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Drug Channels Leadership Forum 2026
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.
Neurologic Medication Costs in a Direct-to-Consumer Pharmacy vs Commercial Insurance Plans, JAMA Network Open
Mark Cuban wins again—but the professors seem baffled.
This JAMA Network Open article compared 33 medicines paid by third-party commercial insurance with patient-paid prescriptions from Mark Cuban Cost Plus Drug Company (MCCPDC).
Consistent with numerous similar studies, MCCPDC consistently delivered lower total system costs, i.e., the sum of patient out-of-pocket costs plus the balance paid by the plan. See the dark bars below.
However, insured patients sometimes pay more out of pocket at MCCDPC (light bars below).
Oddly, the authors said it was “difficult to precisely specify why and how” Cuban's direct-to-consumer model achieved lower total costs. Their best guess: something to do with “the complex commercial status quo involving insurers, PBMs, and pharmacies.”
You don’t say… 🙄
P.S. Click here to read the lively debate on this article among the Drug Channels community.
This JAMA Network Open article compared 33 medicines paid by third-party commercial insurance with patient-paid prescriptions from Mark Cuban Cost Plus Drug Company (MCCPDC).
Consistent with numerous similar studies, MCCPDC consistently delivered lower total system costs, i.e., the sum of patient out-of-pocket costs plus the balance paid by the plan. See the dark bars below.
However, insured patients sometimes pay more out of pocket at MCCDPC (light bars below).
Oddly, the authors said it was “difficult to precisely specify why and how” Cuban's direct-to-consumer model achieved lower total costs. Their best guess: something to do with “the complex commercial status quo involving insurers, PBMs, and pharmacies.”
You don’t say… 🙄
[Click to Enlarge]
P.S. Click here to read the lively debate on this article among the Drug Channels community.
2026 National Preferred Formulary: Exclusion List Changes Coming January 1, 2026, Evernorth Health Services
Here’s an important update on our Stelara analysis featured in The Stelara Biosimilar Price War: How PBM-Affiliated Private Labels Are Reshaping the Market.
Starting January 2026, Express Scripts’ National Preferred Formulary will remove the Stelara reference product in favor of three ustekinumab products:
OTOH, the PBM continues a bizarre pricing double standard, where cheaper options share space with a pricier, PBM-affiliated product. And don’t even get me started on plan sponsors’ unrequited love of rebates over lower prices…
As I noted in last month’s news roundup, the PBM’s trade group continues to demand that manufacturers "lower the list price"—yet remains silent while its largest members maintain higher list prices.
Oh well. I suppose it's only hypocrisy if you had other beliefs to begin with.
Starting January 2026, Express Scripts’ National Preferred Formulary will remove the Stelara reference product in favor of three ustekinumab products:
- Two deeply discounted biosimilars from Teva and Biocon
- The higher-priced, PBM-affiliated private label version from Cigna’s Quallent Pharmaceuticals (via Samsung Bioepis)
OTOH, the PBM continues a bizarre pricing double standard, where cheaper options share space with a pricier, PBM-affiliated product. And don’t even get me started on plan sponsors’ unrequited love of rebates over lower prices…
As I noted in last month’s news roundup, the PBM’s trade group continues to demand that manufacturers "lower the list price"—yet remains silent while its largest members maintain higher list prices.
Oh well. I suppose it's only hypocrisy if you had other beliefs to begin with.
CY2026 Landscape (202509) (ZIP), Centers for Medicare & Medicaid Services
Medicare Part D is getting worse for many seniors.
When the IRA passed, I warned it would trigger the collapse of the stand-alone prescription drug plan (PDP) market. Sadly, my prediction is now coming true.
In 2026, there will be only 360 plans—a 22% drop from 2025. Just four companies–Centene, HCSC, Humana, and UnitedHealth–will account for 84% of all PDPs. During my December 2024 webinar, I had projected that there would 340 plans for 2026.
Here's a look at the historical number of PDPs. Look out below!
What's more, Part D plans are shifting costs in ways that hurt many enrollees with higher deductibles and a greater reliance on coinsurance for nonspecialty brand drugs. Medicare beneficiaries who don’t hit the $2,000 annual out-of-pocket cap may end up paying more than in previous years. See Changes in Medicare Part D Plan Designs After the Inflation Reduction Act.
Even with the demonstration program handouts, the Part D market is increasingly fragile: fewer choices, greater concentration, and massive disruption for beneficiaries.
Thanks, IRA! 🙃
When the IRA passed, I warned it would trigger the collapse of the stand-alone prescription drug plan (PDP) market. Sadly, my prediction is now coming true.
In 2026, there will be only 360 plans—a 22% drop from 2025. Just four companies–Centene, HCSC, Humana, and UnitedHealth–will account for 84% of all PDPs. During my December 2024 webinar, I had projected that there would 340 plans for 2026.
Here's a look at the historical number of PDPs. Look out below!
[Click to Enlarge]
What's more, Part D plans are shifting costs in ways that hurt many enrollees with higher deductibles and a greater reliance on coinsurance for nonspecialty brand drugs. Medicare beneficiaries who don’t hit the $2,000 annual out-of-pocket cap may end up paying more than in previous years. See Changes in Medicare Part D Plan Designs After the Inflation Reduction Act.
Even with the demonstration program handouts, the Part D market is increasingly fragile: fewer choices, greater concentration, and massive disruption for beneficiaries.
Thanks, IRA! 🙃
The 340B Drug Discount Program: Litigation Topics and Trends, Congressional Research Service
Are you fascinated by the 340B Drug Pricing Program? Do you get your kicks reading court filings and legal decisions?
Then I have a treat for you! The Congressional Research Service just dropped this comprehensive roundup of all the litigation swirling around the program. So fun!
ICYMI, the Congressional Budget Office also dropped Growth in the 340B Drug Pricing Program. The report reinforces much of what we already know: the program fuels higher federal spending, raises costs for commercial payers, and accelerates hospital vertical integration. Crucially, the analysis makes clear tha t 340B’s rapid expansion is being driven by the strategic choices of hospitals and clinics, not by broader drug pricing trends or overall market dynamics.
Enjoy!
Then I have a treat for you! The Congressional Research Service just dropped this comprehensive roundup of all the litigation swirling around the program. So fun!
ICYMI, the Congressional Budget Office also dropped Growth in the 340B Drug Pricing Program. The report reinforces much of what we already know: the program fuels higher federal spending, raises costs for commercial payers, and accelerates hospital vertical integration. Crucially, the analysis makes clear tha t 340B’s rapid expansion is being driven by the strategic choices of hospitals and clinics, not by broader drug pricing trends or overall market dynamics.
Enjoy!
New Spinoff Of ‘The Pitt’ Follows Heroic Workers At Pharmaceutical Ad Agency, The Onion
Paula really enjoyed the first season of HBO's The Pitt. I know she'll enjoy this sequel!
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