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...
It's time for Drug Channels Institute’s (DCI) 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 updated and revised our infamous illustration of the major vertical business relationships within the largest companies.
These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical integration strategies. Scrutiny of these companies’ actions continues to grow.
Drug Channels readers save 10% with code 26DRCH10*
Pricing & Contracting USA arrives at an important moment for our industry. As you work to navigate the evolving healthcare landscape, this annual event brings together 70+ expert speakers to lead the critical discussions that will drive comprehensive market strategy, uniting Medicaid, Policy, Pricing, Contracting & Reporting thought leaders.
Event features include:
Wholesaler/Manufacturer Team-to-Team Meet-and-Greets: Direct industry collaboration led by McKesson and Cencora.
Executive Programming: Fireside Chats with External Counsel, Closed Door Executive Strategy Summit and Luncheon.
Interactive Sessions: Speed Networking, AI Lunch and Learn
Strategic Working Groups: Medicaid Working Group Report, 80 Minute Industry Strategy Working Group.
The Hottest Topics: Get ready for coverage on Most Favored Nation (MFN) Pricing Implementation, Medicare Part B Drug Negotiations (2028 Launch), 340B Rebate Model from all stakeholder perspectives, State Medicaid Revenue Transparency Sessions, Cell & Gene Therapy Outcomes-Based Contracting, AI-Powered Pricing Scenario Planning, Direct-to-Consumer Pharma Initiatives, Chargeback Data Accuracy Impact on Rebates, What's new with GTN, GPOs, PBMs, PDABs and SPTR, Government Shutdown Policy Timeline Disruption, and so much more.
Featuring 70+ speakers from: Accord, Alkermes, AstraZeneca, Azurity, Chiesi, CMS, CSL Vifor, Genentech, Gilead, GSK, Keenova Therapeutics, Novartis, OIG, PhRMA, Sandoz, UCB and many more.
Join us where Medicaid, Commercial & Government Teams will collaborate to drive a successful market strategy! View the agenda for Pricing & Contracting USA to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pricing-contracting-usa for further details and to register.
*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).
As I highlighted last week, we are entering the Net Pricing Drug Channel (NPDC) era—a market environment in which net prices, not list prices, determine access, economics, and competitive strategy. This shift represents a structural change in how value is created and captured across the U.S. drug channel.
The NPDC will:
Reward simpler pricing models
Penalize rebate-heavy strategies
Expose business models built on gross-to-net arbitrage
Force channel participants to rethink how they add value when money flows more transparently through the system
The short video below, excerpted from my recent Drug Channels Outlook 2026, explains why this shift is accelerating.
It walks through the key forces now deflating the gross-to-net bubble and explains how manufacturers and other channel participants are responding.
For more context on the emergence of the Net Pricing Drug Channel and the slowdown in the gross-to-net bubble’s growth, see these Drug Channels articles:
Earlier today, the Federal Trade Commission (FTC) announced an extraordinary settlement with Express Scripts that fundamentally reshapes its pharmacy benefit management (PBM) business—and by extension, the entire drug channel.
The settlement addresses virtually every warped incentive that we have been covering on Drug Channels for the past 20 years. I summarize them below, but it’s worth reading the full document (links below) to appreciate just how completely the FTC has dismantled the existing PBM business model.
One small caveat: Plan sponsors could provide a loophole for business-as-usual. (See Section XI.)
William Gibson once said: “The future is already here–it's just not evenly distributed.” That future just arrived for one of the biggest PBMs. Get ready.
Since this article was published last December, Net Pricing Drug Channel developments have accelerated. Manufacturers reduced the list prices for 6 of the 10 products with an MFP for 2026. They have also preemptively reduced list prices for three products that will have MFPs in 2027 and 2028. For more on these trends, see Section 12.1.1. of our new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
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.
I’m pleased to introduce a new recurring feature from Bryce Platt, DCI’s new Director. Each month, Bryce will highlight some of his most notable LinkedIn posts—for those of you who don’t follow him or can’t keep up with his prolific stream of drug channel graphics.
Best, Adam
Welcome to my first Drug Channels post! Yes, it may feel a bit strange to see an article here that isn’t written by Adam.
I post daily on LinkedIn, but some posts deserve a deeper look or a wider audience. This roundup highlights a few of my favorites from the past month, along with added context and takeaways.
Let me know what you think and how I can make these roundups even more useful.
Don't miss DCI’s upcoming webinar on Friday, April 10, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Bryce Platt will unpack the good, the bad, and the ugly of the PBM industry—and what it means for you. Click here to learn more and sign up.
For 2026, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (United Health Group)—have once again excluded hundreds of drugs from their standard formularies. Our updated counts appear below.
The 2026 lists highlight how formulary preferences for Humira and Stelara are dominated by private-label biosimilars affiliated with the same parent companies that operate the three largest PBMs. Many of the preferred products feature lower list prices, signaling growing tension between traditional rebate-driven formularies and emerging net-price-based competition.
These developments matter because the pricing system that underpins PBMs’ formulary leverage is weakening. The gross-to-net bubble is deflating and the industry is moving toward what we call the Net Pricing Drug Channel (NPDC).
As low list prices, direct-to-patient distribution, and cost-plus reimbursement models gain traction, formulary exclusions will no longer deliver the economic power they once did. These changes threaten PBMs’ leverage—and profits.
As usual, Mark Cuban is leading the way. AbbVie itself now appears to be following. Consider this year’s formulary review a preview of what market access looks like when the rebate game starts to unwind.
Today’s guest post comes from Chrissy Hand, Chief Product and Commercial Officer at CoverMyMeds.
Chrissy highlights key themes in the future of patient access. She argues that policy changes, complex benefit designs, and affordability challenges require patient support services to be faster, more connected, and better aligned with real-world patient and provider needs.
