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...
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channels Outlook 2026.
Today's rerun provides background for the webinar, when I will discuss the consequences of the Inflation Reduction Act for the 340B program and contract pharmacies. Click here to see the original post from May 2025.
Two weeks ago, Senator Bill Cassidy—now chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP)—dropped a must-read, eyebrow-raising report on the out-of-control 340B Drug Pricing Program. (Link below.)
The report reveals previously confidential information showing how billions are funneled to health systems and pharmacies—with manufacturers unable to follow the flow.
Below, we use these new disclosures to illustrate the 340B program’s hidden prescription economics for 340B contract specialty pharmacies operated by CVS Health and Walgreens Boots Alliance.
As you can see, the program’s participants earn substantial margins, while plans and third-party payers foot the bill.
In the video clip below, I explain how PBM compensation models continue to evolve:
Traditional profit sources, such as mail dispensing of nonspecialty drugs and retained rebates, have become less significant.
Retail network spreads now account for a small portion of large PBMs’ overall profits.
Specialty dispensing profits, manufacturer administrative fees, and revenues from group purchasing organizations (GPOs) have emerged as major contributors to PBM profitability.
Understanding how PBMs generate profits is key to navigating the evolving drug channel landscape. Watch the full webinar replay and download the complete slide deck to explore these dynamics in more depth.
Today’s guest post comes from Laura Jensen, Chief Commercial Officer and President, Pharma Solutions at GoodRx
Laura explores the structural hurdles that slow time-to-therapy and outlines practical ways stakeholders can streamline the path from prescription intent to treatment initiation.
Contrary to popular belief, the Inflation Reduction Act’s (IRA) maximum fair prices (MFPs) could temporarily boost profits for retail pharmacies serving Medicare Part D patients.
As I show below, retail pharmacies risk becoming collateral damage from significant deflation in the gross-to-net bubble for drugs subject to an MFP. Welcome to our bonkers healthcare system—where everyone wants lower prices, until they actually get them.
What’s more, list price cuts will reduce profits from 340B contract pharmacy operations, while weakening covered entities’ main objections to a 340B rebate model. Get ready for a 340B slowdown.
For more on the intended and unintended consequences of the IRA—and its interplay with 340B—join me for my live video webinar, Drug Channels Outlook 2026, on December 12, 2025, from 12:00 p.m. to 1:30 p.m. ET.
Today’s guest post comes from Josh Schwartz, Vice President, Medical Affairs, North America at BeOne Medicines and Matt Shaulis, General Manager, North America at BeOne Medicines.
Josh and Matt aim to raise awareness about the negative effects of insurer-imposed policies such as therapeutic substitution and step therapy. They argue that physicians have a deeper understanding of disease states and individual patient biology than insurance companies and pharmacy benefit managers (PBMs). To ensure the best outcomes, they contend that doctors—not insurers—should determine each patient’s optimal treatment plan.
Happy Thanksgiving, everyone! Before you stretch your stomach, stretch your mind with some fresh food for thought from across the drug channel. In this issue:
What else should you expect for 2026? Find out during my upcoming live video webinar, Drug Channels Outlook 2026, on December 12, 2025, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up. As always, we are offering special discounts if you want to bring your whole team.
Today’s guest post comes from Stephen Hom, EVP, Chief Commercial Officer, and Co-Founder of RIS Rx.
Stephen argues that patient affordability remains one of the most critical—and often overlooked—barriers to treatment adherence. Drawing on his experience as a community pharmacist, he suggests that cost isn’t just a financial issue—it’s a clinical one.
As I’ve been warning for years, the Inflation Reduction Act of 2022 (IRA) has nearly obliterated the stand-alone Medicare Part D prescription drug plan (PDP) market.
DCI’s exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals:
The number of PDPs has plummeted by 55% since the IRA’s passage, to a record low of 360 plans for 2026.
Preferred cost-sharing pharmacy networks are disappearing, with their share falling to the lowest level since 2014. That’s a post-IRA net loss of 505 plans with these networks.
Just five companies—Aetna, Health Care Service Corporation, Humana, UnitedHealthcare, Wellcare—will account for 94% of all PDPs in 2026. In recent years, four major plan sponsors—Cigna, Clear Spring Health, Elevance Health, and Mutual of Omaha—have exited the PDP market.
See the charts below and our analysis of the remaining national players, along with updated data on preferred networks in Medicare Advantage prescription drug (MA-PD) plans.
Even with the demonstration program handouts, the Part D market is increasingly fragile: fewer choices, greater concentration, and massive disruption for beneficiaries.
Thanks, IRA! 🙃
What else should you expect for 2026? Find out during my upcoming live video webinar, Drug Channels Outlook 2026, on December 12, 2025, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up. As always, we are offering special discounts if you want to bring your whole team.
2026 is shaping up to be another transformative year for the U.S. drug channel.
Join Adam J. Fein, Ph.D.—president of Drug Channels Institute (DCI) and author of Drug Channels—for his exclusive live video webinar:
Gain the latest data, forecasts, and policy insights to plan confidently for the year ahead. Our Outlook webinars are trusted annually by thousands of industry leaders for data-driven market insight.
This 90-minute online event—part of The Drug Channels 2025 Video Webinar Series—streams live from the Drug Channels studio in beautiful downtown Philadelphia.
Start the new year with clarity and confidence. Dr. Fein—one of the industry’s most trusted voices—will share an essential briefing on the trends, market forces, and policy developments that will shape the U.S. drug channel in 2026 and beyond.
Market & Policy Outlook: GLP-1 disruption; expectations for Medicare Part D; first-year implications of Medicare’s MFP implementation
PBMs & Payers: Profit model evolution, transparency pressures, and the future of discount cards, TrumpRx, and direct-to-patient strategies
Industry Integration: The evolving biosimilar market, wholesaler influence, and vertical integration trends for patient- and provider-administered drugs
Regulatory & Legislative Changes: The future of the 340B Drug Pricing Program and state/federal PBM oversight
And much more!
As always, Dr. Fein will clearly distinguish objective facts and data from his interpretations. This 90-minute video webinar will include a dedicated Q&A session, where attendees can unmute and engage directly with Dr. Fein.
Today’s guest post comes from Steve Randall, Chief Technology Architect at ConnectiveRx.
Steve examines how artificial intelligence (AI) is reshaping the role of patient support hubs in the specialty drug ecosystem. As policy, payer, and gross-to-net pressures mount, he argues that the hub model must evolve from a service function into a revenue-protection strategy—one that uses “embedded AI” to enhance, not replace, human judgment.
Today’s guest post comes from Lara Loveman, VP of Pharma Solutions at Outcomes.
Lara discusses how shifting market forces and evolving reimbursement models are reshaping pharmaceutical marketing strategies. She suggests that pharmacist-led interventions—particularly in chronic disease management—can both protect pharmaceutical investment and drive better health outcomes.
On Monday, Cigna announced that it would be abandoning traditional manufacturer rebates and moving to a new, “rebate-free” approach—essentially a point-of-sale (POS) rebate model paired with a cost-plus pharmacy reimbursement framework. Here’s the press release.
Moving manufacturers’ rebates and discounts to the point of dispensing is a big win for patients, who can share in the savings that pharmacy benefit managers (PBMs) negotiate with drugmakers. It's a practical, patient-friendly step toward shrinking the gross-to-net bubble that has inflated out-of-pocket costs for years.
Yet as always, the fine print matters. Below are three crucial considerations that reveal why this move might be less revolutionary than it first appears—and why it may not be widely adopted by plan sponsors. Perhaps these will spark some questions for Cigna's management about the company's increasingly opaque profit model during tomorrow’s third-quarter earning call.
This isn’t the first time that Express Scripts has tried to alter how its plan sponsors manage their pharmacy benefits. After reading the analysis below, you can decide whether this latest attempt is true reform—or the triumph of hope over experience.
Eeek! It’s time for the Drug Channels Halloween roundup of terrifying tales from the dark corners of the healthcare system. Gather your favorite demon hunters and help maintain the Honmoon. This month’s tricks and treats include:
Today’s guest post comes from Mark Thierer, Chief Executive Officer of EVERSANA.
Mark explains how combining direct-to-patient and direct-to-payer strategies can improve transparency, streamline access, and better align key stakeholders. He introduces EVERSANA DIRECT, the company’s new approach to market access.
In recent years, these companies have spent more than $16 billion to acquire management service organizations (MSOs) that oversee physician practices in such specialties as gastroenterology, oncology, ophthalmology, and urology.
Below, we highlight the largest MSO transactions and explore five ways wholesalers benefit from ownership in their downstream physician customers. Ultimately, these strategies may allow wholesalers to exert unprecedented control over market access for provider-administered drugs—if they can figure out how to realize this power.
The stakes have never been higher. With seismic shifts in distribution models, health policy and market access strategies, falling behind on critical trends could mean losing your competitive edge. If you’re a trade, channel, market access or brand professional, Informa Connect’s Trade and Channel Strategies is your must-attend event to stay ahead of the curve.
Why attend? Informa Connect’s Trade and Channel Strategies celebrates two decades of excellence—Experts will explore the evolution of the landscape, unravel its complexities and showcase innovative pharmacy and distribution models shaped by shifting market dynamics. Walk away with actionable strategies to tackle the latest industry challenges.
Why now? The US marketplace is in upheaval, with disruptions at both the pharmacy counter and across the supply chain. Policy changes, market fluctuations and new entrants, like GLP-1 therapies are reshaping the landscape. Traditional models are being replaced by innovative alternatives, leaving companies struggling to adapt. This conference offers critical insights into these changes and equips you to thrive in this evolving environment.
What can you expect? The event features a stellar lineup of industry leaders, including Bill Roth of IntegriChain, who will deliver the keynote address, Navigating Disruption in Today’s Trade and Channel Marketplace. Other notable speakers include:
Christine Hummel, US Head, Trade & Channel Management, Sanofi
Ramita Tandon, Chief Biopharma Officer, Walgreens
Peter A. Arakelian, Head of Channel & Oncology Enterprise Accounts, EMD Serono
Martine Avello, Director, Channel and Distribution, BioMarin Pharmaceutical Inc
Thomas Scalone, Director, Trade Strategy and Operations, Bristol Myers Squibb
Stephanie Wirkes, Head of Distribution and Strategy Execution, Bayer
And more!
Program highlights:
Navigate Regulatory Changes: Stay on top of DSCSA serialization, IRA impacts and PBM reforms that are reshaping the industry
Master Distribution Models: Explore the direct-to-patient revolution, limited distribution networks and innovative cold chain solutions for specialty pharmaceuticals
Optimize Market Access: Learn strategies to balance GTN optimization, payer negotiations and patient affordability
Leverage Technology: Discover how AI, digital tools and analytics are transforming trade strategies
What attendees are saying: “For those of us responsible for navigating and developing specific strategy around this ever-changing marketplace in distribution channel management, this was a bullseye.”
“Most valuable conference of the year to understand pharmacy and distribution related topics. There is no second.”
“One of the best conferences I have ever attended. The speaker selection and topic covered from a strategic and tactical approach were extremely relevant to our business.”
Exclusive Offer—Download the agenda and register today–Use your exclusive promo 25DC10 to save 10%*
*Cannot be combined with other offers, promotions or applied to existing registration. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post comes from from Chad Zerangue, Founder of InfuseFlow and Senior Director, Enterprise Provider Sales at CareMetx.
Chad explains how barriers to access for infused therapies—including site-of-care changes and financial clearance delays—often cause patients to disengage before receiving the first dose. He shares one patient’s story illustrating the need for a strong patient services partner with coordinated systems and digital handoffs.
Special launch pricing is available through October 27, 2025.
This report—our sixteenth edition—remains the most comprehensive, data-driven resource for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.
With 9 chapters, more than 400 pages, 187 exhibits, and over 850 endnotes, this report is unmatched in scope and depth. There’s simply no other resource like it.
Order today to secure your copy of this fully updated, revised, and expanded 2025-26 edition at special discounted prices.
The 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Widely regarded as the industry standard, this encyclopedic resource offers a definitive guide to wholesale distribution’s role in the complex web of U.S. prescription drug channels.
The chart below illustrates the vertical integration and broad reach of the three largest companies in U.S. pharmaceutical distribution. The numbers in the chart correspond to the report chapter that explains and analyzes the specific business segment.
Updated analyses of strategies, market positions, and executive compensation for the Big Three—Cencora, Cardinal Health, and McKesson. We review each company’s business segments and underlying business profitability, based upon our proprietary economic models. This allows you to assess differences among the public companies’ organizational structure and financial performance.
Self-contained chapters that do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific interests and priorities.
The option to download an additional PowerPoint file with images of all 178 exhibits. This popular option helps you share the insights and data with others in your organization. (The exhibits appear within the text for all license versions.)
760 (!) endnotes, most of which have direct hyperlinks to original source materials for deeper learning.
No SpongeBob Squarepants, corny jokes, or pop culture references, all of which have been reluctantly removed.
Thank you for your continued interest in our research. Please email me (afein@drugchannels.net) with any questions before purchasing.
We look forward to sharing this year’s insights with you.
Informa Connect's Pharma/Biotech GTN Summit returns on November 18-20, 2025, in Philadelphia, PA, bringing together hundreds of senior finance, gross-to-net and accounting professionals from across the life sciences industry to tackle the complexities of gross-to-net management.
This year’s CPE-accredited event will deliver cutting-edge insights, proven methodologies, and practical tools to optimize gross-to-net processes and enhance forecasting accuracy. With a sharp focus on policy updates, technology integration,and cross-functional collaboration, the agenda will help you keep pace with the fast-evolving US life sciences landscape and its unique complexities, providing the ultimate forum for model-sharing, benchmarking best practices and inspiring innovation within your team.
Featured Thought Leaders Include:
Brett Nussbaum, Director of Gross to Net Accounting, Novartis
Trevor Ackerman, VP, Global Tax, Amneal Pharmaceuticals
Chris Rocco, Head of US Market Access Data, Reporting and Analytics, GSK
Prakash Chainani, VP - Finance, HR & IT, Lifestar Pharma LLC (a Mankind Group Company)
Bal Ram Chopra, Senior VP, Finance, US Operations, Indivior
Rosalind Davis, Director, Government Pricing and Contracts, CSL Vifor
Timothy Kocses, Executive Director, US Commercial Controller, Bristol Myers Squibb
Dominic Fatigati, Finance Director, Market Access, US Oncology, AstraZeneca
James Engel, Controller, Finance, Collegium Pharmaceuticals
*Offer exclusively for life sciences manufacturers only. Offer applies to the current rate and maybe not be applied to existing registrations; additional terms may apply, see website for full details.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post comes from Deepak Thomas, Founder and CEO of PHIL.
Deepak explores how demographic shifts and digital expectations are reshaping patient engagement. He argues that to stay competitive, pharmaceutical manufacturers must adopt integrated direct-to-patient (DTP) platforms that streamline access, support insurance coverage, and deliver sustainable commercial impact.
The 340B Drug Pricing Program has emerged as a growing source of profits for pharmacies and pharmacy benefit managers (PBMs).
Drug Channels Institute’s latest exclusive analysis of the 2025 market reveals a highly concentrated market structure increasingly dominated by a handful of major players:
About 32,000 pharmacy locations—nearly 60% of the entire U.S. pharmacy industry—function as contract pharmacies for the hospitals and federal grantees that participate in the 340B program.
The 340B contract pharmacy has become increasingly concentrated with five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via Optum Rx), Walgreens, and Walmart.
It’s time for Drug Channels’ annual update on drug pricing trends at the largest pharmaceutical manufacturers.
This year’s review includes the following nine companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Johnson & Johnson, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data below.
These data highlight divergent trends reshaping the gross-to-net bubble:
Rebates, discounts, and other fees reduced the selling prices of brand-name drugs at the biggest drugmakers to less than half of their list prices.
When accounting for all list price reductions, average brand-name drug prices declined at three manufacturers and increased at six others.
Gross-to-net difference in price changes ranged from −12.8% to +6.3%, reflecting significant differences in the manufacturers’ portfolio mix and pricing strategies.
As I noted in last week’s gross-to-net bubble analysis, manufacturers’ evolving market access strategies increasingly aim to offset—or circumvent—growing pricing pressure from both commercial and government payers. Drug pricing flat earthers (#DPFE) will be challenged by falling net prices, while policy wonks will be amazed at the unintended consequences unleashed by our crazy system.
The 2025 launch of biosimilars to Johnson & Johnson’s Stelara (ustekinumab) marks another turning point in pharmacy benefit dynamics. But unlike the chaotic rollout of Humira biosimilars, pharmacy benefit managers (PBMs) came prepared.
Private label strategies, aggressive pricing, and exclusive formulary deals have transformed what might have been a slow-crawling biosimilar introduction into a full-on pricing war. As with Humira, the reality of biosimilar economics is far messier—and more revealing—than the policy narratives suggest.
In this post, I examine how the major PBMs—and some of the smaller ones—are handling Stelara biosimilars, what’s changed since the Humira experience, and why their strategies reflect the growing dominance of private-label rebating schemes.
As always, with great pricing power comes great responsibility. Excelsior!
Drug Channels readers save 10% with code 25DRCH10*
Informa Connect's PBM Contracting Summit returns to Chicago this December! Join the industry as expert speakers navigate the complex PBM landscape, gaining unparalleled strategies to enhance patient care and effectively manage costs.
The 2025 event features:
A regulatory snapshot, reviewing state mandates and federal enforcement
Analysis on rebate transparency and next-generation PBM contracting
A look inside the GLP-1 challenge, with a focus on balancing momentum with sustainable models
Perspectives on alternative funding programs with a focus on risk, compliance and cost in managing high-cost therapies
Expert analysis of AI and automation, focusing on prior auth, precision medicine and the future of pharmacy
Examination of digital health disruption and the PBM model
Overview of specialty pharmacy access
Insights into the rise of disruptor PBMs, biosimilars and more
Deep dives into the 340B firestorm, covering policy, pricing and practical fixes
Coverage on redefining network adequacy while balancing access and geography
An outlook into Medicaid for the year ahead
An inside look into the patient voice within PBM contracting
PLUS! Attend a Pre-Summit Workshop on December 8th: GLP-1 Cost, Coverage, and Care - Continuum or Conundrum?
The PBM Contracting Summit remains essential to tackle the rising drug costs head-on–Spotlighting bold innovations in contracting, GLP-1 strategy, AI-powered solutions and federal & state driven regulatory change.
Drug Channels readers will save 10% off when they use code 25DRCH10 and register prior to November 3, 2025.*
*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post comes from Jordan Armstrong, VP of Business Development at AssistRx.
Jordan examines the growing role of direct-to-consumer (DTC) access models in the pharmaceutical sector. He discusses recent regulatory developments, the potential benefits and risks for manufacturers, and key considerations for building sustainable DTC programs.
Drug Channels Institute is proud to host the 2026 Drug Channels Leadership Forum, which will take place from March 16–18, 2026, in Miami. Check out the agenda and request your invitation to this invite-only gathering of senior leaders from across the drug channel ecosystem. You must request an invitation to be considered for attendance. We will begin sending invitations in mid-October.
The healthcare landscape continues to evolve at an unprecedented pace, bringing new challenges and opportunities for patient access and affordability. As legislation shifts, market forces disrupt and cost-sharing programs grow increasingly complex, the need for innovative solutions has never been greater. Are you prepared to navigate this dynamic environment?
The Copay, Reimbursement and Access Congress is back November 18-20, 2025. Driven by real-time marketplace insights and led by the brightest minds in access and reimbursement, Copay 2025 is designed to equip you with the tools and strategies needed to enhance patient affordability, ensure program sustainability and stay ahead of regulatory changes.
Can’t-Miss Highlights:
14+ hours of content featuring 5+ sessions dedicated to deciphering copay legislation and 10+ sessions dedicated to copay operationalization.
Expert insights from top organizations like Sanofi, Geron, Pfizer, Kyowa Kirin, Novartis, J&J, Teva, Nuvation Bio, Celltrion, Exelixis and more.
Illuminating case studies on Mastering Copay Communication, Integrating Field Teams, Navigating Specialty Pharmacy in Rare Disease and Redesigning Insurance to Better Meet Patient Need
Enforcement perspectives on trends and actions within the copay and patient services space
7+ hours of networking to build powerful partnerships, expand your professional network and give your organization a competitive edge
Why Attend?
In today’s healthcare climate, balancing patient access with business objectives is a delicate task. The Congress will address critical questions that access professionals face:
How can programs remain sustainable, innovative and profitable while better supporting patients?
Is your patient support program’s restructuring in response to copay legislation delivering the desired results? Do MFP negotiations and copay smoothing initiatives call for further adjustments?
How will upcoming health policy changes impact patient affordability and commercialization strategies?
Join industry leaders, peers and solution providers to crack the copay code–Benchmark best practices, gain actionable insights, connect with industry trailblazers and drive patient access and affordability forward at Copay 2025.
“The Copay, Reimbursement and Access Congress was a great learning experience that allowed exchanging thought leadership, networking and brainstorming sessions. Audience was enthusiastic and engaged and these after-event sessions were true gems in surfacing interesting ideas.”
*Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post is from Laura Jensen, Chief Commercial Officer and President of Pharma Solutions at GoodRx.
Laura shares her perspective on how direct-to-consumer (DTC) strategies are evolving and the role that platforms like GoodRx can play in improving access.
This week, I’m rerunning some popular posts while I put the finishing touches on DCI’s 
This week, I’m rerunning some popular posts while I put the finishing touches on DCI’s 
This week, I’m rerunning some popular posts while I put the finishing touches on DCI’s 
