shares findings from CareMetx’s 2026 Patient Services Report, based on a survey of more than 100 patient access decision-makers across biopharma, consulting, and specialty care. The results reveal an industry in transition. Hybrid hub models are becoming the norm, technology enablement remains uneven, and interoperability is emerging as a critical gating factor for meaningful progress.

To learn more, download CareMetx's 2026 Patient Services Report.

Read on for Scott’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, February 20, 2026

Labels: Guest Post, Sponsored Post

By Adam J. Fein, Ph.D.

The Centers for Medicare & Medicaid Services (CMS) has just released its initial 2026 data on enrollment in Medicare Part D prescription drug plans (PDPs).

DCI’s exclusive analysis shows that 83% of seniors remain enrolled in PDPs with preferred pharmacy networks—essentially unchanged from 82% in 2025, but sharply lower than the 99% peak in 2023. Meanwhile, the number of major Part D plans offering preferred networks has fallen to a record-low eight.

The new enrollment data reveal a clear shift in competitive positioning: Albertsons and Publix are now preferred in every major plan. Walgreens is holding strong. Walmart—the company that invented the Part D preferred network model—has slipped to the middle of the preferred pack.

Meanwhile, smaller pharmacies have fully abandoned PDPs’ preferred networks in 2026.

At the same time, the IRA’s expansion of the Low-Income Subsidy (LIS) means a growing share of beneficiaries have little financial incentive to use a preferred pharmacy at all. Add in the PBM reforms in the Consolidated Appropriations Act of 2026, and the preferred network model will gradually lose relevance.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, February 18, 2026

Labels: Medicare Part D, Narrow Networks, Pharmacy, Channel Management

Today’s guest post comes from Gerard Rivera, CEO and Co-Founder of RIS Rx.

Gerard reframes patient affordability as a clinical issue rather than a purely financial one. He argues that real-time precision, earlier intervention, and coordinated escalation can reduce gross-to-net failures and improve the patient experience.

To learn more about RIS Rx’s approach, request a RIS Rx savings snapshot.

Read on for Gerard’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, February 13, 2026

Analysis

By Adam J. Fein, Ph.D.

Valentine’s Day is almost here! It’s the perfect time for our annual update on plan sponsors’ enduring sweetheart: copay accumulators and maximizers—the benefit designs that divert manufacturers’ copay support away from patients and toward plans and PBMs.

As of late 2025, about four in ten commercially insured lives were enrolled in plans using a copay accumulator or a maximizer. Patients who rely on single-source, brand-name specialty drugs for autoimmune conditions, multiple sclerosis, and oncology are increasingly likely to encounter these designs. The data below illustrate how widespread these programs have become—and where their impact is most acute.

The potent combination of payer savings and PBM profits continues to attract plan sponsors, while patients remain caught in the middle of a complex and often opaque struggle among insurers, PBMs, and drugmakers. While a growing number of states have acted to restrict these tools, the states' reach remains limited.

Copay accumulators and maximizers exemplify many of the worst features of our crazy drug channel and add troubling complexity to benefit designs that already feature multiple tiers, copayments, coinsurance, deductibles, exclusions, and more. In this Valentine’s story, patients are still not the ones being courted.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, February 10, 2026

Labels: Copay Accumulator Adjustment, Benefit Design, PBMs, Co-pay Offset Programs, Specialty Drugs

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

Angie examines the growing uncertainty surrounding the 340B program and explains why comprehensive reform remains unlikely in the near term. She argues that claims-level transparency must serve as the foundation for a sustainable path forward. She describes Truzo, Kalderos’ solution for manufacturers and covered entities to work in real time to gain visibility into 340B drug discounts.

To learn more, schedule a meeting with the Kalderos legal team.

Read on for Angie’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, February 6, 2026

Labels: Sponsored Post, Guest Post

By Adam J. Fein, Ph.D.

Earlier today, the Federal Trade Commission (FTC) announced an extraordinary settlement with Express Scripts that fundamentally reshapes its pharmacy benefit management (PBM) business—and by extension, the entire drug channel.

The settlement addresses virtually every warped incentive that we have been covering on Drug Channels for the past 20 years. I summarize them below, but it’s worth reading the full document (links below) to appreciate just how completely the FTC has dismantled the existing PBM business model.

One small caveat: Plan sponsors could provide a loophole for business-as-usual. (See Section XI.)

But as I predicted in the Drug Channels Outlook 2026 webinar, we are entering the Net Pricing Drug Channel (NPDC) era.

William Gibson once said: “The future is already here–it's just not evenly distributed.” That future just arrived for one of the biggest PBMs. Get ready.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, February 4, 2026

Labels: PBMs, Benefit Design, Enforcement, Gross-to-Net Bubble, Group Purchasing Organizations (GPOs), Net Pricing Drug Channel, Pharmacy Economics

By Adam J. Fein, Ph.D.

The boffins at the Centers for Medicare & Medicaid Services (CMS) recently dropped the latest National Health Expenditure (NHE) data, which track all U.S. spending on healthcare. (Links below.)

We spent an astounding $5,278,588,000,000 on healthcare in 2024. Yes, that’s $5.3 trillion!

Retail outpatient prescription drugs accounted for less than 9% of that total. More than half of net outpatient drug spending was paid by federal, state, and local government programs. Below, we delve into the spending trends, which reveal the impact of the Inflation Reduction Act (IRA) on Medicare spending, the boom in healthcare marketplaces, and the post-pandemic bust in Medicaid.

Contrary to what you might read, the government’s data show that drug spending growth was not driven by purportedly “skyrocketing” drug prices. In reality, nearly all of the increase in drug spending reflected higher utilization—more people treated, more prescriptions dispensed, and shifts among drugs dispensed—rather than higher net prices.

Prices may grab headlines, but utilization—and taxpayers—are driving the spending story. When prices stop being signals, markets stop being markets.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, February 3, 2026

Labels: Costs/Reimbursement, Health Insurance Exchanges, Industry Trends, Inflation Reduction Act of 2022, Medicare Part D, Net Pricing Drug Channel

Today’s guest post comes from Brok Vandersteen, Vice President of Business Development at AssistRx.

Brok argues that in 2026, traditional patient support program (PSP) models must evolve beyond task execution to deliver actionable insights, adaptive access strategies, and measurable ROI. He outlines four key considerations for transforming PSPs from cost centers into insight-driven engines of value.

To explore how life sciences organizations are rethinking patient support in 2026, download the AssistRx white paper: How Tech + Talent Delivers Patient Support Programs that Go Beyond the Call.

Read on for Brok’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, January 30, 2026

Labels: Sponsored Post, Guest Post