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 nearly 100,000 subscribers and followers. Learn more...

Wednesday, June 19, 2024

Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from April 2024.


Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents.

Today, we examine how manufacturers’ specialty networks contribute to this concentration. In DCI’s exclusive analysis below, we show that specialty pharmacies affiliated with pharmacy benefit managers (PBMs) play an outsized role in manufacturer-designated dispensing networks.

A typical network contains about five specialty pharmacies—but one in three specialty products with a manufacturer-designated network contains only a single specialty pharmacy. In those exclusive networks, independent and smaller specialty pharmacies are the big winners.

Read on for DCI’s updated profile of specialty networks—and ponder why smaller pharmacies are winning the battle for exclusive networks.

Tuesday, June 18, 2024

The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

One important update to the figures below: We (and many others) had significantly underestimated Walgreens' revenues and market share. As we discuss below, its market share is closer to 10%, compared with the 3% that we originally reported.

Click here to see the original post from April 2024.


Drug Channels Institute’s (DCI’s) latest analysis finds that participants in the specialty pharmacy market continue to get more diverse—although revenues remain highly concentrated.

We have identified nearly 1,800 dispensing sites with specialty pharmacy accreditation—about 40% of which are owned by hospitals, physician practices, and other healthcare providers.

Alas, specialty pharmacies owned by the three largest pharmacy benefit managers (PBMs) have the most brass in their pocket, as they accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.

Read on for DCI’s latest overview of the 2023 marketplace and revenues of the biggest market participants, along with key specialty pharmacy trends.

Monday, June 17, 2024

The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from April 2024.


Three is still the magic number for pharmacy benefit managers (PBMs).

For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.

Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.

Friday, June 14, 2024

Expanding our Definitions of Out-of-Pocket Costs: Three Imperatives for Biopharmaceutical Manufacturers

Today’s guest post comes from Christine Juday, Head of Market Access at Real Chemistry.

Chris discusses new research on how patients perceive out-of-pocket costs. As she explains, many patients and unpaid caregivers consider out-of-pocket costs for medication within the context of their total spending. She then recommends three ways that manufacturers can improve patients' access and affordability.

Click here to learn more about Real Chemistry’s suite of market access consulting and payer/IDN marketing solutions. You can also sign up for its weekly Value Report, summarizing the week in drug pricing, access, and value news.

Read on for Chris' insights.

Wednesday, June 12, 2024

Hospitals Are Relying More on PBMs to Manage Manufacturers' 340B Contract Pharmacy Restrictions: DCI's 2024 Market Analysis

The 340B contract pharmacy market shows little sign of slowing down. Drug Channels Institute’s exclusive analysis of the 2024 market reveals that:
  • About 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and federal grantees that participate in the 340B program. 
  • Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market.
  • Federal grantees are aligned primarily with the vertically intergated organizations' retail pharmacies, while hospitals rely on mail and specialty pharmacies.
Over the past four years, manufacturers’ restrictions on 340B contract pharmacies have led hospitals to deepen their relationships with the largest PBMs—even as those PBMs have simultaneously limited hospitals’ direct participation in specialty pharmacy networks.

For an updated look at what’s next for the 340B contract pharmacy market, join Adam J. Fein, Ph.D., on June 21 for his latest live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Friday, June 07, 2024

Choosing the Right Hub Partner: A Blueprint for Decision-Makers

Today’s guest post comes from Nasir Ali, Chief Product Officer at CareMetx.

Nasir highlights manufacturers' top objectives and vendor metrics from CareMetx’s recent survey of leaders and decision makers in the specialty pharmaceutical industry. He then outlines key questions to help manufacturers evaluate their potential hub partners.

You can donwload CareMetx’s full 2024 Patient Services Report here: Revealing Manufacturer Priorities: Patients Naturally Take Center Stage.

Read on for Nasir’s insights.

Tuesday, June 04, 2024

Pharmacist Salaries and Employment in 2023: The Grass Keeps Getting Greener in Hospitals

It’s time for the annual update to Drug Channels Institute’s (DCI) analysis of pharmacist salaries and employment.

2023 was another tough year for pharmacists working in retail settings. While average salaries grew, they did not keep pace with overall inflation. Pharmacist employment at drug stores shrank but grew at supermarkets and mass merchants.

Meanwhile, employment and salaries in non-retail settings—hospitals, physician offices, outpatient centers, and home healthcare—continued to grow. These settings now employ one in three U.S. pharmacists. Greener grass—or just different soil?

Full salary and employment data below for your enjoyment or sorrow.

What’s ahead for 340B-eligible hospitals? Find out during The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 webinar.

Friday, May 31, 2024

Shifting Strategies: Tackling Patient Support Program Reverification

Wednesday, May 29, 2024

Drug Channels News Roundup, May 2024: CVS & Cordavis & Humira, 340Boom, AFP Slowdown, Asembia Wrap-Up, and GLP-1 Humor

Summer unofficially began over the weekend. Let’s turn up the heat with these sizzling news bites, seared to perfection on the Drug Channels grill:
  • CVS Health’s Cordavis business seems to want quasi-regulatory oversight of Humira biosimilars
  • 340B’s skyrocketing growth continues, but the market is changing
  • Plans sponsors' fading interest in alternative funding programs
  • A post-Asembia review from DCI’s trip to Las Vegas
Plus, South Park goes after insurance companies and PBMs over GLP-1 coverage.

P.S. Join my nearly 56,000 LinkedIn followers for daily links to neat stuff.

Register now for The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 event.

Wednesday, May 22, 2024

Why the IRA Will Encourage Part D Plans to Prefer High-List, High-Rebate Drugs (video)

In my recent Drug Channel Implications of the Inflation Reduction Act video webinar, I explained the intended and unintended consequences of the Inflation Reduction Act of 2022 (IRA) for the commercial market and drug channel participants.

In the video excerpt below, I walk through a mathematical example to show why the IRA will encourage Part D plans to prefer high-list, high-rebate specialty drugs, even as the government and manufacturers will prefer a low-list-price version. What’s more, a product with a maximum fair price (MFP) may also raise total costs for the healthcare system—despite the likely political posturing and spin.

If this clip whets your appetite for more, register to watch a replay of the full 90-minute video webinar from April.

Curious about the IRA will disrupt the 340B market? Then register for The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 webinar.

Click here if you can’t see the video below.


Tuesday, May 21, 2024

The 340B Drug Pricing Program: Trends, Controversies, and Outlook (NEW Live Video Webinar)

Dr. Adam J. Fein, president of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s new live video webinar:


This event will be broadcast live on
Friday, June 21, 2024, from 12:00 p.m. to 1:30 p.m. ET

This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2024 Video Webinar Series.

WHAT YOU WILL LEARN

The federal 340B Drug Pricing Program continues to grow much more quickly than the overall pharmaceutical market. For 2023, total purchases under the 340B program exceeded $124 billion. DCI estimates that 340B discounts equated to more than 17% of total value of gross-to-net reductions for brand-name pharmaceuticals. The 340B program also remains a significant and controversial source of profits for the pharmacy and pharmacy benefit management (PBM) industries.

In this all-new webinar, Dr. Fein will provide a fact-based look at the 340B program, summarize the multiple controversies surrounding the program’s operations, and deliver a clear-eyed outlook for the program’s future. Key topics will include:
  • Current operations of the 340B program
  • 340B growth trends by dispensing/administration channel and covered entity type
  • Following the 340B dollar
  • Contract pharmacy controversies
  • Impact of CMS’s latest 340B guidance for the Inflation Reduction Act
  • PBM and pharmacy profits from the 340B program
  • Vertical integration and third-party administrators
  • How state Medicaid program reforms are affecting the 340B program
  • Manufacturers’ 340B strategies
  • State and federal legislative actions and outlook
  • And much more!
PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last at least 90 minutes to accommodate audience questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. He will also draw from exclusive information found in DCI's 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Read on for full details on pricing and registration.

Friday, May 17, 2024

HCP Perspectives: Access Challenges in Treating Diabetes & Obesity

Today’s guest post is from Dr. Preeti Parikh, a practicing pediatrician and VP, Executive Medical Director at GoodRx.

At the recent Publicis Health Media HealthFront event, Preeti hosted a dialogue on the main stage with Dr. Minisha Sood. They discussed new GoodRx research and had a candid discussion about their daily challenges in caring for patients—especially those living with diabetes and obesity.

Click here to watch the full video of the conversation between Drs. Parikh and Sood.

Read on for Preeti’s insights.

Tuesday, May 14, 2024

Another IRA Surprise: Part B Coinsurance Inflation Adjustments Are Increasing Patient Costs

Contrary to what you may have heard, the Inflation Reduction Act’s (IRA) inflation rebates for Medicare Part B drugs do not always save money for seniors.

As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.

Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.

Friday, May 10, 2024

Solving Access Barriers in Biomarker Testing: 5 Tips for Manufacturers

Today’s guest post comes from Hannah Baxter, Associate Partner at The Dedham Group; Jen Klarer, Partner, Head of Cell & Gene Therapy at The Dedham Group; and Carolyn Zele, Advisor, Solution Consulting at MMIT.

The authors discuss the access barriers facing patients who need biomarker testing. They discuss five ways manufacturers can prevent these barriers from affecting patients.

To learn more about navigating the complexities of market access, contact MMIT and its sister company, The Dedham Group.

Read on for their insights.

Tuesday, May 07, 2024

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2024 Update

It's time for Drug Channels’ annual update of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels.

Below you’ll find our latest illustration of the major vertical business relationships among the largest companies along with some of the notable activity since our previous update. These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical efforts.

The companies face renewed scrutiny from the Federal Trade Commission, the Office of Inspector General, and members of Congress. But until anyone takes action, we will continue to live with the golden rule of the drug channel: Whoever has the gold gets to make the rules.

Friday, May 03, 2024

Bracing for Impact: The Future of Hub, PAP, and Affordability Programs Under the Inflation Reduction Act

Today’s guest post comes from Chris Dowd, Senior VP of Market Development at ConnectiveRx.

Chris explains how the Inflation Reduction Act of 2022 (IRA) will impact hub, patient assistance programs (PAP), and affordability programs. He discusses steps manufacturers can take to accommodate the anticipated budget reductions while maintaining access and affordability for patients.

To learn more, join Chris on June 4 at 1:00 p.m. ET for a free online panel discussion about how brands can continue to offer robust patient support despite IRA challenges.

Read on for Chris’ insights.

Tuesday, April 30, 2024

Drug Channels News Roundup, April 2024: CVS’s Humira Strategy, White Bagging “Savings,” IRA vs. Part D Plans, Walgreens Specialty Update, Pharmacies vs. GoodRx, and Oncology Fun

April is over, so it's time to hop into this month’s selection of noteworthy news:
  • CVS Health’s formulary boosts a Humira biosimilar
  • An insurer ditches buy-and-bill to save money for plans—but maybe not for patients?
  • My $0.02 on how Medicare Part D plans will react to the Inflation Reduction Act
  • Walgreens' unexpected specialty pharmacy strength
  • A video deconstruction of my infamous Drug Channels article on GoodRx
Plus, a cartoonist illustrates my recent keynote on the battle for oncology margin.

P.S. Join my nearly 55,000 LinkedIn followers for daily links to neat stuff.

Friday, April 26, 2024

Breaking Down Barriers: Helping Patients Get Therapies Quickly

Today’s guest post comes from Kevin Kettler, President of CoverMyMeds.

Kevin asks: What if there were no barriers across the therapy access and reimbursement process? In his view, eliminating barriers requires a combination of expert insight, actionable data, and simplification of the providers' experiences.

Click here to learn more about CoverMyMeds’ comprehensive technology solutions.

Meet CoverMyMeds in Booth 1305 at the Asembia AXS24 Summit. To keep up with CoverMyMeds and all the action at Asembia, click here to sign up for daily recaps from Asembia.

Read on for Kevin’s insights.

Wednesday, April 24, 2024

Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks

Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents.

Today, we examine how manufacturers’ specialty networks contribute to this concentration. In DCI’s exclusive analysis below, we show that specialty pharmacies affiliated with pharmacy benefit managers (PBMs) play an outsized role in manufacturer-designated dispensing networks.

A typical network contains about five specialty pharmacies—but one in three specialty products with a manufacturer-designated network contains only a single specialty pharmacy. In those exclusive networks, independent and smaller specialty pharmacies are the big winners.

Read on for DCI’s updated profile of specialty networks—and ponder why smaller pharmacies are winning the battle for exclusive networks.

Monday, April 22, 2024

Visit Drug Channels in Booth #1801 at #Asembia24 for a Special “Ask Me Anything With Adam” (#AMAWA)

Next week, the Drug Channels Institute team will be attending Asembia’s AXS24 Summit at the wonderful Wynn Las Vegas.

And for the first time—thanks to our new friends at HMP Global—DCI will have its very own booth! (Click here for a special sneak peek.)

As you might expect, we will hit Vegas in true Drug Channels style. Stop by booth #1801 for fun and games:
  • Partake in a special in-person Ask Me Anything with Adam (#AMAWA) session with DCI president Adam J. Fein, Ph.D.! The AMAWA session will start on Monday, April 29, at 4:30 p.m. (Bring your phone if you want a selfie!)

    Adam won’t be speaking at Asembia this year, so be sure to visit booth #1801 on Monday afternoon to get his hot take on whatever topic is vexing you.
  • Spin the Drug Channels Wheel O’ Fun and win fabulous prizes!
  • Meet Bar Stern, DCI’s newest and most bearded team member!
  • Enjoy snacks, treats, and espresso!
DCI’s booth will be in the back of the hall, with all of the cool kids. Here’s a handy map:

[Click to Enlarge]

Remember: What happens in Booth #1801, stays in Booth #1801. 😉

BONUS TIP

While you’re in Vegas, be sure to visit the fantastic new exhibition about the gross-to-net bubble at Circus Circus.

10/10 would pop the gross-to-net bubble in Vegas again!

Friday, April 19, 2024

How GoodRx is Evolving Its Reimbursement Approaches to Help Pharmacies and Consumers

Today’s guest post comes from Jim Sheninger, Pharmacy Strategy Officer at GoodRx.

Jim describes GoodRx's emerging pharmacy contracting strategies. In addition to working through pharmacy benefit managers (PBMs), GoodRx now also contracts directly with Walgreens, CVS, and other national and regional pharmacies. These direct agreements are based on acqusition cost, which helps pharmacies stabilize gross margins while still providing low pricing for consumers. 

To learn more about GoodRx and its pharmacy partnerships, reach out to network@goodrx.com.

Read on for Jim’s insights.

Tuesday, April 16, 2024

The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents

Drug Channels Institute’s (DCI’s) latest analysis finds that participants in the specialty pharmacy market continue to get more diverse—although revenues remain highly concentrated.

We have identified nearly 1,800 dispensing sites with specialty pharmacy accreditation—about 40% of which are owned by hospitals, physician practices, and other healthcare providers.

Alas, specialty pharmacies owned by the three largest pharmacy benefit managers (PBMs) have the most brass in their pocket, as they accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.

Read on for DCI’s latest overview of the 2023 marketplace and revenues of the biggest market participants, along with key specialty pharmacy trends.

Friday, April 12, 2024

How Patient Engagement Can Reduce Brand Launch Risks

Today’s guest post comes from Jessica Lens, Chief Patient Experience Officer at CareMetx.

Jessica discusses the challenges of patient nonadherence. She then outlines how manufacturers can build adherence into their patient services program to increase patient engagement.

To learn more about enhancing patient engagement and adherence, download CareMetx's new report: Driving Brand Success: Minimize Risk and Capture Missed Value from Patient Engagement and Adherence.

Read on for Jessica’s insights.

Tuesday, April 09, 2024

The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead

Three is still the magic number for pharmacy benefit managers (PBMs).

For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.

Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.

Monday, April 08, 2024

SAVE THE DATE: Drug Channels Leadership Forum, March 17-19, 2025

I am pleased to announce the inaugural Drug Channels Leadership Forum! This unique, new event will be held from March 17 to 19, 2025, at the Turnberry Resort and Spa in Miami.

The Leadership Forum will be an executive gathering where drug channel leaders can network and discuss key issues and challenges facing the commercial healthcare system. We intend to bring together people from the entire drug channel: pharmaceutical manufacturers, pharmacy benefit managers (PBMs), health plans, insurers, and plan sponsors, wholesalers and distributors, pharmacies, providers, buying groups, government officials, and more.

I’m personally assembling the agenda, which will be a mix of one-on-one fireside chats with industry leaders combined with hard-hitting, topical panel discussions. And of course, I'll be there to moderate the entire event and lead the fireside chats. Thanks to DCI’s partnership with HMP Global, we can bring this novel event to the drug channels community.

To maximize the value of networking and learning, the event will have a limited number of attendees. Click here to request an invitation.

We will also have a very limited number of sponsors. Click here to learn more about sponsorship opportunities.

Read on for the full press release. Hope you can join us!