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...
Today’s guest post comes from William Grambley, Chief Product Officer at AssistRx.
William discusses four specific use cases for how AI can create efficiencies and improve patient support programs for both healthcare providers and patients. He provides three considerations that life sciences organizations should evaluate when adopting AI in their patient support programs.
Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.
DCI has identified nearly 1,900 dispensing locations with specialty pharmacy accreditation. Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates.
As in prior years, pharmacies linked to the three largest pharmacy benefit managers (PBMs) accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. We also explore how these pharmacies contribute to PBMs’ profitability—and spotlight the growing influence of provider- and health system-owned dispensing channels.
Once again, “specialty” mostly means affiliated with a PBM.
In today’s fast-moving pharmaceutical marketplace, insight is everything. Whether you're building trust with customers, launching new products, or guiding internal teams, understanding the economic forces that shape drug distribution, reimbursement, and pricing is essential.
At Drug Channels Institute (DCI), we know how critical this knowledge is—and how hard it can be to find credible, up-to-date training that fits into a busy professional’s schedule. That’s why we created our DCI eLearning Modules: a suite of six interactive, expertly narrated courses that deliver must-know insights in 45 minutes or less.
These modules were built from the ground up for pharmaceutical professionals—from seasoned experts to newcomers looking to understand the industry's complex web of relationships. Each course distills our signature Drug Channels expertise into engaging, bite-sized lessons that are ideal for:
Sales and field teams: seeking clearer context for their customer conversations
Market access, training, and internal strategy groups: who need to understand payer and channel dynamics
Any professional: ready to level up their understanding of pharmaceutical economics
Each module features:
Interactive graphics and animations for improved retention
Expert voice-over narration to guide you through complex topics
References to key DCI reports for optional deep dives
iPad compatibility for learning on the go
The modules are available only via a site-wide license, giving your entire organization access through your internal learning platform. We also offer licenses to our secure hosted learning environment—no internal setup required! (Sorry, individual licenses are not currently available.)
What You’ll Learn: A Snapshot of Each Module
1. Follow the Dollar: How Funds Flow in the Distribution and Reimbursement Channels
This foundational course breaks down the financial and product flows in U.S. pharmaceutical distribution. You'll learn how money and medicines move between manufacturers, wholesalers, pharmacies, PBMs, and payers—and how each relationship affects costs and outcomes.
2. The Economics of Retail, Mail, and Specialty Pharmacies
Gain a clear-eyed view of how different pharmacy channels generate revenue and manage costs. Understand reimbursement dynamics, cost estimation methods, and how profitability varies across drug types and dispensing models.
3. The Business of Specialty Pharmacy
Specialty drugs are revolutionizing care—and reshaping the pharmacy business. This module explores how these products are distributed, covered by insurance, and supported through value-added services.
4. The Economics of Provider-Administered Specialty Drugs
Navigate the unique dynamics of provider-administered drugs, from buy-and-bill systems to ASP reimbursement. Understand how coverage types, care sites, and financial relationships affect access and profitability.
5. Understanding Pharmacy Benefit Managers
PBMs wield enormous influence—but many professionals may not fully understand their true impact. Learn how PBMs operate, where they make money, and how they interact with manufacturers, payers, and pharmacies.
6. Pharmaceutical Wholesalers: Business Strategies and Financial Economics
Take a deep dive into how wholesalers operate, generate profits, and provide critical services. You’ll come away understanding the difference between full-line wholesalers and specialty distributors—and why that matters for your strategy.
Bottom line: If you or your team work in any part of the pharmaceutical value chain, DCI’s eLearning modules will make you smarter, faster. They’re the shortest path to mastering the industry's most important (and most misunderstood) topics.
Today’s guest post comes from Jim Hundemer, Chief Information Security Officer (CISO), and Sudhakar Velamoor, Chief Technology Officer (CTO), of Kalderos.
Jim and Sudhakar discuss some of the complex challenges manufacturers face as they deal with outdated data systems, information silos, misapplied discounts, and growing cyber security threats. They argue that these challenges will lead to lost revenue, third-party security breaches, and diminished patient care.
It's time for Drug Channels’ annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. As you can see below, we have revised, renovated, and refurbished our infamous illustration of the major vertical business relationships among the largest companies.
Proponents of these vertical integration arrangements argue that they create opportunities to mine healthcare costs. However, these organizations remain highly controversial, due to the potential for anti-competitive behavior. We summarize some of the key issues below.
While some major companies have narrowed their focus or unwound previous integration efforts, ongoing consolidation and selective deconsolidation will continue to reshape the healthcare biome by trying to build something epic, block by block.
It's time for Drug Channels’ annual examination of U.S. brand-name drug pricing.
For 2024, average brand-name drugs’ list prices grew by only 2.3%. What’s more, after adjusting for overall inflation, brand-name drug net prices dropped for an unprecedented seventh consecutive year. Details and additional commentary below.
As I predicted two years ago, the combined impact of changes to Medicaid rebates, the Inflation Reduction Act (IRA), and novel formulary access strategies have led multiple manufacturers to pop the gross-to-net bubble for high-list/high-rebate products. Consider the 18 products with list-price cuts shown below. Other drugmakers have reduced the rate of price increases, thereby inflating the bubble more slowly.
Employers, health plans, and pharmacy benefit managers (PBMs) determine the extent to which patients with insurance share in this ongoing deflation. But signs of change to the conventional approaches are undeniable.
New channel models—including smaller PBMs, cost-plus pharmacies, patient-paid discount card prescriptions, and manufacturers’ direct-to-patient businesses—are creating novel paths for drugs that can be sold without gross-to-net bubble distortions.
The bubble won’t vanish overnight. But for the first time in years, I can foresee a time when SpongeBob SquarePants will move on from Drug Channels.
ICYMI, the largest three pharmaceutical wholesalers—Cardinal Health, Cencora, and McKesson—are using vertical integration to build significant market positions in businesses beyond drug distribution.
In the video clip below, I review the vertical integration status of the largest three pharmaceutical wholesalers, illustrated in the chart below.
[Click to Enlarge]
I also:
Explain how wholesalers have strengthened their position in buy-and-bill channels for provider-administered drugs through vertical integration with their downstream customers.
Discuss how and why private equity roll-up activity has provided wholesalers with strategic opportunities to acquire ownership stakes in practice management companies.
Outline the market access implications for provider-administered biosimilars in the buy-and-bill market.
It’s time to pay attention to the money behind the 340B curtain.
Minnesota just released the industry‘s first ever mandated financial report on the 340B Drug Pricing Program. Below, I do a wicked deep dive into the data and highlight crucial implications about spending, profits, pharmacies, plans, patients, program integrity, and more.
There are important limitations to these data. But Minnesota’s report marks a valuable first step on the yellow brick road to the wonderful world of transparency. I suspect similar reports are gonna be popular.
For 2025, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (United Health Group)—have again each excluded hundreds of drugs from their standard formularies. You can find our updated counting below.
As you’ll see below, the combination of formulary exclusion and private labels is creating an increasingly confusing and crowded biosimilar marketplace.
For 2025, the Big Three PBMs shifted national formularies to favor their private-label biosimilars over Humira and its many biosimilar competitors. In fact, nearly all marketed Humira biosimilars are excluded from the larger PBMs’ 2025 formularies. Meanwhile, Stelara—this year’s big pharmacy benefit biosimilar launch—remains on the PBMs’ formularies, but will share space with PBMs’ private label products.
Like it or not, PBMs’ financial benefits from their private-label product align with the benefits to plan sponsors and patients. But the PBMs’ strategies, combined with the warped incentives baked into the Inflation Reduction Act, raise questions about the viability of the biosimilar marketplace.
Three’s still company in the world of pharmacy benefit managers.
For 2024, nearly 80% of all equivalent prescription claims were processed by three familiar companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. The names haven’t changed, but shifting relationships and contract shakeups have altered the plot, with Express Scripts stepping into a new lead role.
Below, we break down the latest market share data from Drug Channels Institute (DCI), explore the developments driving these changes, and examine what they signal for the future of the PBM landscape.
Today’s guest post comes from Josh Marsh, Vice President and General Manager, Sonexus™ Access and Patient Support at Cardinal Health.
Josh discusses how patient support programs are evolving, including the shift toward outsourcing individualized hub functions. He lists five characteristics pharmaceutical companies should look for when evaluating outsourced support for long-term program success.
Spring has officially arrived in sunny downtown Philadelphia—the proud home base of Drug Channels. As you can see on the right, we celebrated in Miami at the Drug Channels Leadership Forum.
The vernal equinox also brought a surprising surge of industry updates and noteworthy news you won’t want to miss:
Blue Shield of California provides a puzzling update to its PBM unbundling effort
The Stelara biosimilar price war begins
My reaction to Optum Rx’s pharmacy reimbursement announcement
A valuable Follow the Dollar primer
Plus, Dr. Glaucomflecken reviews UnitedHealth Group's vertical integration strategy.
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.
This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.
