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.
Drugs, Discounts and Data: Crafting Sustainability in an Imperfect System
By Angie Franks, Chief Executive Officer, Kalderos
For years, manufacturers have operated in a healthcare ecosystem defined by opaque revenue flows, disconnected systems and limited visibility into where drug discounts are actually having an impact. Everyone has acknowledged the problem, which goes well beyond drug discount programs, but very little has changed in over a decade.
That is starting to shift.
Between growing scrutiny of PBMs, rising affordability concerns and increased focus on 340B program integrity, transparency is no longer a policy talking point. It is becoming an operational necessity, and stakeholders across the healthcare ecosystem are stepping into this new reality.
Fragmentation Is Fueling Waste
Saying that the system needs fixing is not controversial. Nearly every stakeholder can agree that the drug pricing landscape has become too complex, too opaque, and too wasteful. It’s clear that the need is real and imminent for an objective, transparent and reliable source of truth about prescription drug discounts and claims.
A lack of claims-level visibility across the transaction landscape often leaves manufacturers without a clear picture of what is fueling gross-to-net (GTN) leakage or where market access investments are most effective. On any given dispense, overlapping financial obligations—such as Medicaid rebates, 340B discounts, chargebacks, and commercial rebates—may converge without a unified view. This fragmentation results in duplicate discounts, revenue leakage, and diminished forecasting accuracy, placing increasing financial strain on the entire healthcare ecosystem.
Ultimately, patients feel the impact.
When billions of dollars are lost to fragmented systems and disconnected data, fewer resources are available for innovation, patient support programs and expanding access to medicines. Meanwhile, complexity and opacity continue benefiting intermediaries instead of improving affordability for patients.
The issue is not the existence of discounts. The issue is the inability to consistently validate where those discounts occur and whether multiple discounts are being paid on the same claim across programs.
Moving from Reconciliation to Pro-Active Governance
The industry is no longer standing still. Legal, regulatory, and market pressures are accelerating a broader shift toward transparency and accountability across drug discount programs. Instead of chasing problems after the fact, manufacturers are beginning to identify risk earlier, reduce leakage and establish stronger financial control across programs.
The opportunity is not theoretical—the progress is tangible. To date, seven pharmaceutical manufacturers have moved away from legacy approaches and fragmented systems in favor of a more transparent, claims-level model. They won’t be the last.
Now it’s a matter of “when,” not “if,” the rest of the industry follows. Manufacturers are increasingly recognizing that disconnected point solutions and retrospective reconciliation are no longer enough to manage the growing complexity of today’s drug discount ecosystem.
Recent court rulings have made it increasingly clear that manufacturers are within their rights to condition 340B pricing on data submission requirements. That marks a meaningful shift away from a longstanding status quo where manufacturers were often forced to identify noncompliance and recoup lost revenue only after claims had already been processed.
Kalderos has built a growing database of more than 100 million verified claims to support this kind of visibility and infrastructure. That foundation is designed to help organizations move from fragmented data and reactive workflows to a model grounded in clearer oversight and stronger financial control.
Debates about what health policy in the United States looks like are not likely to be settled soon, but the movement we’re seeing towards greater transparency is proof of meaningful change. Good, reliable, comprehensive and easily accessible data is the backbone of any modern and complex system—and this one should be no different.
Fixing this system starts with visibility. The organizations that embrace transparency and proactive governance today will be the ones best positioned to reduce waste, strengthen financial control and ensure healthcare resources are being directed where they matter most: supporting innovation, improving affordability and expanding patient access to medicines.
The tides are already turning. The only question is who will adapt fast enough to stay ahead.
Register for our upcoming free webinar GTN Oversight: A New Standard of Transparency Is Here that will explore why claims collection is only the starting point and why manufacturers need to act now to turn claims-level visibility into broader GTN oversight, stronger financial control, and better decision-making.
Sponsored guest posts are bylined articles that are screened by Drug Channels to ensure a topical relevance to our exclusive audience. The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish a guest post on Drug Channels, please contact Paula Fein (paula@DrugChannels.net).
No comments:
Post a Comment