Drug Channels

Building What’s Next: Join Industry Leaders to Shape Access and Affordability Trends Ahead of Asembia AXS26

noreply@blogger.com (Adam J. Fein, Ph.D.) — Thu, 02 Apr 2026 10:30:00 +0000

Today’s guest post comes from Chrissy Hand, Chief Product and Commercial Officer at CoverMyMeds.

Chrissy highlights key themes in the future of patient access. She argues that policy changes, complex benefit designs, and affordability challenges require patient support services to be faster, more connected, and better aligned with real-world patient and provider needs.

Join CoverMyMeds’ April 23 AXS26 Innovation Roundtable.

Read on for Chrissy’s insights.
Read more »

Drug Channels News Roundup, March 2026: Cigna’s 340B Workaround, Merck’s ARPA Surprise, Walgreens’ Automation Bet, Why Rebates Hurt Patients, and a DCI Team Photo

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 31 Mar 2026 11:00:00 +0000

Spring is here in always-sunny Philadelphia. The vernal equinox has brought us an unexpected bounty of noteworthy news:

Cigna’s clever vertical integration move

Merck cuts drug prices—and Medicaid and 340B pay more

Walgreens’ big pharmacy technology play

How plans profit—and patients lose—from highly rebated drugs

Plus: A bonus photo from the Drug Channels Leadership Forum

P.S. Join my nearly 69,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

PBM Industry Update 2026: Trends, Challenges, and What's Ahead.

Don't forget to register for DCI’s next webinar on Friday, April 10, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Bryce Platt will unpack the good, the bad, and the ugly of the PBM industry—and explore what it means for you. Click here to learn more and sign up.

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

noreply@blogger.com (Adam J. Fein, Ph.D.) — Mon, 30 Mar 2026 11:00:00 +0000

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.

PBM Industry Update 2026: Trends, Challenges, and What's Ahead.

For a deeper dive into the state of the industry, register for DCI’s next webinar on April 10, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Bryce Platt will unpack the good, the bad, and the ugly of the PBM industry—and explore what it means for you. Click here to learn more and sign up.

The Rare Journey Needs a Special Pharmacy Partner

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 27 Mar 2026 10:30:00 +0000

Today’s guest post is from Bansi Nagji, Chief Executive Officer at PANTHERx Rare.

Bansi argues that rare disease pharmacy is a fundamentally different model built around precision, speed, and hyper-personalized care. He suggests how manufacturers and stakeholders must rethink their assumptions to effectively support the unique demands of rare disease patient journeys.

Hear from PANTHERx patients and their caregivers about what it’s like to live each day with a rare disease.

Read on for Bansi’s insights.
Read more »

Reflections and Photos from the Drug Channels Leadership Forum 2026

noreply@blogger.com (Adam J. Fein, Ph.D.) — Wed, 25 Mar 2026 10:30:00 +0000

We had an absolutely incredible time at the second annual Drug Channels Leadership Forum (DCLF)!

Despite some travel challenges, we still filled the room for a sold-out event packed with thought-provoking discussions, candid insights, and dynamic exchanges about the forces shaping the drug channel. The 340B session was legendary!

We are grateful to everyone who took the stage to share their insights and to all who participated in making this event so impactful. A huge thank you to our speakers for sharing their expertise and unfiltered perspectives—and to everyone in the room for making the conversations so engaging.

I had the privilege of speaking on stage with leaders from AstraZeneca, Boehringer Ingelheim, Cardinal Health, 46Brooklyn, Nephron Research, and Prime Therapeutics.

And Mark Cuban wrapped up the first day with his unfiltered and highly entertaining take on U.S. healthcare. (Spoiler: He had a few opinions.)

Click here to see a selfie of Mark and me from the stage.

I also had the privilege of introducing the Drug Channels Institute team, seven members of whom attended the event.

Two of DCI’s newest team members—Tyler Novotny and Bryce Platt—each moderated panels.

You can find more photos by searching for #DCLF2026 on LinkedIn.

BTW, you won’t see any news stories about the DCLF. That’s because the media were not invited and the sessions were not recorded. No livestreams. No transcripts. You had to be in the room where it happened.😉

The DCLF will return in March 2027.

P.S. A special shoutout to the phenomenal HMP Global team, who delivered a truly first-class experience for nearly 400 attendees. Your hard work and dedication made this event unforgettable!

NOW AVAILABLE: The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 24 Mar 2026 04:30:00 +0000

I am pleased to announce Drug Channels Institute’s new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, now available for purchase and immediate download.

Download a free 32-page report overview–including Key Industry Trends, What’s New in this edition, the Table of Contents, and a List of Exhibits.

Review pricing and license options and download the full 2026 report.

Special launch pricing discounts will be valid through April 6, 2026.

This report—our seventeenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. If you make strategic decisions in this industry, this report is essential reading.

WHAT’S INSIDE

Nearly 1,300 endnotes, most of which have hyperlinks to source materials

Substantial new material—outlined on page x of the report overview

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover). Click here to contact us if you would like to pay by corporate check or ACH.

Want to bundle the report with DCI’s video webinars? Email Marie Caldwell (mcaldwell@hmpglobal.com).

If you preordered, you should have received an email with download instructions last week. Didn’t get it? Contact us at dcisupport@hmpglobal.com, and we’ll take care of it.

WHAT’S GOING ON

Every year, the DCI team researches and writes economic reports with up-to-date, fact-based economic analyses of key drug channel participants. Our reports synthesize a wealth of statistical data, research studies, financial information, and our unique business experiences into definitive, nonpartisan resources.

Our goal is simple: help you understand how the drug channel really works—and where it’s going.

That's why DCI reports are widely used by nearly every company involved in the drug channel:

Pharmaceutical manufacturers

Wholesalers, pharmacists, and pharmacy owners

Payers, insurers, and plan sponsors

Hospitals, benefit managers, and managed care executives

Policy analysts, investors, consultants, and more

In other words, this report helps you understand what your customers, partners, and competitors are reading—and how they’re thinking.

The chart below illustrates the depth and breadth of the 2026 edition. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.

FUN FACTS ABOUT THE 2026 EDITION

The 12 chapters are self-contained—you don't need to read them in order. (Really!) Use the report as a reference guide or read it end-to-end. It’s designed as both a foundational resource and a deep dive into the latest trends and developments.

There are tons of internal hyperlinks to help you navigate and focus on what matters most to you.

We’ve updated all market and industry data with the most current insights, including our annual analyses of the largest pharmacies, specialty pharmacies, and PBMs.

Many sections have been expanded and reorganized to better reflect the latest industry developments. Check out the What’s New section in the report overview for details.

One of the available licenses gives you the option to download an additional PowerPoint file with images of all 270 exhibits—making it easier to share insights with your team. (Note: All license versions include exhibits within the text.)

There are a staggering 1,284 endnotes (!), most of which have direct hyperlinks to original source materials. This allows you to validate, explore, and go deeper.

We have reluctantly removed all corny jokes and pop culture references. So, no memes and absolutely no references to SpongeBob SquarePants.

Thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me. We look forward to helping you succeed in the evolving U.S. drug channel.

Medical Benefit Maximizers Are Emerging as a Critical Market Force: What Manufacturers Need to Understand

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 20 Mar 2026 10:30:00 +0000

Today’s guest post comes from Michael Harris, Vice President of Patient Support Services Strategy at Valeris.

Michael explores the rise of medical benefit maximizers as a new—and often overlooked—force shaping patient access. He outlines how these strategies can erode access, absorb support dollars, and introduce hidden risks for brands.

To learn more about Valeris’ technology solutions and data analytics capabilities, connect with Valeris.

Read on for Michael’s insights
Read more »

The Top 15 U.S. Pharmacies of 2025: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 17 Mar 2026 10:30:00 +0000

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). We’re offering special discounted pricing if you order before April 6, 2026.

PBM Industry Update 2026: Trends, Challenges, and What's Ahead.

Don’t miss DCI’s next webinar on April 10, 2026, from 12:00 p.m. to 1:30 p.m. ET. Dr. Adam J. Fein and Bryce Platt will unpack the good, the bad, and the ugly of the PBM industry—and explore what it means for you. Click here to learn more and sign up.

Reshaping Patient Affordability: The Power of Expertise and Agility

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 13 Mar 2026 11:00:00 +0000

Today’s guest post comes from Logan Melchione, Vice President of Patient Affordability at Paysign.

Logan examines how pharmaceutical manufacturers must rethink copay assistance in an era affected by maximizers, accumulators, and intensifying payer scrutiny. She argues that brands can both gain a strategic advantage and safeguard adherence by embracing claims-based precision, real-time adaptability, and transparent program design.

Request an analysis of your copay assistance program by emailing Paysign at affordability@paysign.com or by visiting paysign.com/rx.

Read on for Logan’s insights.
Read more »

PBM Industry Update 2026: Trends, Challenges, and What’s Ahead (NEW Live Video Webinar)

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 10 Mar 2026 11:00:00 +0000

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

PBM Industry Update 2026:

Trends, Challenges, and What’s Ahead

This event will be broadcast live on:

Friday, April 10, 2026
12:00 p.m. to 1:30 p.m. ET

Dr. Fein will be joined by Bryce Platt, a Director at DCI and an expert on PBMs' contractual and business relationships with plan sponsors.

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 Bryce Platt for an exclusive deep dive into the latest trends, data, and strategies shaping the pharmacy benefit management (PBM) industry. Drawing from the brand-new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, they will provide invaluable insights to help you and your team stay informed about this rapidly evolving market.

Adam and Bryce will share their expert analysis on critical industry developments, including:

The competitive landscape of major PBMs, with exclusive new market share data from DCI

Key business trends among leading PBMs and their impact on the market

PBMs’ expanding role in specialty pharmacy and how it’s reshaping the industry

Exclusive insights into the Federal Trade Commission’s settlement with Express Scripts

The outlook for the rebate system and the emergence of the Net Pricing Drug Channel

What the Consolidated Appropriations Act of 2026 (CAA) means for PBMs’ profits and business strategies

The evolving role of independent PBMs and their market positioning

How health-system-owned PBMs are changing the game

Fresh data on plan sponsors’ perspectives on their PBM partners

Key takeaways from PBMs’ 2026 commercial formularies

The coming shifts in PBM compensation models

The risks and rewards of PBM-affiliated private-label products and GPOs

Latest developments in the 340B Drug Pricing Program

State and federal PBM regulations: What’s ahead?

Emerging controversies, challenges, and threats to watch in the industry

And much more!

As always, the presenters will clearly distinguish their opinions and interpretations from the objective facts and data.

This 90-minute video webinar will feature a dedicated Q&A session, where attendees can unmute and engage directly with Adam and Bryce.

Register now to stay informed and get ahead of the curve on the PBM industry!

PRICING OPTIONS

Take advantage of this exclusive educational opportunity for just $420 per viewing device. Once you register, you'll receive a unique Zoom access link within 24 hours—making it easy to add the event to your calendar and ensure you don’t miss out.

Special Discounts For Teams!

We understand that many professionals are working remotely, so we’re offering substantial savings for multiple registrations from the same organization. What's more, an unlimited number of attendees can watch together at a single physical location with one registered device.

Important Reminder: Each device at a single physical location must have its own registration. The webinar may not be recorded, streamed, broadcast, or shared across different locations, devices, or sites.

Click here to register. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)

PBM Industry Update 2026: Trends, Challenges, and What’s Ahead

Questions about corporate pricing? Please contact Marie Caldwell (mcaldwell@hmpglobal.com).

Purchasing access for multiple sites? We'll contact you for your participant list. Or, download this spreadsheet and email your registrants’ information to dcisupport@hmpglobal.com.

Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover). Prefer check or ACH? Click here to request an invoice.

Click here for other important things to know about this event.

Time to Evolve: Hubs Flex to New Demands

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 06 Mar 2026 12:00:00 +0000

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

Josh examines how hub models are evolving under mounting commercial, operational, and technological pressures. He argues that the next generation of patient services will be defined not by a single model, but by adaptability and shared strategy.

To learn more, download Cardinal Health’s latest hub evolution insights from its two-year trend archive: 2026 insourcing and outsourcing trends for patient hubs.

Read on for Josh’s insights.
Read more »

Preorder Now: DCI’s 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 03 Mar 2026 12:00:00 +0000

On March 24, 2026, Drug Channels Institute will release The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our seventeenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. If you make strategic decisions in this industry, this report belongs on your desk.

12 chapters, 500+ pages, 270 exhibits, and nearly 1,300 endnotes. No other resource matches the scope, depth, and rigor of this resource.

We are offering you the opportunity to preorder the thoroughly updated, revised, and expanded 2026 edition at special discounted prices. Preordering guarantees early access and locks in the lowest available price. Those who preorder will receive a download link before March 30.

Download a free 32-page pre-publication overview (including Key Industry Trends, What's New in this edition, the Table of Contents, and a List of Exhibits)

Review pricing/license options and place a preorder

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover). Click here to contact us if you would like to pay by corporate check or ACH.

Email Marie Caldwell (mcaldwell@hmpglobal.com) if you’d like to bundle the report purchase with access to DCI’s video webinars.

Special preorder and launch pricing discounts will be valid through April 6, 2026. After that date, prices increase. Secure your discount now.

The report was researched and written by the Drug Channels Institute team, led by Adam J. Fein, Ph.D. As shown below, the 2026 edition delivers unmatched depth and breadth. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.

The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers contains the most current market and industry data available, including DCI’s annual analyses of the market positions of the largest pharmacies, specialty pharmacies, and PBMs. Throughout the report, we have added new industry data, deepened our coverage of many topics, and expanded our analysis of emerging trends.

This definitive, nonpartisan report will aid pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospital executives, pharmacy buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and anyone else who wants to understand and benefit from this ever-changing industry. If your organization competes, negotiates, invests, or sets policy in this market, this report will sharpen your strategy.

There are many notable updates in this 2026 edition, including:

A new Section 4.3.4. analyzes manufacturers’ direct-to-patient (DTP) websites and TrumpRx within the broader context of patient-paid prescriptions.

A new Section 5.5. deconstructs the three largest PBMs’ gross profits. Some of this material previously appeared in Chapter 11.

Material in Section 7.1., Section 9.1., and Section 9.3. reflects the PBM legislative reforms contained within the Consolidated Appropriations Act, 2026 (P.L. 119-75), which became law in February 2026.

Material in Section 8.4. and Section 9.3. incorporates implications of the 2026 settlement between Express Scripts and the Federal Trade Commission.

A new Section 6.3.3. reviews research on how the IRA’s implementation has affected out-of-pocket spending by Medicare Part D beneficiaries.

A new Section 11.2.4. analyzes pharmacies’ dispensing profits under the Inflation Reduction Act of 2022 (IRA).

A new Section 12.1.4. evaluates the potential implications of most favored nation (MFN) and tariff policies on the drug channel.

In Section 12.3.1., our illustration of major vertical business relationships among drug channel businesses now incorporates affiliated third-party administrators (TPAs) and administrative services only (ASO) platforms.

We have also improved our presentation of material about the IRA and the 340B Drug Pricing Program.

You can read about these changes starting on page x of the report overview.

Thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me. We look forward to supporting your team’s success in 2026.

Beyond DTP 2.0: How Flexible Direct-to-Patient Programs Power Best-In-Class Patient Experiences

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 27 Feb 2026 10:36:00 +0000

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.
Read more »

Drug Channels News Roundup, February 2026: Mark Cuban on FTC-ESI, What Patients Really Want, QALYs vs. MFN, 340B’s Site of Care Shift, and New Faces at DCI

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 24 Feb 2026 11:00:00 +0000

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.
Read more »

The State of Patient Access: What Industry Leaders Reveal in a New Survey About Hub Models, Technology, and the Road Ahead

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 20 Feb 2026 11:00:00 +0000

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.
Read more »

Medicare Part D Pharmacy Networks in 2026: Supermarkets Dominate as Drugstores Stall and Independents Walk Away

noreply@blogger.com (Adam J. Fein, Ph.D.) — Wed, 18 Feb 2026 11:00:00 +0000

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.
Read more »

The Key to a Better Patient Experience: Improved GTN

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 13 Feb 2026 11:00:00 +0000

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.
Read more »

Copay Accumulators and Maximizers in 2025: Popular, Profitable, and Problematic

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 10 Feb 2026 11:00:00 +0000

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.
Read more »

In an Uncertain 340B Environment, Kalderos Offers a Clear Path Forward

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 06 Feb 2026 11:30:00 +0000

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.
Read more »

The FTC Blows Up Express Scripts’ PBM Model—and Launches the Net Pricing Drug Channel

noreply@blogger.com (Adam J. Fein, Ph.D.) — Wed, 04 Feb 2026 18:56:00 +0000

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.
Read more »

Latest CMS Data Reveal Six Trends Reshaping U.S. Drug Spending

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 03 Feb 2026 11:30:00 +0000

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.
Read more »

From Cost Center to Insights Center: How Patient Support Will Go Beyond the Call in 2026

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 30 Jan 2026 08:13:00 +0000

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.
Read more »

Drug Channels News Roundup, January 2026: Cuban vs. Optum, McKesson’s Biosimilar Play, States vs. Accumulators, 340B Windfalls, and Ozempic Ads

noreply@blogger.com (Adam J. Fein, Ph.D.) — Tue, 27 Jan 2026 11:30:00 +0000

Super Bowl LX is almost here! Time for some blowout beer and snack commercials, occasionally interrupted by an actual football game. DCI’s hometown Philadelphia Eagles will not be going to the big game, so the city’s light poles will remain Crisco-free and upright.

While you wait for kickoff, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron:

Mark Cuban takes on Optum’s Patrick Conway in a fiery debate

McKesson makes its private-label biosimilar move

State anti-accumulator laws keep gaining ground

340B hospitals are still specialty drug profiteers

Plus: Will Ozempic's new ad campaign make us nostalgic for 2006?

P.S. Join my more than 67,000 LinkedIn followers for daily links to neat stuff, along with sharp, thoughtful commentary from the DCI community.
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New Drug Launches in a Self-Pay World: Why Access Strategy Matters as Much as Innovation

noreply@blogger.com (Adam J. Fein, Ph.D.) — Fri, 23 Jan 2026 11:30:00 +0000

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

Laura argues that patient self-pay has evolved from a temporary bridge to a core access strategy for new drug launches. She examines how manufacturer-funded self-pay offers can be operational from day one.

Click here to learn more about GoodRx’s access and affordability solutions.

Read on for Laura’s insights.
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The Big Three PBMs’ 2026 Formulary Exclusions: MFP, Private Label Biosimilars, and Direct-to-Patient Threats for PBMs

noreply@blogger.com (Adam J. Fein, Ph.D.) — Thu, 22 Jan 2026 05:30:00 +0000

For 2026, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (United Health Group)—have once again excluded hundreds of drugs from their standard formularies. Our updated counts appear below.

The 2026 lists highlight how formulary preferences for Humira and Stelara are dominated by private-label biosimilars affiliated with the same parent companies that operate the three largest PBMs. Many of the preferred products feature lower list prices, signaling growing tension between traditional rebate-driven formularies and emerging net-price-based competition.

These developments matter because the pricing system that underpins PBMs’ formulary leverage is weakening. The gross-to-net bubble is deflating and the industry is moving toward what we call the Net Pricing Drug Channel (NPDC).

As low list prices, direct-to-patient distribution, and cost-plus reimbursement models gain traction, formulary exclusions will no longer deliver the economic power they once did. These changes threaten PBMs’ leverage—and profits.

As usual, Mark Cuban is leading the way. AbbVie itself now appears to be following. Consider this year’s formulary review a preview of what market access looks like when the rebate game starts to unwind.
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