BlinkRx Insights: Beyond the Hub - Rethinking the Prescription Journey

By Tyler Novotny and Bryce Platt

PBM-affiliated private label biosimilars would seem to have a built-in formulary advantage. But for ustekinumab, that advantage has not carried over to Medicare Part D.

A recent JAMA Network Open study identified 12 ustekinumab products available for formulary coverage in early 2026. Yet the average Part D plan covered only 2.3 biosimilars. Even more surprising, PBM affiliated private label products were largely missing from formularies connected to their corporate siblings.

CVS Health’s Cordavis labeled Pyzchiva received no Part D coverage. Optum Rx’s Nuvaila labeled Wezlana appeared in just 0.4% of UnitedHealth plans.

The results run against the conventional logic of vertical integration. If a PBM can influence formulary placement, why not direct volume toward its own product like in commercial formularies? The answer lies in the Inflation Reduction Act’s (IRA) Part D redesign, which made the economics of an affiliated private label biosimilar potentially less attractive in Medicare than in the commercial market.

Below, we follow the incentives that help explain why PBM-affiliated biosimilars remain largely absent from Medicare Part D formularies.

Today's guest post comes from Bryce Aronson, Director of Business Development at AssistRx.

Bryce covers three considerations taking effect in January 2027—the end of Medicare Part D premium support, a faster Medicaid redetermination timeline, and the shift away from once-a-year reverification—and what they mean for patient support programs. He explores how affordability solutions can help reduce coverage disruptions, minimize unnecessary PAP utilization, and maintain continuity of therapy throughout the transition.

To learn more about AssistRx's affordability solutions, access their webinar, State of Patient Support 2026: Turning Regulatory Policy, AI and Direct-to-Patient Pressure into Program Strategy.

Read on for Bryce's insights.

By Bryce Platt, PharmD

Kids are heading back to school, but the drug channel never stops handing out homework. Fortunately, we did some of the research prep for you.

In this issue:

• HRSA's Revised 340B Rebate Model Pilot

• Households Feel the Cost of Prescription Drugs More

• The Drivers of Specialty Drug Spending

• Lost Brand Coverage in Medicare Part D Plans After the IRA

Extra: Let’s Go on an Adventure to Find Out What Your Prescription Actually Costs You!

P.S. Join my nearly 42,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

Notice Regarding 340B Rebate Model Pilot Program, HRSA

Today's guest post comes from Jay Weaver, VP, Payer Solutions at PANTHERx^® Rare.

Jay describes the clinical and operational work that often happens behind the scenes at a Rare Pharmacy. He explains how these capabilities—including greater personalization, real-world evidence, and specialized clinical expertise—can support therapeutic success and help payers assess the value of Rare Pharmacy.

To learn more about the PANTHERx approach to Rare Pharmacy, download their guide, Five Criteria for Payers to Evaluate a Rare-Focused Specialty Pharmacy.

Read on for Jay's insights.

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

In June 2025, the FDA announced that CAR-T therapies would no longer be subject to a REMS program.

The FDA’s removal of CAR-T REMS requirements eliminates one obstacle to expanding treatment beyond traditional academic medical centers. That change could disproportionately benefit the Big Three wholesalers, which have spent billions building positions in community oncology while simultaneously investing in cell-and-gene-therapy distribution and support infrastructure.

Read on for our review of this dynamic sector and ponder how wholesalers’ community oncology roll-up activities could interact with their cell and gene therapy (CGT) investments. Will wholesalers capture a growing share of CAR-T’s economics, or will hospitals continue to hold the upper hand?

Today's guest post comes from Josh Marsh, Vice President and General Manager at Cardinal Health Sonexus™ Access and Patient Support.

Josh examines the risks manufacturers take when transitioning a patient services hub from one vendor to another. He argues that scaling with a proven, flexible blueprint can help hubs with speed, patient continuity, and confident decision-making.

To learn more, download Cardinal Health Sonexus™ Access and Patient Support's framework: 5 Questions Every Manufacturer Should Ask Before a Hub Transition.

Read on for Josh's insights.

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.

Informa Connect’s Medicaid Drug Rebate Program Summit
October 5-7, 2026 | Chicago, IL
Drug Channels readers save 10% with code 26DRCH10*
View Agenda | Download Brochure

The Medicaid Drug Rebate Program Summit returns to Chicago this October! Join 700 annual attendees and nearly 90 expert speakers to master complex regulatory guidelines to deliver compliant government pricing and reporting programs.

The 2026 event features:

• Direct state engagement: One-on-one Medicaid dispute resolution with 31+ confirmed states.
• Comprehensive coverage: MFP implementation, inflation rebates first invoicing, pharma tariffs, Buy America rules, onshoring strategies, PBM reforms, FTC transparency mandates, and physician-administered product challenges, 340B, AMP, URA, GTN, SPTR, FMV, FSS, Medicaid Parts D and B, and more.
• Unparalleled faculty: Industry leaders from Gilead, AbbVie, Amgen, AstraZeneca, Genentech, Eli Lilly; legal authorities from Hogan Lovells, Arnold & Porter, Covington & Burling; government representatives including CMS, OIG, VA, and 31+ state Medicaid agencies.
• Networking: Opportunities to build valuable connections with more than 700 annual attendees.

Prior attendees praise the event as “An excellent forum to meet industry professionals and gain insight into best practices, current and future, of what’s to come regarding manufacturers and government regulations.”

The MDRP Summit remains essential for anyone navigating the complex intersection of pharmaceutical economics, compliance, and government programs. With expert speakers, targeted sessions, and valuable networking opportunities, this event delivers actionable insights you can implement immediately.

View the agenda for MDRP 2026 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/MDRPSummit for further details and to register.

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.