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...
Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.
In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.
The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.
As you’ll see below, our analysis describes a 340B program that generates financial gains far in excess of any contribution back to the people of the state. There is also no clear accountability for how those dollars are used.
Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.
For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.
However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.
Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.
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.
Three is still the magic number for pharmacy benefit managers (PBMs).
For 2025, 80% of all equivalent prescription claims were processed by three companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. Express Scripts continued to pull ahead of its peers, while CVS Caremark’s claim volume declined for the second year.
Independent PBMs continued to gain business from these larger PBMs, showing fragmentation at the margins. Many smaller PBMs still rely on their larger competitors for claims processing, network management, and rebate negotiation. So even if a plan sponsor chooses an alternative PBM, the Big Three can still win with behind-the scenes economics.
The Big Three PBMs’ dominance persists, but they face growing regulatory and competitive constraints. The largest PBMs are restructuring their businesses in response to client demands, legislative changes, and legal pressures. The emerging Net Pricing Drug Channel will accelerate these shifts, forcing changes in how PBMs generate profits, structure contracts, and justify their role in the drug channel.
For 2025, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $751 billion in 2025, up 10% from the 2024 figure.
GLP-1 agonist drugs have become the dominant driver of revenue growth. Over the past five years, increases in dispensing revenues from GLP-1 products accounted for about 60% of retail pharmacies’ total revenue growth.
The table below—one of 270 in our new report—racks up DCI's first look at the 15 largest organizations that competed for a share of those dollars. For a sneak peek at the complete report, click here to download our free 32-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 Stephen Hom, Co-Founder, EVP & Chief Operating Officer of RIS Rx.
Drawing on RIS Rx’s proprietary data and case studies, Stephen highlights patterns that can undermine patient support program effectiveness. He argues that a more data-driven approach can help manufacturers identify hidden risks, improve program performance, and ensure that affordability resources reach the patients they are intended to support.
It’s time for Drug Channels Institute’s latest exclusive analysis of the 340B contract pharmacy market, which continues to boom along with the overall program’s expansion.
However, our 2026 analysis finds that the contract pharmacy market is now entering a more mature phase characterized by consolidation, slower growth, and increasing dominance by the industry’s largest participants.
Below, we characterize the state of the marketplace:
Nearly two-thirds of the entire U.S. pharmacy industry participates as contract pharmacies for the 340B hospitals and federal grantees.
The number of 340B pharmacy locations declined for the third year, due largely to the retail pharmacy shakeout and manufacturers’ 340B policies.
Meanwhile, the total number of unique contract pharmacy/covered entity relationships continues to expand. Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna, CVS Health, UnitedHealth Group, Walgreens, and Walmart—now account for a record 77% of all relationships.
Read on for our latest analysis of this ever-expanding profit pool for pharmacies and PBMs. For a deep dive on what the 340B program’s growth means for drug channel participants, join Adam J. Fein, Ph.D., and Tyler Novotny on June 12 for a new live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.
Today’s guest post comes from Angie Franks, Chief Executive Officer at Kalderos.
As Angie explains, the industry still lacks the transparency needed to effectively manage where discounts occur and how funds move across stakeholders. She argues that improving visibility and coordination across the ecosystem is essential to building a more sustainable and accountable model for both innovation and patient support.
Summer unofficially kicked off last weekend. So fire up the grill and enjoy these noteworthy delicacies, seared to perfection on the Drug Channels barbeque:
Don't miss DCI’s upcoming webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.
Here at Drug Channels, we’ve been closely tracking the evolution of the pharmacy benefit management (PBM) industry for many years.
The short video below—excerpted from DCI’s recent PBM Industry Update 2026: Trends, Challenges, and What’s Ahead video webinar—reviews the shifting market positions of the largest PBMs and explains why vertical integration continues to reshape the industry’s competitive dynamics.
I also discuss the proliferation of smaller PBMs, many of which still depend on the largest PBMs for claims processing, pharmacy networks, rebate negotiation, and other core services. However, the market is entering what we believe will be a significant shakeout phase.
The growing administrative complexity of state and federal regulation will disproportionately burden smaller PBMs that lack the scale, capital, and integrated infrastructure of the largest organizations. Over the next five years, we expect many smaller PBMs to disappear through acquisition, consolidation, or business failure.
Meanwhile, vertical integration will continue to create strategic and financial advantages for the largest healthcare organizations—along with new opportunities to shift profits, manage risk, and coordinate services across multiple parts of the healthcare system.
Don't miss DCI’s next live video webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.
Today’s guest post comes from Peter Darch, SVP of Strategy and Operations at PHIL Inc.
Peter explains that growing pressure on drug pricing is exposing structural inefficiencies in gross-to-net (GTN) across traditional distribution channels. He argues that single-channel ecosystems can better coordinate affordability, coverage, and dispensing, improving both patient outcomes and brand performance.
The onslaught of pharmacy-related news doesn’t end. It may even be increasing in volume due to AI.
But don’t worry—I’ve gathered some high-impact information over the last month from my LinkedIn posts that you can quickly read between your sets at the gym.
I recommend reading BETWEEN your sets, but some may be brave enough to read during the set itself.
Don't miss DCI’s upcoming webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.
Join industry expert Adam J. Fein, Ph.D., and his colleague Tyler Novotny, MBA, for an exclusive deep dive into the 340B Drug Pricing Program—one of the most complex and controversial segments of the U.S. pharmaceutical market.
In this all-new webinar, Adam and Tyler will deliver a fact-based, data-driven analysis of the 340B program’s structure, economics, and rapid evolution. He’ll unpack the key controversies reshaping the program, explain what’s really happening behind the headlines, and provide a clear, actionable outlook for stakeholders across the drug channel.
Whether you’re in pharma, provider organizations, pharmacy, or policy, you’ll gain the insights needed to understand where 340B is headed—and what it means for your business.
Key topics include:
The structure and economics of the 340B program
Growth trends among covered entities and their partners
340B’s expanding role in pharmacy—and its impact on PBMs and retail
DCI’s latest data on the contract pharmacy marketplace and the leading participants
The role of third-party administrators and vendors in the 340B ecosystem
What’s behind the growing controversy over the definition of an eligible patient
Why diversion and duplicate discounts have become flashpoints
The implications of the Net Pricing Drug Channel for 340B pricing dynamics
How 340B funds are generated and distributed across participating entities
How employers and plan sponsors could reshape the program’s future
Manufacturers’ evolving distribution strategies for 340B contract pharmacies
Recent legal developments affecting manufacturer policies and contract pharmacy arrangements
The expanding influence of state legislation
The impact of the Inflation Reduction Act on program operations and oversight
The HRSA vs. CMS oversight crisis
The outlook for a potential 340B rebate model
What’s ahead for state and federal policy
Emerging risks, challenges, and threats to watch
Plus: fresh insights and expert perspective you won’t find anywhere else.
As always, they will clearly distinguish their opinions and interpretations from the objective facts and data.
This 90-minute video webinar will feature a dedicated Q&A session, where attendees can unmute and engage directly with Tyler and Adam.
Register now to stay informed and get ahead of the curve on 340B!
PRICING OPTIONS
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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. What's more, an unlimited number of attendees can watch together at a single physical location with one registered device.
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.
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IMPORTANT THINGS TO KNOW
Watch and listen via any modern browser via computer, tablet, or mobile. (No telephone access.)
Each registrant will receive an email with a link to watch the event. This link is unique to the registrant and can only be accessed once.
Every registrant will also receive a link to download Dr. Fein's slides.
This event is part of The Drug Channels 2026 Video Webinar Series. If you already purchased access to the 2026 Drug Channels Video Webinar Series, then you already should have received an email from Zoom with a link to access the June 12, 2026, event.
Organizations that purchased corporate access for The Drug Channels 2026 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.
Today’s guest post comes from George Moore, Chief Product and Technology Officer at CareMetx.
George argues that customer relationship management (CRM) program customization delivers short-term workflow gains at the expense of long-term scalability, integration simplicity, and upgradeability. He highlights three common pitfalls and offers an approach on how to avoid them.
Below, we share our proprietary analyses of the specialty market’s participants. DCI identified more than 1,900 pharmacy locations that have achieved specialty pharmacy accreditation from one of the two major independent accreditation organizations.
Despite growing revenues from specialty drugs, overall growth in accredited pharmacies has plateaued. However, pharmacy locations owned by healthcare providers—hospitals, health systems, physician practices, and other healthcare providers—continue to expand and now account for nearly 40% of all accredited specialty pharmacy locations.
Read on for a bit of our arithmomania. Because in specialty pharmacy, what gets counted reveals who really counts.
Today’s guest post comes from Cindy Baksh, Chief Product Officer at ConnectiveRx.
Cindy explains that many gross-to-net (GTN) exposures now occur at the claim level, where evolving payer tactics, pharmacy economics, and copay complexity create unpredictable leakage. She argues that manufacturers must augment downstream review with real-time visibility and intervention to protect both revenue and patient access.
Spring has officially arrived at Drug Channels' worldwide headquarters in beautiful downtown Philadelphia. (Photo proof at right.) So, dive into this month’s curated crop of noteworthy news:
Today’s guest post comes from Laura Jensen, Chief Commercial Officer and President, Pharma Direct at GoodRx.
Laura suggests that manufacturers must move beyond payer-centric models toward integrated, direct-to-consumer and employer channel strategies that connect pricing, demand, and fulfillment. She argues that this approach will help manufacturers convert patient intent into therapy initiation while expanding access at scale.
Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.
In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.
The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.
As you’ll see below, our analysis describes a 340B program that generates financial gains far in excess of any contribution back to the people of the state. There is also no clear accountability for how those dollars are used.
Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.
For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.
However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.
Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.
Next week, the DCI team will be attending Asembia’s AXS26 Summit in fabulous Las Vegas. Please say hello if you see us!
Today’s guest post comes from Karishma Desai, Associate Director of Data Strategy at Claritas Rx.
Karishma explains how the complexities of specialty therapies require a customer relationship management (CRM) system that unifies consent management. She goes on to explain that by embedding AI into the patient journey, automating workflows at scale, and enhancing collaboration among stakeholders, organizations can reduce delays, improve adherence, and deliver better patient outcomes.
Today’s guest post comes from Brok Vandersteen, Vice President of Business Development at AssistRx.
Brok explains how missteps during patient support program transitions—ranging from service disruptions to data misalignment—can undermine access, adherence, and brand trust. He describes best practices organizations can use to ensure a smooth transition while protecting patients, providers, and program outcomes.
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.
Don't forget to register for DCI’s next 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 explore what it means for you. Click here to learn more and sign up.
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