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 Angie Franks, CEO at Kalderos.
Angie examines how data fragmentation contributes to inefficiencies in drug discount programs and the broader gross-to-net bubble—the widening difference between a drug’s revenue at list prices and what manufacturers actually receive. Angie outlines how better access to consistent, claims-level data could help reduce waste, improve program integrity, and enhance collaboration among stakeholders in the drug channel.
During my recent video webinar—What’s Next for Retail Pharmacy: Data, Debate, and Disruption—Antonio Ciaccia of 46brooklyn Research joined me to explore the data, trends, and strategic shifts driving a major shakeout in the retail pharmacy sector.
In the short video excerpt below, I break down five key economic forces putting intense pressure on U.S. drugstores. This clip offers just a glimpse of our broader conversation, which also covered PBMs, wholesalers, the evolving competitive landscape, and more.
Today’s guest post comes from Chris Dowd, Senior VP of Market Development at ConnectiveRx.
Chris revisits his November 2024 forecasts to assess how they’ve held up through mid-2025, giving them an overall grade of A-. He examines which trends played out as expected, where the landscape shifted more dramatically, and how these developments are reshaping patient access strategies.
After multiple years of mandated disclosure of negotiated hospital-insurer rates, those of us who follow the buy-and-bill channel might have expected transparency to reduce drug price variability, lower hospital markups, and accelerate adoption of lower-cost biosimilars.
Alas, that’s not what the latest data reveal.
DCI’s analysis of four national commercial insurers—Aetna, Anthem, Cigna, and UnitedHealthcare—and 26 hospitals found that:
Hospitals still earn significant markups over average sale price (ASP). 340B hospitals earn even more.
Insurers pay wildly varying amounts for the same drug.
Some hospitals get paid significantly more than others for the same drug.
Insurers can pay more for a lower-cost biosimilar than for the higher-cost reference product.
While provider-administered biosimilars are significantly cheaper than their reference products, hospitals and insurers are still making them expensive for plan sponsors. Meanwhile, patients with coinsurance and deductibles are paying higher out-of-pocket costs.
Transparency was supposed to clean things up—but someone forgot to bring the mop.
Today’s guest post comes from Stacey Little, Chief Growth Officer at AssistRx.
In this guest post, Stacey explores how artificial intelligence (AI) is helping life sciences organizations move beyond fragmented support models to deliver more integrated and personalized patient engagement. She outlines three distinct approaches to structuring patient support programs and discusses how AI-driven tools—such as AllazoHealth—can help tailor interventions across the entire treatment journey.
Let’s cut through the steamy summer haze with a refreshing breeze of industry insights from Drug Channels—perfect for pondering while you float in your favorite pool:
P.S. Want more real-time insights? Join my more than 64,000 LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the DCI community.
Today’s guest post comes from Gregory Morris, Chief Strategy Officer at CareMetx.
Gregory examines how Annual Reverification (AR) processes must evolve in response to changing payer dynamics and increasing benefit complexity. Rather than focusing solely on throughput and operational efficiency, he argues for the importance of more nuanced strategies that help ensure patients maintain access to therapy—even when coverage details shift behind the scenes.
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 Medicaid Drug Rebate Program Summit returns to Chicago this September! Join 700 annual attendees and nearly 100 expert speakers to master complex regulatory guidelines to deliver compliant government pricing and reporting programs.
The 2025 event features:
Workshops covering Government Pricing and Reporting 101, Tactical Calculations and Strategy, Commercialization for Emerging Pharma, SPTR, and 340B Boot Camp.
Tracked Programming, where you'll build your own agenda with options such as 340B Evolution, State Level Trends, The IRA Rollercoaster, and The New Administration.
Town Hall Style Learning where you'll review best practices and policy ideas.
State Dispute Resolution Meetings where you'll participate in targeted discussions between manufacturers and states to resolve rebates, reporting, and compliance questions.
Opportunity to attend a Closed-Door Executive Strategy Summit, where senior executives will participate in interactive discussions bridging policy with business strategy.
Fireside Chats where an expert panel of attorneys discuss the most pressing issues facing MDRP and Government Pricing.
OIG Address reviewing recent investigations, audit findings, and enforcement actions related to government pricing programs, and a focus on upcoming enforcement priorities.
Opportunities to network and build valuable connections with more than 700 annual attendees.
PLUS–Don’t miss a Keynote from CMS.
Previous attendees praise the event as "An excellent forum to meet industry professionals and gain insight into best practices, current and future, of what's to come regarding manufacturers and government regulations."
The MDRP Summit remains essential for anyone navigating the complex intersection of pharmaceutical economics, compliance, and government programs. With expert speakers, targeted sessions, and valuable networking opportunities, this event delivers actionable insights you can implement immediately.
View the agenda for MDRP 2025 to see the complete picture–the program, speakers, and more, and visit www.informaconnect.com/MDRPSummit for further details and to register.
Drug Channels readers will save 10% off when they use code 25DRCH10 and register prior to August 22, 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).
Is the gross-to-net bubble—the ever-widening gap between brand-name drug sales at list prices and their net revenues after rebates and discounts—finally beginning to deflate?
Drug Channels Institute (DCI) estimates that the gross-to-net reductions for all brand-name drugs reached $356 billion in 2024, a 7% increase over the previous year. Yet despite this record total, the bubble expanded at the slowest rate in at least a decade.
In our analysis below, we highlight five key forces driving this shift. Among them: manufacturers’ evolving market access strategies, which increasingly aim to offset—or circumvent—growing pricing pressure from both commercial and government payers.
Meanwhile, many patients remain adrift in the drug channel’s murky waters. As for SpongeBob SquarePants—the longtime mascot of the gross-to-net bubble here at Drug Channels—he’s still with us…but may be eyeing the exit.
Today’s guest post comes from Lindsay Reel, VP of Pharmacy Practice & Specialty Solutions at EVERSANA.
In this article, Lindsay shares a pharmacist’s firsthand perspective on the growing complexity of patient access and the limitations of traditional pharmacy models. She argues that emerging Direct-to-Patient (DTP) strategies can reshape the care experience by addressing longstanding inefficiencies, enhancing transparency, and simplifying therapy initiation for both patients and providers.
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!
Happy 249th birthday, America! Before you launch your July 4 festivities, Drug Channels humbly offers some fact-based fireworks to heal our troubled nation:
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.
Last week, President Trump signed yet another executive order, this time promising to make healthcare pricing more transparent.
While this marks another federal push for disclosure, states have already been quite active in this space. Since 2017, 24 states have passed 38 laws targeting healthcare transparency, with a strong focus on unraveling the complex economics of pharmacy benefit managers (PBMs).
But has all this legislation actually provided clarity—or just more red tape?
Below, I analyze four state reports on manufacturers’ rebate and fee payments to PBMs. The findings are dispiriting: mandated disclosures have yielded little actionable, reliable data. Lawmakers got to pat themselves on the back for “transparency,” but the data tell a different story. Federal efforts haven’t been much better.
Should we continue down the path of government-mandated reporting, or should plan sponsors be left to negotiate their own deals?
This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.
It's time for Drug Channels’ annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. As you can see below, we have revised, renovated, and refurbished our infamous illustration of the major vertical business relationships among the largest companies.
Proponents of these vertical integration arrangements argue that they create opportunities to mine healthcare costs. However, these organizations remain highly controversial, due to the potential for anti-competitive behavior. We summarize some of the key issues below.
While some major companies have narrowed their focus or unwound previous integration efforts, ongoing consolidation and selective deconsolidation will continue to reshape the healthcare biome by trying to build something epic, block by block.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.
Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.
DCI has identified nearly 1,900 dispensing locations with specialty pharmacy accreditation. Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates.
As in prior years, pharmacies linked to the three largest pharmacy benefit managers (PBMs) accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. We also explore how these pharmacies contribute to PBMs’ profitability—and spotlight the growing influence of provider- and health system-owned dispensing channels.
Once again, “specialty” mostly means affiliated with a PBM.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.
Three’s still company in the world of pharmacy benefit managers.
For 2024, nearly 80% of all equivalent prescription claims were processed by three familiar companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. The names haven’t changed, but shifting relationships and contract shakeups have altered the plot, with Express Scripts stepping into a new lead role.
Below, we break down the latest market share data from Drug Channels Institute (DCI), explore the developments driving these changes, and examine what they signal for the future of the PBM landscape.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.
For 2024, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $683 billion, up 9% from the 2023 figure. GLP-1 agonist drugs remained the most significant driver of prescription revenue at retail pharmacies, accounting for more than 80% of dispensing revenue growth for 2024.
The table below—one of 268 in our new report—cues up DCI's first look at the 15 largest organizations that battled for those revenues. For a sneak peek at the complete report, click here to download our free 30-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits).
Today’s guest post comes from Sean Wagner, VP of Client Partnerships and Carolyn Zele, Advisor, Solution Consulting at MMIT.
Sean and Carolyn argue that planning for a successful drug launch must begin early—often well before Phase III. In this article, they present a six-step framework to help manufacturers align clinical development with payer expectations, patient needs, and real-world access dynamics.
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.
Today’s guest post comes from Logan Melchione, VP of Patient Affordability at Paysign.
Logan explores how maximizers have reshaped the patient affordability landscape and pressured pharmaceutical manufacturers to adapt their copay strategies. In this guest post, she outlines her perspective on the limitations of traditional copay solutions, describes Paysign’s data-driven approach to first-fill identification of maximizer impact, and shares how the company reports saving millions while improving patient access.
To request an analysis of your program’s maximizer exposure risk and learn more about Paysign solutions, email affordability@paysign.com or visit paysign.com/rx.
It’s time for Drug Channels’ annual look at pharmacist salaries and employment.
There was more bad news, as employment in retail pharmacies and drugstores dropped by 8,500 positions in 2024, following a drop of 4,800 positions in 2023. Employment in mass merchants and supermarkets with pharmacies increased. Meanwhile, employment at hospitals surged to a new high, growing by nearly 7,000 positions in 2024.
Average salaries hit $137,000, but varied widely across practice settings. However, salary growth did not keep pace with overall inflation.
Get ready for the future of pharmacy on June 20, 2025 (12:00–1:30 p.m. ET). Dr. Adam J. Fein and Antonio Ciaccia will unpack the good, the bad, and the ugly of the pharmacy industry—and explore what it means for you. This dynamic session will blend expert insights and real-time debate. Click here to register.
To watch the webinar or enter into a direct agreement with GoodRx, pharmacies are not waiving their rights to participate in ongoing litigation against GoodRx. Pharmacies are not required to agree to GoodRx's Terms of Use in order to watch the webinar.
Don’t miss DCI’s June 20, 2025, webinar, featuring Dr. Adam J. Fein and Antonio Ciaccia. We’ll unpack the good, the bad, and the ugly of the pharmacy industry—and explore what it means for you. This dynamic session will blend expert insights and real-time debate. Join us!
The Inflation Reduction Act (IRA) is triggering increases in Medicare beneficiaries’ spending on their Part B drugs.
Though CMS touts that the IRA’s inflation-based coinsurance adjustments will "lower out-of-pocket costs," the results have been more complicated. Below, we update and expand on our previous analysis.
We find that a growing number of Part B drugs now have inflation-adjusted coinsurance rates that are rising, not falling. In many cases, the rate dips temporarily before snapping back to the standard 20%.
Even more troubling, these fluctuations have led to unexpected increases in patients’ out-of-pocket expenses—even when a drug’s price was declining.
These unpredictable coinsurance shifts are another example of the IRA’s unintended consequences. Rather than enjoying stable or reduced costs, some seniors are finding themselves on a financial rollercoaster.
Don’t miss DCI’s next webinar on June 20, 2025 (12:00–1:30 p.m. ET), featuring Dr. Adam J. Fein and Antonio Ciaccia. We’ll unpack the good, the bad, and the ugly of the pharmacy industry—and explore what it means for you. This dynamic session will blend expert insights and real-time debate. Hope you can join us!
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 20, 2025
12:00 p.m. to 1:30 p.m. ET
Dr. Fein will be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors. Adam and Antonio will share their unique insights on the pharmacy market and engage in a dynamic, real-time debate you won’t want to miss!
Join industry experts Adam and Antonio for an exclusive deep dive and discussion into the latest trends, data, and strategies shaping the retail pharmacy industry. Drawing from their organizations’ respective research, they will provide invaluable insights to help you and your team stay informed about this rapidly changing marketplace.
Topics will include:
The competitive landscape of retail pharmacy, with exclusive market data from DCI and 46brooklyn
Key economic trends among leading PBMs and their impact on the market
PBMs’ controversial effect on pharmacy and how they’re shaping the industry
The medications driving pharmacy profits and the ones bringing financial pain
The benefits and shortcomings of state and federal PBM regulations, including a debate over the new Arkansas law
Exclusive insights into the latest state transparency reports
The complex roles of pharmaceutical wholesalers in pharmacies’ supply chain
The risks and rewards of acquisition cost pharmacy reimbursement
The pros and cons of the 340B Drug Pricing Program for retail pharmacies
How hospital-owned pharmacies are changing the game
The outlook for shakeout and consolidation
Actionable takeaways for pharmaceutical manufacturers and pharmacy leaders
Emerging controversies, challenges, and threats to watch in the industry
And much more!
As always, Adam and Antonio will clearly distinguish their opinions and interpretations from the objective facts and data.
What’s more, this 90-minute video webinar will feature a live discussion and debate between Adam and Antonio. Watch these two experts challenge conventional wisdom—and each other—in an unprecedented throwdown.
Register now to stay informed and get ahead of the curve on the pharmacy industry!
PRICING OPTIONS
Take advantage of this exclusive educational opportunity for just $420 per viewing device. Once you register, you'll receive a unique Zoom access link within 24 hours—making it easy to add the event to your calendar and ensure you don’t miss out.
Special Discounts For Teams!
We understand that many professionals are working remotely, so we’re offering substantial savings for multiple registrations from the same organization:
Register multiple devices for as low as $295 each—a 30% discount!
Unlimited attendees can watch together at a single physical location (one registered device required).
Important Reminder: Each device at a single physical location must have its own registration. The webinar may not be recorded, streamed, broadcast, or shared across different locations, devices, or sites.
Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)
Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Need to pay via check or ACH? Click here to request an invoice.
IMPORTANT THINGS TO KNOW
Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.
We will use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.
Every registrant will receive an email from Zoom with links to download Adam and Antonio’s slides.
The day after the event, every registrant—whether they attended the live event or not—will receive an email from Zoom with information on how to access a video replay of the live event and download all slides.
This event is part of The Drug Channels 2025 Video Webinar Series. If you already purchased access to the 2025 Drug Channels Video Webinar Series, then you should have received an email from Zoom with a link to access the June 20, 2025, event.
Organizations that purchased corporate access for The Drug Channels 2025 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.
Each registration for a DCI webinar is valid for a single device at a single physical location. Each device at a physical location requires its own registration. Attendees are not permitted to record, stream, share, or project a DCI webinar to other sites or locations. Purchasers who violate this limitation by recording, streaming, sharing, or projecting a DCI webinar to other sites, devices, or locations will be liable for the full cost of all locations that viewed the webinar. DCI reserves the right to prohibit purchasers who violate our terms from attending future DCI webinars.
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: 
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: 
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: 
