Football season is officially back. Personally, my signal is hearing my uncle curse about bad calls from 1,000 miles away, but you may have already seen a game.
This news roundup is short enough to fit into an ad break or two. *Caveat: may lead to rabbit holes that take much longer than an ad break.
In this issue: Extra: A drug channel dating mismatch
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Analysis: How New Federal Policies and Lower List Prices Are Reducing 340B Savings, 340B Report
340B covered entities are watching their margins shrink as list prices decrease.
340B Report has some data behind how the IRA and other new federal policies are squeezing 340B margins nationally. The ten IRA-negotiated Part D drugs already account for roughly 30% of the entire Part D market, and more join the list every year, including Medicare Part B drugs starting in 2028.
Health centers are feeling it more than hospitals right now, since Part D drugs make up a bigger share of their dispensing.
Here's how the math behind a shrinking 340B ceiling price works.
This is one piece of what we call the Net Pricing Drug Channel #NPDC (more background on NPDC here): the entire gross-to-net bubble deflating, not just the chunk that funds 340B. PBM rebates negotiated as a percentage of list price, plan cost-sharing built on list prices, and wholesaler/pharmacy spreads off WAC are all exposed to the same pressure as list prices keep falling toward net.
340B Report has some data behind how the IRA and other new federal policies are squeezing 340B margins nationally. The ten IRA-negotiated Part D drugs already account for roughly 30% of the entire Part D market, and more join the list every year, including Medicare Part B drugs starting in 2028.
Health centers are feeling it more than hospitals right now, since Part D drugs make up a bigger share of their dispensing.
Here's how the math behind a shrinking 340B ceiling price works.
[Click to Enlarge]
This is one piece of what we call the Net Pricing Drug Channel #NPDC (more background on NPDC here): the entire gross-to-net bubble deflating, not just the chunk that funds 340B. PBM rebates negotiated as a percentage of list price, plan cost-sharing built on list prices, and wholesaler/pharmacy spreads off WAC are all exposed to the same pressure as list prices keep falling toward net.
Why Are Drug Manufacturers Cutting List Prices? Inside the 2026 WAC Reduction Trend, BGBx and Hayden Consulting Group
Very related to the last news item, cutting your drug's list price by 50% can result in more money for some manufacturers.
Seven leading brands cut their WAC by an average of 50% (up to 75%) effective January 2026, and five of those seven were selected for Medicare drug price negotiation. Novo is cutting Wegovy, Ozempic, and Rybelsus WAC by up to 50% effective January 2027 to line up with new MFPs.
Here's a comparison of gross-to-net pricing and #NPDC pricing.
BGBx and Hayden Consulting Group covered five places the savings show up.
Seven leading brands cut their WAC by an average of 50% (up to 75%) effective January 2026, and five of those seven were selected for Medicare drug price negotiation. Novo is cutting Wegovy, Ozempic, and Rybelsus WAC by up to 50% effective January 2027 to line up with new MFPs.
Here's a comparison of gross-to-net pricing and #NPDC pricing.
[Click to Enlarge]
BGBx and Hayden Consulting Group covered five places the savings show up.
- Payer rebate savings, particularly for heavily contracted, high-rebate brands
- Patient support programs
- Statutory programs like we saw with 340B above
- Reduced liability in the catastrophic phase where liability jumps from 10% to 20% for manufacturers
- Prompt payment and distribution fees to wholesalers
Cost of Access: Patient Affordability Now Shapes Utilization, IQVIA
Copay assistance doesn't just cut abandonment at the first fill. It can also nearly double how long patients stay on therapy.
IQVIA's analysis compares commercial patients with and without copay card support across abandonment at first fill, one-year adherence, and six-month persistence. Abandonment fell in every category studied, with the sharpest improvements in immunology and antihypertensives.
Here's the impact of copay cards on patient behavior.
Across all markets, average days adherent roughly doubled—102 days to 202 days—and six-month persistence more than doubled, from 21% to 48%. Immunology had the biggest abandonment improvement but didn't see the same adherence and persistence lift, a reminder that affordability is a powerful lever but not the only one.
IQVIA's analysis compares commercial patients with and without copay card support across abandonment at first fill, one-year adherence, and six-month persistence. Abandonment fell in every category studied, with the sharpest improvements in immunology and antihypertensives.
Here's the impact of copay cards on patient behavior.
[Click to Enlarge]
Across all markets, average days adherent roughly doubled—102 days to 202 days—and six-month persistence more than doubled, from 21% to 48%. Immunology had the biggest abandonment improvement but didn't see the same adherence and persistence lift, a reminder that affordability is a powerful lever but not the only one.
Indirect Impacts of the Inflation Reduction Act Benefit Redesign on Medicare Part D, Milliman
A new Milliman white paper walks through how the IRA has reshaped Part D funding mechanics. One major piece is the direct subsidy has exploded from $29.58 PMPM in 2024 to $254.72 PMPM in 2027.
For some plans, that direct subsidy can be higher than their whole bid to CMS, resulting in a negative premium, which starts a spiral.
Milliman frames it as a funding-mechanics problem more than a benefit-design failure since reinsurance used to true up to actual experience, and capitation doesn't.
Some of these issues (like RxHCC recalibration) should improve on its own in coming years. The rest needs legislative action to address.
For some plans, that direct subsidy can be higher than their whole bid to CMS, resulting in a negative premium, which starts a spiral.
[Click to Enlarge]
Milliman frames it as a funding-mechanics problem more than a benefit-design failure since reinsurance used to true up to actual experience, and capitation doesn't.
Some of these issues (like RxHCC recalibration) should improve on its own in coming years. The rest needs legislative action to address.
If the Drug Channel Had Dating Profiles, LinkedIn
Dating apps work because both sides are optimizing for the same outcome. The drug channel has multiple stakeholders swiping on completely different goals.
Here's a reimagining of each link in the drug channel into a dating profile.
Here's a reimagining of each link in the drug channel into a dating profile.
[Click to Enlarge]
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