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

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

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.

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

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.

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

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.

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

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.

The Key to a Better Patient Experience: Improved GTN

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.