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 30,000 subscribers. Learn more...

Friday, July 10, 2020

CMS Best Price Proposal and Copay Assistance: How New Rule Could Change the Access Landscape

Today’s guest post comes from Rick Fry, Senior Vice President of Commercial Solutions and Jason Zemcik, Senior Director of Product Management at TrialCard.

Rick and Jason outline their view of the crucial issues in the new proposed rule from Centers for Medicare and Medicaid Services (CMS) regarding copay accumulator adjustment programs. They preview the public comments that TrialCard expects to submit to CMS.

Please visit TrialCard’s copay accumulator program resources to learn more about mitigating copay accumulator programs. Contact sales@trialcard.com to discuss solutions for your organisation.

Read on for Rick’s and Jason’s insights.

Thursday, July 09, 2020

The Top 15 Specialty Pharmacies of 2019: PBMs Stay On Top (rerun)

This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from April 2020.


In Drug Channels Institute's list of the top 15 pharmacies of 2019, we show that many of the largest U.S. pharmacies are now central-fill mail and specialty pharmacies operated by PBMs and insurers.

To complement that broader ranking, we present below our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues. Consistent with our previous analyses, PBMs and insurers have retained their dominance over specialty drug channels, while smaller pharmacies are facing increased competition and profit pressures.

I see upside for specialty pharmacies in the aftermath of the pandemic. This growth will come at the expense of provider-administered drug channels. I expect the top companies’ share will increase in 2020, due to mergers and business transitions among the largest PBMs. However, the increasing role of government payers may create opportunities for smaller pharmacies.

This Friday, I’ll discuss how COVID-19 will affect the specialty pharmacy market during the first of my two live video webinars.

Wednesday, July 08, 2020

Four Unexpected Ways that the COVID-19 Medicaid Boom Will Affect PBM and Pharmacy Profits (rerun)

This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from April 2020.


The U.S. economy is in a medically-induced coma. Unemployment is soaring. Companies are teetering on the brink of bankruptcy. It is unclear when our lives will return to their pre-pandemic state.

One thing seems apparent: As people lose jobs and health insurance, Medicaid enrollment will jump, perhaps by as much as 20% to 30%. This will have profound implications for the drug channel.

Today, I focus on how this increase will affect retail pharmacies and pharmacy benefit managers (PBMs). Below, I review Medicaid enrollment trends, how states manage prescriptions, and the factors driving the coming boom in Medicaid enrollment.

As I explain, many (but not all) retail pharmacies will benefit from Medicaid growth. PBMs, however, will not fare as well. Read on and see if you agree.

Tuesday, July 07, 2020

Pharmacy DIR Fees Hit a Record $9 Billion in 2019—That’s 18% of Total Medicare Part D Rebates (rerun)

This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from February 2020.


Pharmacy-related price concessions in Medicare Part D—known as pharmacy DIR fees--have grown faster than most people realize.

We estimate that these payments reached $9.1 billion in 2019. This figure indicates that about 18% of total Medicare Part D rebates are now paid by pharmacies, not manufacturers. Details below.

To address concerns about how these fees are computed, the Centers for Medicare & Medicaid Services (CMS) has proposed some minimal transparency requirements for monitoring the metrics behind DIR fees. I suspect that the proposal will have no near-term impact on slowing the growth trends.

Our long time readers know that I’ve been skeptical about pharmacy owners’ claims regarding the impact of DIR fees. But it does now appear that these payments have become a significant economic burden. When the facts change, I change my mind. What do you do?

Monday, July 06, 2020

The Top 15 U.S. Pharmacies of 2019: Specialty Drugs Drive the Industry’s Evolution (rerun)

This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from March 2020.


Next week, Drug Channels Institute will release our 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 11th edition of our popular and comprehensive examination of the entire drug pricing, reimbursement, and dispensing system.

The exhibit below—one of 203 in our new report—provides a first look at the 15 largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2019. I also highlight business developments that shifted market share among the biggest players.

As you will see, pharmacy industry prescription dispensing revenues reached a record $446 billion in 2019. Revenues were highly concentrated due to the rapid growth of large specialty pharmacies and the multiple transactions that we discuss throughout our report.

For a sneak peek at the complete report, click here to download a free pre-publication draft overview (including the table of contents and a list of exhibits). We’re offering special discounted pricing if you order before March 22, 2019.

Wednesday, June 24, 2020

Drug Channels News Roundup, June 2020: CVS’s New GPO, CMS on Copay Accumulators, GoodRx Fees, Supermarket Pharmacies, and Merck’s Ken Frazier

Happy 244th birthday, America! Before you declare your (socially-distanced) independence, get up close and personal with these Drug Channels fireworks:
  • CVS launches a new GPO for its PBM
  • CMS rethinks copay accumulators
  • Here’s how GoodRx makes money
  • Supermarkets face pharmacy challenges
Plus, powerful and important comments from Ken Frazier, CEO of Merck.

P.S. Join the more than 9,500 followers of my curated links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted: Amazon’s activities, PillPack’s bad reviews, 340B outrages, rebate reform redux, biosimilar pricing, managed Medicaid market shares, drug pricing, blockchain hype, and the warp speed vs. hyperspace debate.

Tuesday, June 16, 2020

PBMs and Drug Spending in 2019: CVS Health and Express Scripts Outperform Prime Therapeutics

It’s time for our annual Drug Channels examination of PBM drug spending reports. For 2019, we again aim our magnifying glass at the annual trend reports from the largest pharmacy benefit managers (PBMs): CVS Health, Express Scripts, and Prime Therapeutics. (See their report links below.)

Once again, we find that commercial drug spending did not race higher—contrary to what you keep hearing from journalists and politicians. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. At some plan sponsors, total drug spending even declined. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth.

Notably, clients of Prime Therapeutics fared worse than those of Express Scripts and CVS Caremark. Below, I explain three factors behind Prime’s underperformance. Its third place finish highlights why the PBM industry continues to consolidate.

Friday, June 12, 2020

The Ripple Effect of Medication Access Barriers—Disruption to Stakeholder Workflows, Damage to Brand Perception, and Detriment to Innovation

Today’s guest post comes from Julia Phillips, VP, Pharma Accounts & Enablement at CoverMyMeds.

Julia discusses how medication access challenges can negatively impact brand-name drugs.

For more, check out this overview of CoverMyMeds' technology solutions that enhance patients’ access: Enabling Medication Access Through Technology.

Read on for Julia’s insights.

Tuesday, June 09, 2020

New HRSA Data: 340B Program Reached $29.9 Billion in 2019; Now Over 8% of Drug Sales

The 340B Drug Pricing Program has logged another year of incredible growth.

According to data provided to Drug Channels by the Health Resources and Services Administration (HRSA), discounted 340B purchases were at least $29.9 billion in 2019. That figure is an astonishing 23% higher than its 2018 counterpart.

Since 2014, purchases under the 340B program have tripled. Over the same period, manufacturers’ net drug revenues have grown at an average rate that’s below 5%. Consequently, the 340B program has grown to account for more than 8% of the total U.S. drug market and about 16% of the total rebates and discounts that manufacturers provide.

What’s more, the 340B program is now almost as large as the Medicaid program’s outpatient drug sales. However, 340B lacks Medicaid’s regulatory infrastructure and controls. Medicaid rebates directly and transparently lower drug costs for the government, while 340B discounts disappear into providers’ financial statements. It’s troubling and hard to defend.

Read on for our latest details on the 340B program’s ongoing and startling growth.

Wednesday, June 03, 2020

Pharmacist Job Market in 2019: Salaries Grew, Retail-to-Hospital Employment Shift Accelerated

The Bureau of Labor Statistics (BLS) recently released its employment data for 2019. That means it’s time to update our annual Drug Channels analysis of pharmacist salaries and employment.

Average base salaries were about $125,000, though there was substantial variation across practice settings.

Total pharmacist employment grew in 2019. Consistent with our previous analyses, the share of pharmacists who work at hospitals reached a new high.

However, the number of pharmacists working in retail settings decreased. The challenges facing the retail pharmacy industry, which I discuss in this video, are now showing up in the employment data. It’s more bad news for the pharmacists who are working for the weakened.

Monday, June 01, 2020

Visit Asembia’s Specialty Pharmacy Summit Virtual Experience

Like many of you, I was disappointed that Asembia had to cancel its 2020 Specialty Pharmacy Summit.

As a small consolation, Asembia is providing a series of on-demand business sessions. You can view them for FREE if your registration to the 2020 Specialty Pharmacy Summit was transferred to the 2021 Summit. Everyone else will have to pay a small fee.

Click here to register for access to Asembia’s Specialty Pharmacy Summit Virtual Experience. (You must register and create a new account, even if you are eligible for free access.)

Virtual business sessions cover such topics as market trends, the specialty pipeline, accreditation, federal health policy, digital health, and more.

Two highlights:
  • The State of Specialty Pharmacy 2020: Market Data and Trends—Adam J. Fein, Drug Channels Institute (That’s me!)
  • US Specialty Pharmaceuticals Trends, Issues and Outlook—Doug Long, IQVIA
For the full Las Vegas experience, I suggest that you review this important story before viewing the business sessions.

In the meantime, mark your calendars for the 2021 Specialty Pharmacy Summit, which is scheduled for May 2 to 5, 2021.

Wednesday, May 27, 2020

Drug Channels News Roundup, May 2020: COVID-19 and Formularies, Retail-to-Mail Trends, ABC on Biosimilars, and Social Distancing the CVS Way

FWIW: Summer is finally here. Before you venture outside for your lockdown barbeque, check out these noteworthy items off the Drug Channels grill:
  • Payers predict how COVID-19 will affect formularies
  • Our analysis of the 2020 retail-to-mail shift
  • AmerisourceBergen profiles biosimilars
Plus, CVS pharmacy offers a clever way to measure appropriate social distancing.

P.S. Join the nearly 9,400 followers of my curated links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted: hospital profits, drug spending, prior authorization at specialty pharmacies, legal issues for drug importation, private equity funding for a start-up PBM, physicians vs. PBMs, trends in Google Trends, and more. I continue to tweet under-the-radar stories about how the coronavirus is affecting drug channels and healthcare spending.