Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 100,000 subscribers and followers. Learn more...
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.
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.
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.
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.
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.)
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!
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
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.
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.
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.
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.
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.
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.
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.
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.)
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.
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.
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.
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.
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.
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.
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:
