Analysis

Today's guest post comes from Geoffrey Chaiken and Matthew Chaiken, Co-founders of BlinkRx.

Geoffrey and Matthew examine how efforts to improve patient access have contributed to an increasingly fragmented prescription journey. They suggest that a more integrated approach can reduce complexity, improve visibility and control for manufacturers, and create a simpler path to therapy for patients.

To learn more about the BlinkRx Prescription Journey Management Platform, visit BlinkRx.

Read on for Geoffrey and Matthew's insights.

Posted by BTP on Thursday, September 3, 2026

Labels: Guest Post, Sponsored Post

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.

Posted by BTP on Tuesday, September 1, 2026

Labels: Biosimilars, Medicare Part D, Pharmacy Economics, Specialty Drugs

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.

Posted by BTP on Friday, August 28, 2026

Labels: Guest Post, Sponsored Post

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

HRSA published a revised 340B Rebate Model Pilot Program, and it's set to launch January 1, 2027.

The Inflation Reduction Act created a nonduplication requirement between the Maximum Fair Price (MFP) and the 340B ceiling price. Determining which one applies at the transaction level is something the traditional upfront discount model cannot do reliably.

Posted by BTP on Tuesday, August 25, 2026

Labels: 340B, Costs/Reimbursement, Medicare Part D, Specialty Drugs

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.

Posted by BTP on Friday, August 21, 2026

Labels: Guest Post, Sponsored Post

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?

Posted by Adam J. Fein, Ph.D. on Tuesday, August 18, 2026

Labels: Buy-and-Bill, Cell and Gene Therapies, Hospitals, Physicians, Specialty Drugs, Wholesalers

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.

Posted by BTP on Friday, August 14, 2026

Labels: Guest Post, Sponsored Post

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.

Posted by BTP on Tuesday, August 11, 2026

Labels: Medicare Part D, Narrow Networks, Patient Perspective, Pharmacy, Pharmacy Economics, Specialty Drugs

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.

Posted by BTP on Monday, August 10, 2026

Labels: Sponsored Post

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.

Posted by BTP on Friday, August 7, 2026

Labels: Guest Post, Sponsored Post

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.

Posted by Adam J. Fein, Ph.D. on Tuesday, August 4, 2026

Labels: Costs/Reimbursement, Health Care Policy, Industry Trends, Inflation Reduction Act of 2022, Medicare Part D

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.

Posted by BTP on Friday, July 31, 2026

Labels: Guest Post, Sponsored Post

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.

Generic and Biosimilar Economics in a Payer-Engineered Market, IQVIA

Between 2009-2013, generic drugs reached 57% of peak uptake within 1 month of launch.

In the last five years, it took 6 months on average to reach the same level.

This slowdown in adoption isn't necessarily from reduced competition or prescriber resistance—it's coming from more control of coverage from payers/PBMs.

[Click to Enlarge]

A Drug Channels Institute analysis from earlier this year covers how Optum Rx formularies for Humira include only two preferred options, both from Amgen including the Nuvaila-branded version. Most other biosimilars were removed entirely.

Posted by BTP on Tuesday, July 28, 2026

Labels: 340B, Biosimilars, Medicare Part D

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.

Posted by BTP on Friday, July 24, 2026

Labels: Guest Post, Sponsored Post

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.

Posted by Adam J. Fein, Ph.D. on Tuesday, July 21, 2026

Labels: Gross-to-Net Bubble, Industry Trends, Net Pricing Drug Channel, PBMs

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.

Posted by BTP on Friday, July 17, 2026

Labels: Guest Post, Sponsored Post

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.

Posted by Adam J. Fein, Ph.D. on Wednesday, July 15, 2026

Labels: 340B, Health Care Policy, Hospitals, Industry Trends, Inflation Reduction Act of 2022, Pharmacy Economics

By Bryce Platt, PharmD

Provider-administered drugs are one of the fastest-growing and least-managed cost drivers for commercial plan sponsors.

Despite that, recent data from the Pharmaceutical Strategies Group show that only 35% of commercial plan sponsors currently have a site of care (SOC) program in place for specialty pharmacy. That result is surprising given the size of the savings at stake.

Medicare has figured this out and started site-neutral payments over a decade ago, but the employers who fund the bulk of commercial health spending largely haven't.

The evidence supporting SOC management is no longer the story. The real question is why so many commercial plans continue paying hospital prices when lower-cost alternatives already exist.

LOCATION DRIVES COSTS, NOT CLINICAL NEED

Commercial plans often pay substantially more when specialty drugs are reimbursed at hospitals rather than physician offices or through specialty pharmacies. An Oliver Wyman analysis, which we highlighted in our 2025–26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, showed a set of seven drugs and the commercial reimbursements paid under patients’ medical benefit compared with reimbursements paid to specialty pharmacies under patients’ pharmacy benefits.

Posted by BTP on Tuesday, July 14, 2026

Labels: Benefit Design, Buy-and-Bill, Hospitals, Specialty Drugs

Today's guest post comes from Megan Wetzel, Vice President of Product, Access and Affordability at CoverMyMeds.

Megan examines how prior authorization execution has become a strategic differentiator for biopharma brands as formulary changes and expanding utilization management put more pressure on access. She argues that building consistent, scalable prior auth execution can reduce therapy delays, improve determination time, and strengthen brand performance across the product lifecycle.

To learn more about CoverMyMeds' prior authorization solution, download their case study: From Decline to Growth: How One Brand Expanded Access in Late Lifecycle.

Read on for Megan's insights.

Posted by BTP on Friday, July 10, 2026

Labels: Guest Post, Sponsored Post

By Adam J. Fein, Ph.D.

For years, the controversy surrounding the 340B Drug Pricing Program has centered on hospitals, manufacturers, and contract pharmacies.

But employers and health plans have become major participants in the program's economics—even though many don't realize it.

The short video below—excerpted from DCI’s recent 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders webinar—explains why.

In eight minutes, I discuss:

• How retrospective identification of contract pharmacy claims can eliminate manufacturer rebates for commercial plans while increasing plan costs

• What PBMs’ growing role in the 340B contract pharmacy market means for pharmacy benefits

• Why the economics differ from what many employers believe is happening at the pharmacy counter

• What newly reported Minnesota data reveal about who ultimately funds hospitals' 340B net profits

Whether you support or oppose the current structure of 340B, it is becoming harder to ignore that the debate is expanding beyond manufacturers and hospitals. Employers, health plans, and policymakers are beginning to ask who ultimately finances the program—and what those economics mean for benefit costs and premiums.

Posted by Adam J. Fein, Ph.D. on Wednesday, July 8, 2026

Labels: 340B, Benefit Design, PBMs, Pharmacy, Video

By Adam J. Fein, Ph.D.

Happy 250th birthday, America! Before you launch your semiquincentennial festivities, Drug Channels offers some fireworks of our own:

• The PBM Shakeout Is Gaining Momentum

• 340B: From Opacity and Expansion to Transparency and Accountability

• Why Do Many Employers Say They Don’t Receive 100% Of Their PBM Rebates?

• Mark Cuban Wins the Generic Price War (Again)

Plus: Congratulations to Ge Bai on her nomination!

P.S. Join my nearly 71,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

Abarca Health and LucyRx Announce Strategic Combination to Create the Only Modern PBM Built for Commercial and Government Scale, PR Newswire

Abarca Health and LucyRx recently announced their merger.

As we discussed in our April webinar, the PBM market is entering a significant consolidation phase. LucyRx has already acquired two smaller competitors in 2024 and 2025.

Posted by Adam J. Fein, Ph.D. on Monday, June 29, 2026

Labels: 340B, Benefit Design, Generic Drugs, Health Care Policy, Mergers and Acquisitions, PBMs

Today’s guest post comes from Geoffrey Chaiken and Matthew Chaiken, Co-founders of BlinkRx.

Geoffrey and Matthew examine the important role of patient services providers. They suggest several questions manufacturers can ask when evaluating a patient services partner’s technology infrastructure, pharmacy network design, data visibility, and operational capabilities.

Click here to learn more about BlinkRx’s patient services solution.

Read on for Geoffrey and Matthew’s insights.

Posted by BTP on Friday, June 26, 2026

Labels: Guest Post, Sponsored Post

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

It’s time for Drug Channels’ annual look at pharmacist salaries and employment. The latest data might be a tough pill to swallow.

As we predicted, the situation was grim for retail pharmacists. Employment in retail outpatient pharmacies fell by 8,200 positions in 2025, following a drop of 11,700 positions over 2023 and 2024 combined.

Meanwhile, pharmacist employment at hospitals grew by 3,000 positions, after hospitals added more than 11,000 pharmacist jobs in 2023 and 2024. Nearly half of all pharmacists now work outside a traditional retail setting.

Overall pharmacist salaries averaged $140,920, but varied widely across practice settings. Salary growth in many settings, however, did not keep pace with overall inflation.

Our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers documents how and why retail pharmacy economics are under sustained pressure. Since 2018, the two remaining national drugstore chains have collectively closed nearly 3,000 locations, reflecting margin compression and weaker front-end economics.

Posted by Adam J. Fein, Ph.D. on Tuesday, June 23, 2026

Labels: Hospitals, Industry Trends, Pharmacy, Pharmacy Economics

Today’s guest post comes from Nareda Mills, President of Patient Solutions at Inizio Engage.

Nareda examines how growing access complexity is reshaping specialty commercialization. She explores the emerging role of Non-Dispensing Pharmacies (NDPs) and argues that by improving coordination, visibility, and patient engagement, they can accelerate time-to-therapy and create a more seamless access experience.

Click here to learn more about Inizio Engage’s hub services.

Read on for Nareda’s insights.

Posted by Adam J. Fein, Ph.D. on Thursday, June 18, 2026

Labels: Guest Post, Sponsored Post

By Bryce Platt, PharmD

Summer officially starts this weekend!

Consider doing a few of your lifting sets (or work meetings) outside.

The healthier you are, the longer you’ll be able to read our news roundups, so everybody wins!

In this issue:

• A Leaky Biosimilar Funnel

• Reasons for Growth in Hospital Specialty Pharmacies

• The Impact of Payment Arrangements on Medicaid Utilization

• Drug Innovation Versus Cost Containment

Extra: The Process of Filling a Pharmacy Prescription

P.S. Join my nearly 36,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

2026 Biosimilars Report, Cardinal Health

Despite the projected $232 billion opportunity for biosimilars over the next decade, only 10% of biologics losing exclusivity have a biosimilar in development.

Biosimilar development is a business, and there are several factors that make biosimilars a more difficult market to enter such as price erosion, reimbursement uncertainty, and development barriers.

Posted by Adam J. Fein, Ph.D. on Wednesday, June 17, 2026

Labels: Biosimilars, Health Care Policy, Hospitals, Pharmacy, Specialty Drugs

By Bryce Platt, PharmD

For years, Medicare Part D plans often preferred high-list/high-rebate branded multiple sclerosis (MS) drugs over lower-cost generics. That was rational behavior inside an irrational system.

The Inflation Reduction Act (IRA) offers one example of how incentives can change behavior in the system. New research in JAMA Health Forum reveals a significant reversal in Medicare Part D formulary coverage for MS drugs. After years of plans favoring brand-name drugs over generics, 2025 formularies shifted to near-universal generic coverage.

However, in return patients got narrower formularies, higher upfront costs, and way more taxpayer dollars spent than expected.

While this wasn’t the case for all drug classes, in MS, the IRA Part D redesign has forced plans to care more about net drug spending. Below, we analyze the formulary data and explain why the coverage patterns changed so abruptly—and what new tradeoffs have emerged.

Posted by Adam J. Fein, Ph.D. on Tuesday, June 16, 2026

Labels: Benefit Design, Inflation Reduction Act of 2022, Medicare Part D

This week, we’re rerunning some popular posts while we prepare for today’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 Bryce Platt, PharmD

Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.

In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.

The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.

Posted by Adam J. Fein, Ph.D. on Friday, June 12, 2026

Labels: 340B, Costs/Reimbursement, Hospitals

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 Adam J. Fein, Ph.D. 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 Adam J. Fein, Ph.D. 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 Adam J. Fein, Ph.D. 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 Adam J. Fein, Ph.D. on Monday, June 8, 2026

Labels: PBMs, Pharmacy, Specialty Drugs, Trends

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 Adam J. Fein, Ph.D. on Friday, June 5, 2026

Labels: Guest Post, Sponsored 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 Adam J. Fein, Ph.D. on Tuesday, June 2, 2026

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

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 Adam J. Fein, Ph.D. on Friday, May 29, 2026

Labels: Guest Post, Sponsored 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.

Optum Rx Introduces Industry’s First Transparent Pharmacy Care Model, Business Wire

One consequence of the Net Pricing Drug Channel is that intermediaries—pharmacies, wholesalers, and PBMs—will move to decouple their compensation from list prices.

Posted by Adam J. Fein, Ph.D. on Wednesday, May 27, 2026

Labels: 340B, Benefit Design, PBMs

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.

Posted by Adam J. Fein, Ph.D. on Wednesday, May 20, 2026

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

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 Adam J. Fein, Ph.D. on Friday, May 15, 2026

Labels: Guest Post, Sponsored Post

By Bryce Platt, PharmD

The onslaught of pharmacy-related news doesn’t end. It may even be increasing in volume due to AI.

But don’t worry—I’ve gathered some high-impact information over the last month from my LinkedIn posts that you can quickly read between your sets at the gym.

I recommend reading BETWEEN your sets, but some may be brave enough to read during the set itself.

In this issue:

• Why Drug Launch Price Analyses May Be Misleading

• Pharmacy Closures Are Accelerating—New Data Reveal Where and Why

• How Hospitals Really Get Paid for Uncompensated Care (It’s More Complicated Than You Think)

• 340B Hospitals vs. Federal Grantees: The Overlooked Differences That Matter

Extra: What If Specialty Pharmacy Worked Like a Luxury Hotel? A Surprising Reimagining

P.S. Join my more than 33,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

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

Posted by Adam J. Fein, Ph.D. on Wednesday, May 13, 2026

Labels: 340B, Hospitals, Pharmacy, Specialty Drugs

Join Dr. Adam J. Fein, president of Drug Channels Institute (DCI) and the editor of Drug Channels, for his latest exclusive video webinar:

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

This event will be broadcast live on:
Friday, June 12, 2026
12:00 p.m. to 1:30 p.m. ET

Register Now

Dr. Fein will be joined by Tyler Novotny, MBA, the SVP at DCI.

The webinar will be broadcast live from the Drug Channels studio in beautiful downtown Philadelphia. It is part of The Drug Channels 2026 Video Webinar Series.

WHAT YOU WILL LEARN

Join industry expert Adam J. Fein, Ph.D., and his colleague Tyler Novotny, MBA, for an exclusive deep dive into the 340B Drug Pricing Program—one of the most complex and controversial segments of the U.S. pharmaceutical market.

In this all-new webinar, Adam and Tyler will deliver a fact-based, data-driven analysis of the 340B program’s structure, economics, and rapid evolution. He’ll unpack the key controversies reshaping the program, explain what’s really happening behind the headlines, and provide a clear, actionable outlook for stakeholders across the drug channel.

Posted by Adam J. Fein, Ph.D. on Tuesday, May 12, 2026

Labels: 340B, Industry Trends, Video

Today’s guest post comes from George Moore, Chief Product and Technology Officer at CareMetx.

George argues that customer relationship management (CRM) program customization delivers short-term workflow gains at the expense of long-term scalability, integration simplicity, and upgradeability. He highlights three common pitfalls and offers an approach on how to avoid them.

To learn more, download CareMetx’s Guide to Building an Agile, Scalable Hub Architecture.

Read on for George’s insights.

Posted by Adam J. Fein, Ph.D. on Friday, May 8, 2026

Labels: Guest Post, Sponsored Post

By Adam J. Fein, Ph.D.

The Drug Channels Institute (DCI) team attended Asembia’s AXS26 Summit last week. Once again, the specialty pharmacy market delivered a classic paradox: a sprawling, fragmented landscape of participants paired with highly concentrated economics controlled by a handful of PBM-affiliated giants.

Below, we share our proprietary analyses of the specialty market’s participants. DCI identified more than 1,900 pharmacy locations that have achieved specialty pharmacy accreditation from one of the two major independent accreditation organizations.

Despite growing revenues from specialty drugs, overall growth in accredited pharmacies has plateaued. However, pharmacy locations owned by healthcare providers—hospitals, health systems, physician practices, and other healthcare providers—continue to expand and now account for nearly 40% of all accredited specialty pharmacy locations.

Read on for a bit of our arithmomania. Because in specialty pharmacy, what gets counted reveals who really counts.

Posted by Adam J. Fein, Ph.D. on Tuesday, May 5, 2026

Labels: Channel Management, Hospitals, Industry Trends, PBMs, Physicians, Specialty Drugs

Today’s guest post comes from Cindy Baksh, Chief Product Officer at ConnectiveRx.

Cindy explains that many gross-to-net (GTN) exposures now occur at the claim level, where evolving payer tactics, pharmacy economics, and copay complexity create unpredictable leakage. She argues that manufacturers must augment downstream review with real-time visibility and intervention to protect both revenue and patient access.

To learn more, register for ConnectiveRx’s free webinar on June 17: Gross-To-Net FOMO: What GTN Dangers Are You Missing Post-Launch?

Read on for Cindy’s insights.

Posted by Adam J. Fein, Ph.D. on Friday, May 1, 2026

Labels: Guest Post, Sponsored Post

By Adam J. Fein, Ph.D.

Spring has officially arrived at Drug Channels' worldwide headquarters in beautiful downtown Philadelphia. (Photo proof at right.) So, dive into this month’s curated crop of noteworthy news:

• The patient experience at PBM-affiliated specialty pharmacies

• New evidence of profit shifting in vertically integrated Part D businesses

• The growing gap between non-profit hospitals’ public mission and financial reality

Plus: Behind-the-scenes at DCI

P.S. Join my nearly 70,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

How PBMs’ Vertically Affiliated Pharmacies Shape Access Pathways for Oncology and Autoimmune Patients, IQVIA

This new IQVIA data shows striking differences in the patient experience at PBM-affiliated pharmacies compared with non-affiliated pharmacies.

Here’s our summary of the data.

[Click to Enlarge]

As you can see, for patients starting a new brand-name drug:

• Oral oncology: 84% approval at PBM-affiliated pharmacies vs. 70% at unaffiliated pharmacies
• Autoimmune: 63% vs. 61%

But the pathway matters:

• First-fill approvals are far higher at PBM-affiliated pharmacies (42% vs. 14% in oncology; 29% vs. 8% in autoimmune)
• At unaffiliated pharmacies, many patients only get approved after switching (14% oncology; 20% autoimmune)

Bottom line: PBM-affiliated pharmacies capture a disproportionate share of specialty volume. 

Posted by Adam J. Fein, Ph.D. on Tuesday, April 28, 2026

Labels: 340B, Costs/Reimbursement, Hospitals, Medicare Part D, PBMs, Specialty Drugs

Today’s guest post comes from Laura Jensen, Chief Commercial Officer and President, Pharma Direct at GoodRx.

Laura suggests that manufacturers must move beyond payer-centric models toward integrated, direct-to-consumer and employer channel strategies that connect pricing, demand, and fulfillment. She argues that this approach will help manufacturers convert patient intent into therapy initiation while expanding access at scale.

To learn more about GoodRx’s pharma solutions, visit GoodRx Pharma Direct.

Read on for Laura’s insights.

Posted by Adam J. Fein, Ph.D. on Friday, April 24, 2026

Labels: Guest Post, Sponsored Post

By Bryce Platt, PharmD

Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.

In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.

The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.

As you’ll see below, our analysis describes a 340B program that generates financial gains far in excess of any contribution back to the people of the state. There is also no clear accountability for how those dollars are used.

Posted by Adam J. Fein, Ph.D. on Thursday, April 23, 2026

Labels: 340B, Costs/Reimbursement, Hospitals

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.

Next week, the DCI team will be attending Asembia’s AXS26 Summit in fabulous Las Vegas. Please say hello if you see us!

Posted by Adam J. Fein, Ph.D. on Tuesday, April 21, 2026

Labels: Hospitals, PBMs, Specialty Drugs

Today’s guest post comes from Karishma Desai, Associate Director of Data Strategy at Claritas Rx.

Karishma explains how the complexities of specialty therapies require a customer relationship management (CRM) system that unifies consent management. She goes on to explain that by embedding AI into the patient journey, automating workflows at scale, and enhancing collaboration among stakeholders, organizations can reduce delays, improve adherence, and deliver better patient outcomes.

To learn more, download Claritas Rx’s white paper: The Omnichannel Gap: Building the CRM of the Future for Patient Services.

Read on for Karishma's insights.

Posted by Adam J. Fein, Ph.D. on Monday, April 20, 2026

Labels: Guest Post, Sponsored Post

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

Brok explains how missteps during patient support program transitions—ranging from service disruptions to data misalignment—can undermine access, adherence, and brand trust. He describes best practices organizations can use to ensure a smooth transition while protecting patients, providers, and program outcomes.

To learn more, download AssistRx’s Hub Transition Process Checklist. You can also schedule a meeting with the AssistRx team at the Asembia Summit in Las Vegas.

Read on for Brok’s insights.

Posted by Adam J. Fein, Ph.D. on Friday, April 17, 2026

Labels: Guest Post, Sponsored Post

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.

The chart below provides an updated illustration of the major vertical business relationships among insurers, PBMs, specialty pharmacies, healthcare services, and other companies within U.S. drug channels. The companies are listed alphabetically by insurer name.

Posted by Adam J. Fein, Ph.D. on Tuesday, April 14, 2026

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

Informa Connect’s Life Sciences Pricing & Contracting USA
May 18-20, 2026 | Philadelphia, PA

Drug Channels readers save 10% with code 26DRCH10*

Pricing & Contracting USA arrives at an important moment for our industry. As you work to navigate the evolving healthcare landscape, this annual event brings together 70+ expert speakers to lead the critical discussions that will drive comprehensive market strategy, uniting Medicaid, Policy, Pricing, Contracting & Reporting thought leaders.

Event features include:

• Wholesaler/Manufacturer Team-to-Team Meet-and-Greets: Direct industry collaboration led by McKesson and Cencora.


• Executive Programming: Fireside Chats with External Counsel, Closed Door Executive Strategy Summit and Luncheon.


• Interactive Sessions: Speed Networking, AI Lunch and Learn


• Strategic Working Groups: Medicaid Working Group Report, 80 Minute Industry Strategy Working Group.


• The Hottest Topics: Get ready for coverage on Most Favored Nation (MFN) Pricing Implementation, Medicare Part B Drug Negotiations (2028 Launch), 340B Rebate Model from all stakeholder perspectives, State Medicaid Revenue Transparency Sessions, Cell & Gene Therapy Outcomes-Based Contracting, AI-Powered Pricing Scenario Planning, Direct-to-Consumer Pharma Initiatives, Chargeback Data Accuracy Impact on Rebates, What's new with GTN, GPOs, PBMs, PDABs and SPTR, Government Shutdown Policy Timeline Disruption, and so much more.

Featuring 70+ speakers from: Accord, Alkermes, AstraZeneca, Azurity, Chiesi, CMS, CSL Vifor, Genentech, Gilead, GSK, Keenova Therapeutics, Novartis, OIG, PhRMA, Sandoz, UCB and many more.

Posted by Adam J. Fein, Ph.D. on Monday, April 13, 2026

Labels: Sponsored Post