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 Scott Genone, Chief Product Officer at CareMetx.
Scott shares key takaways from CareMetx’s recent survey of over 100 industry leaders. He outlines four trends that will define the future of patient services.
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.
Drug Channels readers save 10% on their registration with code 25DC10
When it comes to patient affordability, it’s difficult to imagine a more complex time for our industry. Navigating policy updates, disarming AFPs, considering compliance risks – There are countless barriers to medication access and it remains our responsibility as an industry to ensure patients have access to the life-changing therapies they need.
How are we ensuring our programs are helping those who need it most? How does PAP 2025 help us reach this goal?
PAP 2025 will unite stakeholders from across the industry for vital collaboration focused on transforming patient outcomes. The experts are coming together to define best practices for PAP programs and answer top-of-mind questions for access professionals, including:
What can we do to catch, block and disarm AFPs?
How are we improving health equity to bridge the gaps in healthcare?
Are we effectively showcasing resources to empower patients?
What is the potential impact of the new administration on health policy?
Event highlights:
Customizable Content: Benefit from add-on workshops, dedicated tracks, breakout discussions and more to customize your experience and strategize on your specific needs.
Expert-Led Sessions: Uniting manufacturers, foundations, clinics and more, benchmark your program with leaders to see how you can improve your program to accelerate access.
Actionable Takeaways: Uncover tangible solutions for your organization to streamline programs, optimize operations and improve patient outcomes.
Networking: Robust networking opportunities with an expected 700+ access professionals to expand your network and establish powerful partnerships.
Featured speakers:
Judd Caulfield, Takeda Pharmaceuticals – Expert in healthcare policy, sharing insights on upcoming regulatory changes, IRA response and the impact on access programs.
Shanelle Gabriel, Starting Something Productions, Inc – Well-versed in advocacy work, sharing a powerful patient journey of resilience, creativity and the role of art in patient engagement.
Rachel Thorpe, Otsuka Patient Assistance Foundation – Thought-leader in PAP innovation, diving into methods for patient empowerment.
Liz Austin, Genentech – A veteran in patient assistance, discussing strategies to safeguard and preserve patient access amid the era of PBM reform.
Jacob Foster, Criminal Division, U.S. Department of Justice – On the front lines of policy changes and enforcement, sharing the most recent and impactful cases related to patient assistance and where they are heading next.
*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 Dorothy Gemmell, Chief Commercial Officer and President, Manufacturer Solutions, at GoodRx.
Dorothy highlights five trends to watch in 2025. She then describes how GoodRx's Cash Point-of-Sale Solution can help brands improve gross-to-net (GTN) while also making medications more affordable for patients.
During my recent Drug Channels Outlook 2025 video webinar, I tackled a wide range of crucial topics—including the controversial 340B Drug Pricing Program. As I explain in this video excerpt, we may finally see reform of this rapidly expanding program.
What’s more, implementing the Inflation Reduction Act will disrupt the current operations of the 340B program—and could shift program oversight from Health Resources and Services Administration to the Centers for Medicare & Medicaid Services.
The inaugural Drug Channels Leadership Forum (DCLF) is coming soon! This exclusive event will be held from March 17 to 19, 2025, at the Turnberry Resort and Spa in Miami.
Our first event will provide attendees with an opportunity to explore the most pressing strategic issues and crucial uncertainties that will impact all participants across U.S. drug channels.
Speakers and panelists include top industry executives and subject matter experts from throughout the drug channel. Registered attendees include senior executives from pharmaceutical manufacturers, pharmacy benefit managers, health systems, physician practices, pharmacies, wholesalers, and more.
View the full Drug Channels Leadership Forum agenda. It’s filled with senior industry executives who will participate in fireside chats with me as well as topical panel discussions moderated by a diverse set of subject matter experts.
Click here to request an invitation to attend. DCI will carefully review all submissions to include participants from a broad range of organizations. We are extending invitations on a rolling basis. Once you receive your invitation, you will have 15 business days to accept and complete the registration by paying the registration fee.
Please note that the DCLF is strictly limiting the number of attendees from technology companies, business services, financial firms, and other industry vendors. Vendors are only able to participate as part of a sponsorship. Click here to learn more about available sponsorship opportunities. There will be no exhibit hall and no media.
Everyone here at Drug Channels Institute (DCI) is excited to bring this novel event to the drug channels community. Visit the event website for more information on the registration process and our policies.
Below, I have reproduced our original press release. I hope you can join us!
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.
