P.S. Join my nearly 71,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.
Abarca Health and LucyRx Announce Strategic Combination to Create the Only Modern PBM Built for Commercial and Government Scale, PR Newswire
Abarca Health and LucyRx recently announced their merger.
As we discussed in our April webinar, the PBM market is entering a significant consolidation phase. LucyRx has already acquired two smaller competitors in 2024 and 2025.
Many smaller PBMs still rely on the Big Three PBMs for critical infrastructure, including claims processing, pharmacy networks, rebate administration, and other core services.
At the same time, the growing complexity of state and federal regulation is creating additional operational and compliance burdens. Thanks, CAA! 🙃
Those costs will fall most heavily on smaller PBMs that lack the scale, capital resources, and integrated capabilities of the industry's largest players.
Meanwhile, transparency is becoming less of a differentiator. Or, as Syndrome put it in The Incredibles: “When everyone’s super, no one will be.”
Even today, many plan sponsors are skeptical about smaller PBMs’ transparency claims. For smaller PBMs, fewer than half of plan sponsors (44%) believe they had full revenue transparency, and only 51% said they understood rebate handling. Smaller PBMs have an edge—but it’s narrower than you might think.
The result? More pressure on smaller PBMs and, likely, more consolidation across the sector.
ICYMI, here’s my PBM shakeout video:
As we discussed in our April webinar, the PBM market is entering a significant consolidation phase. LucyRx has already acquired two smaller competitors in 2024 and 2025.
Many smaller PBMs still rely on the Big Three PBMs for critical infrastructure, including claims processing, pharmacy networks, rebate administration, and other core services.
At the same time, the growing complexity of state and federal regulation is creating additional operational and compliance burdens. Thanks, CAA! 🙃
Those costs will fall most heavily on smaller PBMs that lack the scale, capital resources, and integrated capabilities of the industry's largest players.
Meanwhile, transparency is becoming less of a differentiator. Or, as Syndrome put it in The Incredibles: “When everyone’s super, no one will be.”
Even today, many plan sponsors are skeptical about smaller PBMs’ transparency claims. For smaller PBMs, fewer than half of plan sponsors (44%) believe they had full revenue transparency, and only 51% said they understood rebate handling. Smaller PBMs have an edge—but it’s narrower than you might think.
The result? More pressure on smaller PBMs and, likely, more consolidation across the sector.
ICYMI, here’s my PBM shakeout video:
Drug Channels’ Adam Fein: 340B Entering New ‘Era of Transparency’, 340B Report
William Newton at 340B Report wrote an excellent summary of DCI's recent webinar on the evolving 340B landscape: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.
As we discussed, manufacturers increasingly face the risk of triplicate discounts on the same prescription: an upfront 340B discount, an IRA Maximum Fair Price (MFP) refund, and a Medicaid rebate paid to states.
During the webinar, I shared several predictions:
As we discussed, manufacturers increasingly face the risk of triplicate discounts on the same prescription: an upfront 340B discount, an IRA Maximum Fair Price (MFP) refund, and a Medicaid rebate paid to states.
During the webinar, I shared several predictions:
- The Inflation Reduction Act (IRA) will accelerate efforts to increase visibility into 340B claims and transactions.
- CMS and the courts—not Congress—will continue to drive many of the most significant changes to the 340B program.
- The Net Pricing Drug Channel (#NPDC) will reduce 340B margins for covered entities and lower fee opportunities for contract pharmacies.
- Plan sponsors will intensify efforts to stop rebate losses from 340B contract pharmacy claims.
2026 Trends in Specialty Drug Benefits Report, Pharmaceutical Strategies Group
A persistent puzzle in the pharmacy benefit world surfaced again in Pharmaceutical Strategies Group’s (PSG) latest benefit design reports.
PBMs frequently state that they pass through 95%+ of manufacturer rebates to their employer clients. Yet employer surveys tell a different story (as summarized in the chart below):
What's striking is that we've seen similar results for many years. Check out Section 9.1.1. of our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
So what's behind the disconnect?
Click here to check out the DCI community’s lively LinkedIn debate on my question.
PBMs frequently state that they pass through 95%+ of manufacturer rebates to their employer clients. Yet employer surveys tell a different story (as summarized in the chart below):
- Traditional drugs: 66% of employers report receiving 100% of rebates, while 34% use other arrangements.
- Specialty drugs: Only 54% report receiving 100% of rebates, while nearly half use alternative rebate structures.
[Click to Enlarge]
What's striking is that we've seen similar results for many years. Check out Section 9.1.1. of our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
So what's behind the disconnect?
- Are employers defining "100% of rebates" differently than PBMs?
- Do guaranteed rebate arrangements create confusion about what is actually being passed through?
- Will the Consolidated Appropriations Act's transparency requirements narrow this perception gap?
Click here to check out the DCI community’s lively LinkedIn debate on my question.
Identifying Meaningful Patient Savings on Generics: Direct-to-Consumer Prices Versus Commercial Insurance Cost Sharing, Annals of Internal Medicine
For a surprising number of generic drugs, paying cash through Mark Cuban Cost Plus Drug Company (MCCPDC) can be dramatically cheaper than using commercial insurance.
A new study from Annals of Internal Medicine found:
Small caveat: Fewer than 15% of generic prescriptions had out-of-pocket costs above $15.
Nonetheless, this is another reminder from Mark Cuban that complexity is the enemy of low costs and efficiency.
A new study from Annals of Internal Medicine found:
- For generic prescriptions with out-of-pocket costs above $15, nearly 80% would have been cheaper through Cost Plus Drugs.
- For prescriptions with cost sharing above $100, the median patient cost dropped from $140 through insurance to just $25 through Cost Plus.
Small caveat: Fewer than 15% of generic prescriptions had out-of-pocket costs above $15.
Nonetheless, this is another reminder from Mark Cuban that complexity is the enemy of low costs and efficiency.
Nominations and Withdrawal Sent to the Senate, The White House
Congratulations to Ge Bai on her nomination to serve as Assistant Secretary of U.S. Department of Health and Human Services (HHS).
My $0.02: Ge is exceptionally knowledgeable, thoughtful, and dedicated to improving healthcare. She would be a tremendous asset in this important leadership position.
My $0.02: Ge is exceptionally knowledgeable, thoughtful, and dedicated to improving healthcare. She would be a tremendous asset in this important leadership position.
No comments:
Post a Comment