P.S. Join my more than 66,000 LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the DCI community.
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.
Best Practices in Healthcare Survey Webinar, WTW
Here are some intriguing hints that employers are finally gearing up to reshape their pharmacy benefit manager (PBM) relationships.
According to WTW's 2025 Healthcare Survey, by 2027:
Of course, actions speak louder than surveys. Let's see what happens before declaring victory.
P.S. Click here to read the lively debate on this topic among the Drug Channels community—including commentary from a young go-getter named Mark Cuban.
According to WTW's 2025 Healthcare Survey, by 2027:
- 75% will rebid their PBM contract
- 35% will perform acquisition cost analyses
- 33% plan to partner with a new or emerging PBM
[Click to Enlarge]
Of course, actions speak louder than surveys. Let's see what happens before declaring victory.
P.S. Click here to read the lively debate on this topic among the Drug Channels community—including commentary from a young go-getter named Mark Cuban.
Mark Cuban Cost Plus Drug Company Expands Access with Addition of Starjemza® (ustekinumab-hmny) to Give Patients More Power Over Prescription Costs, PR Newswire
Cuban’s Cost Plus Drug Company has launched Starjemza—a biosimilar of Stelara—with a cash price that’s a whopping 99% below the reference product.
Cuban once again exposes the economic contradictions of the drug channel. PBM-affiliated private-label biosimilars have strong formulary positions, despite having much higher list prices than competing biosimilars. See The Stelara Biosimilar Price War: How PBM-Affiliated Private Labels Are Reshaping the Market.
Of course, PBMs can lower list prices of their affiliate’s private label drugs at any time, but ¯\_(ツ)_/¯.
This approach also establishes a powerful cash-pay benchmark that could disrupt many benefit designs—if plan sponsors can break their addiction to rebates and fully embrace truly low-cost products. (It also led to this first rate meme.) We'll see if the WTW survey results above are real.
Cuban once again exposes the economic contradictions of the drug channel. PBM-affiliated private-label biosimilars have strong formulary positions, despite having much higher list prices than competing biosimilars. See The Stelara Biosimilar Price War: How PBM-Affiliated Private Labels Are Reshaping the Market.
Of course, PBMs can lower list prices of their affiliate’s private label drugs at any time, but ¯\_(ツ)_/¯.
This approach also establishes a powerful cash-pay benchmark that could disrupt many benefit designs—if plan sponsors can break their addiction to rebates and fully embrace truly low-cost products. (It also led to this first rate meme.) We'll see if the WTW survey results above are real.
This drug pricing distortion was supposed to go extinct. It’s never been more alive., 46brooklyn Research
Kudos to Antonio Ciaccia and the 46brooklyn Research team for another stellar piece of drug channel sleuthing.
Their latest report exposes questionable generic drug pricing practices within Cigna/Evernorth’s Quallent Pharmaceuticals business.
As their analysis shows, the Quallent’s average AWP-to-WAC ratio was 1.38x—well above the industry standard of 1.20x. At least one product had a ratio of 2.00x. Plan sponsors using AWP-based reimbursement could be overpaying substantially.
If these figures are accurate, it’s yet another reminder: Always check your contract's math.
So far, Cigna has offered no rebuttal or explanation, but I’ll share one if it arrives.
Their latest report exposes questionable generic drug pricing practices within Cigna/Evernorth’s Quallent Pharmaceuticals business.
As their analysis shows, the Quallent’s average AWP-to-WAC ratio was 1.38x—well above the industry standard of 1.20x. At least one product had a ratio of 2.00x. Plan sponsors using AWP-based reimbursement could be overpaying substantially.
[Click to Enlarge]
If these figures are accurate, it’s yet another reminder: Always check your contract's math.
So far, Cigna has offered no rebuttal or explanation, but I’ll share one if it arrives.
Drug Expenditure Dynamics 2000–2022, IQVIA
IQVIA again uses data to provide a counterintuitive reality check on the political rhetoric.
Across 12 major countries, net drug spending accounts for only 9% to 21% of total healthcare costs.
Despite the political noise, U.S. drug spending is—and has been—squarely in the middle of the global pack. Note that these figures include spending on both retail and non-retail drugs, net of rebates and discounts.
Everything in the U.S. healthcare system is more expensive. That's one of the reasons that benchmarking one small part of the system—the brand-name drug share of the figures above—makes little sense. See my comments from last May.
As usual, this report sparked a spirited online debate—although some commenters seemed not to have read past the headline and opened the actual report. 😑
Across 12 major countries, net drug spending accounts for only 9% to 21% of total healthcare costs.
Despite the political noise, U.S. drug spending is—and has been—squarely in the middle of the global pack. Note that these figures include spending on both retail and non-retail drugs, net of rebates and discounts.
[Click to Enlarge]
Everything in the U.S. healthcare system is more expensive. That's one of the reasons that benchmarking one small part of the system—the brand-name drug share of the figures above—makes little sense. See my comments from last May.
As usual, this report sparked a spirited online debate—although some commenters seemed not to have read past the headline and opened the actual report. 😑
Cheaper medicines, free beach trips: U.S. health plans tap prescriptions that feds say are illegal, CNBC
Has the day of reckoning arrived for such shady alternative funding programs (AFPs) like PriceMD, Rx Valet, SHARx, and others?
This powerful CNBC exposé reveals how shady AFPs skirt FDA regulations and guidance by sourcing specialty drugs from "unverified suppliers" and "potentially illicit" online pharmacies.
Employers keep chasing these schemes, creating delays, denials, confusion, and real risks for their beneficiaries. One quibble: The article omits the plans’ decision to exclude specialty drugs from the formulary, so that a patient technically has "no coverage" (wink, wink) for the drug.
As I have long argued, it’s long past time to hold AFPs accountable and stop these dangerous workarounds.
If you have 30 minutes, I highly encourage you to watch the entire video.
This powerful CNBC exposé reveals how shady AFPs skirt FDA regulations and guidance by sourcing specialty drugs from "unverified suppliers" and "potentially illicit" online pharmacies.
Employers keep chasing these schemes, creating delays, denials, confusion, and real risks for their beneficiaries. One quibble: The article omits the plans’ decision to exclude specialty drugs from the formulary, so that a patient technically has "no coverage" (wink, wink) for the drug.
As I have long argued, it’s long past time to hold AFPs accountable and stop these dangerous workarounds.
If you have 30 minutes, I highly encourage you to watch the entire video.
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