Drug Channels News Roundup, August 2025: White Bagging Battles, Private Label Price Hypocrisy, 340B Patient Problems, and UnitedHealth Group’s Woes

Our news-laden summer is ending. Time to pack away your bathing suit, send the kids back to school, and cherish these curated curiosities that I combed from the Drug Channels coastline:

• Aetna’s latest white bagging plan: Saving money or shifting costs?

• 340B covered entities are still not sharing discounts with needy patients

• PBM-affiliated private label biosimilars and their pricing double standard

• UnitedHealth Group’s 2,694 subsidiaries: too big to manage?

P.S. Join my nearly 65,000 LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the DCI community.

Markup Madness 2025: Hospitals, Insurers, and the Broken Buy-and-Bill Market for Biosimilars

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.

Drug Channels News Roundup, July 2025: 340B vs. Patients, Humira Whiplash, Accumulator Fallout, and Pharmacy Struggles

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:

• 340B Discounts Still Not Reaching Needy Patients

• Why do patients switch from biosimilars back to Humira?

• Copay accumulator programs strike again!

• The Grim Outlook for Retail Pharmacies

Plus, a shout-out to three talented journalists.

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.

Drug Channels News Roundup, June 2025: PBM Rebate Flow, 340B’s 2024 Boom, IRA Fallout, MFN Legal Risks—and Mark Cuban’s PBM Rant

Happy 249th birthday, America! Before you launch your July 4 festivities, Drug Channels humbly offers some fact-based fireworks to heal our troubled nation:

• Where the Rebates Really Go

• Another Year of Explosive Growth for the 340B Program

• IRA Fallout for Seniors’ Out-of-Pocket Drug Costs

• Most-Favored-Nation Pricing’s Shaky Legal Foundations

Plus, Mark Cuban's blunt take on why CEOs fuel the PBM status quo.

P.S. Join my nearly 64,000 LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the Drug Channels community.

The 340B Contract Pharmacy Market in 2025: Big Chains and PBMs Tighten Their Grip

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.

The 2025 market data below illustrate just how far the 340B program’s operations have diverged from its original intent. As Senator Bill Cassidy recently noted, the 340B program “was never meant to be part of an earnings call. It was meant to be part of patient care.”

For more on what the 340B program’s growth means for pharmacies, join Adam J. Fein, Ph.D., and Antonio Ciaccia on June 20 for a new live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption.

Follow the 340B Dollar: Senator Cassidy Exposes How CVS Health and Walgreens Profit as 340B Contract Pharmacies

Two weeks ago, Senator Bill Cassidy—now chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP)—dropped a must-read, eyebrow-raising report on the out-of-control 340B Drug Pricing Program. (Link below.)

The report reveals previously confidential information showing how billions are funneled to health systems and pharmacies—with manufacturers unable to follow the flow.

Below, we use these new disclosures to illustrate the 340B program’s hidden prescription economics for 340B contract specialty pharmacies operated by CVS Health and Walgreens Boots Alliance.

As you can see, the program’s participants earn substantial margins, while plans and third-party payers foot the bill.

What do you think? Click here to share your thoughts with the Drug Channels LinkedIn community.  

Inflation-Adjusted U.S. Brand-Name Drug Prices Fell for the Seventh Consecutive Year as a New Era of Drug Pricing Dawns (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.

Click here to see the original post from January 2025.

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It's time for Drug Channels’ annual examination of U.S. brand-name drug pricing.

For 2024, average brand-name drugs’ list prices grew by only 2.3%. What’s more, after adjusting for overall inflation, brand-name drug net prices dropped for an unprecedented seventh consecutive year. Details and additional commentary below.

As I predicted two years ago, the combined impact of changes to Medicaid rebates, the Inflation Reduction Act (IRA), and novel formulary access strategies have led multiple manufacturers to pop the gross-to-net bubble for high-list/high-rebate products. Consider the 18 products with list-price cuts shown below.  Other drugmakers have reduced the rate of price increases, thereby inflating the bubble more slowly.

Employers, health plans, and pharmacy benefit managers (PBMs) determine the extent to which patients with insurance share in this ongoing deflation. But signs of change to the conventional approaches are undeniable.

New channel models—including smaller PBMs, cost-plus pharmacies, patient-paid discount card prescriptions, and manufacturers’ direct-to-patient businesses—are creating novel paths for drugs that can be sold without gross-to-net bubble distortions.

The bubble won’t vanish overnight. But for the first time in years, I can foresee a time when SpongeBob SquarePants will move on from Drug Channels.

Four Revelations from Minnesota’s First 340B Transparency Report (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.

Click here to see the original post from December 2024.

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It’s time to pay attention to the money behind the 340B curtain.

Minnesota just released the industry‘s first ever mandated financial report on the 340B Drug Pricing Program. Below, I do a wicked deep dive into the data and highlight crucial implications about spending, profits, pharmacies, plans, patients, program integrity, and more.

There are important limitations to these data. But Minnesota’s report marks a valuable first step on the yellow brick road to the wonderful world of transparency. I suspect similar reports are gonna be popular.

Drug Channels News Roundup, February 2025: Part D vs. Pharmacies, Accumulator Madness, Wholesaler Vertical Integration, IRA vs. MDs, and a 340B Cartoon

Winter—or at least February—is almost over. Celebrate the imminent return of spring with our selection of noteworthy news from around the drug channel. In this issue:

• How Part D plan sponsors responded to pharmacy DIR changes

• Troubling new data on copay accumulators in marketplace plans

• DCI’s latest vertical integration visualization

• How the IRA will hurt physician practices

Plus, cartoon cats explain the 340B Drug Pricing Program.

P.S. Join my more than 60,000 LinkedIn followers for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Drug Channels News Roundup, January 2025: Mark Cuban Fixes Healthcare, Payers’ G2N Bubble, Pharmacists Rejoice, 340B Shenanigans, and 46Brooklyn vs. Mushrooms

Get ready to climb a Crisco-covered light pole! DCI’s hometown Philadelphia Eagles are going to Super Bowl LIX! Go E-L-G-S-E-S! (No, that's not a typo.)

Before you overturn any cars, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron:

• Touchdown! How Mark Cuban would quarterback the U.S. healthcare system 

• Trick Play: Patients and plans get sacked by a gross spending-to-net bubble

• Defensive line: A comeback for pharmacy students

• Offensive line: Apexus dances in the end zone, while a 340B hospital tackles a patient

Plus, Super Antonio runs downfield in the Mushroom Kingdom.

P.S. I recently passed 60,000 LinkedIn followers. If you haven’t done so already, follow along for my daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Why 340B Reform Could Happen in 2025 (video)

During my recent Drug Channels Outlook 2025 video webinar, I tackled a wide range of crucial topics—including the controversial 340B Drug Pricing Program. As I explain in this video excerpt, we may finally see reform of this rapidly expanding program.

What’s more, implementing the Inflation Reduction Act will disrupt the current operations of the 340B program—and could shift program oversight from Health Resources and Services Administration to the Centers for Medicare & Medicaid Services.

Click here if you can’t see the video below.

Here are some Drug Channels articles with relevant background for the video:

• The 340B Program Reached $66 Billion in 2023—Up 23% vs. 2022: Analyzing the Numbers and HRSA’s Curious Actions

• Follow the 340B Prescription Dollar: How PBMs Profit from 340B Contract Pharmacies

• Hospitals Are Relying More on PBMs to Manage Manufacturers' 340B Contract Pharmacy Restrictions: DCI's 2024 Market Analysis

• Four Revelations from Minnesota’s First 340B Transparency Report

Inflation-Adjusted U.S. Brand-Name Drug Prices Fell for the Seventh Consecutive Year as a New Era of Drug Pricing Dawns

It's time for Drug Channels’ annual examination of U.S. brand-name drug pricing.

For 2024, average brand-name drugs’ list prices grew by only 2.3%. What’s more, after adjusting for overall inflation, brand-name drug net prices dropped for an unprecedented seventh consecutive year. Details and additional commentary below.

As I predicted two years ago, the combined impact of changes to Medicaid rebates, the Inflation Reduction Act (IRA), and novel formulary access strategies have led multiple manufacturers to pop the gross-to-net bubble for high-list/high-rebate products. Consider the 18 products with list-price cuts shown below.  Other drugmakers have reduced the rate of price increases, thereby inflating the bubble more slowly.

Employers, health plans, and pharmacy benefit managers (PBMs) determine the extent to which patients with insurance share in this ongoing deflation. But signs of change to the conventional approaches are undeniable.

New channel models—including smaller PBMs, cost-plus pharmacies, patient-paid discount card prescriptions, and manufacturers’ direct-to-patient businesses—are creating novel paths for drugs that can be sold without gross-to-net bubble distortions.

The bubble won’t vanish overnight. But for the first time in years, I can foresee a time when SpongeBob SquarePants will move on from Drug Channels.

Follow the 340B Prescription Dollar: How PBMs Profit from 340B Contract Pharmacies (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s Drug Channels Outlook 2025 live video webinar. During the webinar, I'll provide an update the 340B program, which continues to defy gravity. Click here to see the original post.

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In my recent The 340B Drug Pricing Program: Trends, Controversies, and Outlook video webinar, I provided an update on the economics of the 340B program, reviewed the multiple controversies surrounding the program’s operations, discussed state and federal legislation, and analyzed how the Inflation Reduction Act of 2022 (IRA) will alter the 340B market.

In the video excerpt below, I walk through a brief history of 340B contract pharmacies. I then document how five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market. I conclude with a “follow the dollar” example of 340B prescription economics with contract pharmacies.

If this clip whets your appetite for more, register to watch a replay of the full 90-minute video webinar from June.

You can also check out our recent data deep dive: Hospitals Are Relying More on PBMs to Manage Manufacturers' 340B Contract Pharmacy Restrictions: DCI's 2024 Market Analysis.

Click here if you can’t see the video below.

Four Revelations from Minnesota’s First 340B Transparency Report

It’s time to pay attention to the money behind the 340B curtain.

Minnesota just released the industry‘s first ever mandated financial report on the 340B Drug Pricing Program. Below, I do a wicked deep dive into the data and highlight crucial implications about spending, profits, pharmacies, plans, patients, program integrity, and more.

There are important limitations to these data. But Minnesota’s report marks a valuable first step on the yellow brick road to the wonderful world of transparency. I suspect similar reports are gonna be popular.

And don't forget to put on your ruby slippers and hear from Doctor of Thinkology Adam J. Fein. During next week’s Drug Channels Outlook 2025 live video webinar, he'll tell you what's ahead for the program that continues to defy gravity.

Drug Channels News Roundup, November 2024: Employers & Their PBMs, Medicaid vs. 340B, U.S. Drug Prices, and Dr. G Shops for Health Plans

Happy Thanksgiving, everyone! Before you stretch your stomach, stretch your mind with our extra-stuffed helping of food for thought. In this issue:

• Intriguing data on how employers oversee their PBMs

• State Medicaid programs carve out PBMs—and get a 340B windfall

• Are U.S. drug prices really higher than other countries?

Plus, Dr. Glaucomflecken gets us ready for the open enrollment season.

P.S. Join my nearly 60,000 LinkedIn followers for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Coming soon: Drug Channels Outlook 2025, our biggest live video webinar of the year. Join Adam J. Fein, Ph.D., on December 13, 2024, from 12:00 p.m. to 1:30 p.m. ET., as he helps you and your team get ready for 2025 by outlining key issues and uncertainties that will surely affect your planning. Click here to learn more and sign up.

The 340B Program Reached $66 Billion in 2023—Up 23% vs. 2022: Analyzing the Numbers and HRSA’s Curious Actions

Reality has again failed to support the spin surrounding the 340B Drug Pricing Program.

For 2023, discounted purchases under the 340B program reached a record $66.3 billion—an astounding $12.6 billion (+23.4%) higher than its 2022 counterpart. The gross-to-net difference between list prices and discounted 340B purchases also grew, to $57.8 billion (+$5.5 billion). 340B purchases are now almost 40% larger than Medicaid’s prescription drug purchases.

Hospitals again accounted for 87% of 340B purchases for 2023. Purchases at every 340B covered entity type grew, despite drug prices that grew more slowly than overall inflation.

Lobbyists claim that manufacturers’ 340B contract pharmacy changes are “stripping billions of dollars from the healthcare safety net.” But every year, the data tell a very different story. Only in the U.S. healthcare system can billions more in payments and spreads be considered a cut.

Read on for full details and our analysis, along with fresh details of troubling behavior by the Health Resources and Services Administration (HRSA).

Hospitals Are Relying More on PBMs to Manage Manufacturers' 340B Contract Pharmacy Restrictions: DCI's 2024 Market Analysis (rerun)

This week, I’m rerunning some popular posts while we put the finishing touches on DCI’s new 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Click here to see the original post from June 2024.

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The 340B contract pharmacy market shows little sign of slowing down. Drug Channels Institute’s exclusive analysis of the 2024 market reveals that:

• About 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and federal grantees that participate in the 340B program. 

• 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), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market.

• Over the past four years, manufacturers’ restrictions on 340B contract pharmacies have led hospitals to deepen their relationships with the largest PBMs—even as those PBMs have simultaneously limited hospitals’ direct participation in specialty pharmacy networks.

For an updated look at what’s next for the 340B contract pharmacy market, join Adam J. Fein, Ph.D., on June 21 for his latest live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Drug Channels News Roundup, August 2024: My $0.02 on the IRA’s MFPs, UNC’s New PBM, Amazon vs. Retail, Fixing 340B, and Mark Cuban Lets Loose

Another news-laden summer is ending. Time to pack away your bathing suit, send the kids back to school, and cherish these curated curiosities that I combed from the Jersey shore:

• Some uncomfortable realities of the Inflation Reduction Act’s (IRA’s) first set of 10 prices

• Amazon goes after retail pharmacies with an amusing lack of self-awareness

• A health system-backed start-up pharmacy benefit manager (PBM) will somehow deliver massive drug costs savings

• An intriguing solution for fixing the 340B program

Plus, Mark Cuban unloads on the healthcare system during an entertaining interview.

P.S. Join my nearly 58,000 LinkedIn followers for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Have you requested an invite to the inaugural Drug Channels Leadership Forum? Attendance will be highly limited, so apply now. Full agenda coming soon!

Follow the 340B Prescription Dollar: How PBMs Profit from 340B Contract Pharmacies (Video)

In my recent The 340B Drug Pricing Program: Trends, Controversies, and Outlook video webinar, I provided an update on the economics of the 340B program, reviewed the multiple controversies surrounding the program’s operations, discussed state and federal legislation, and analyzed how the Inflation Reduction Act of 2022 (IRA) will alter the 340B market.

In the video excerpt below, I walk through a brief history of 340B contract pharmacies. I then document how five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market. I conclude with a “follow the dollar” example of 340B prescription economics with contract pharmacies.

If this clip whets your appetite for more, register to watch a replay of the full 90-minute video webinar from June.

You can also check out our recent data deep dive: Hospitals Are Relying More on PBMs to Manage Manufacturers' 340B Contract Pharmacy Restrictions: DCI's 2024 Market Analysis.

Click here if you can’t see the video below.

Drug Channels News Roundup, July 2024: My $0.02 on FTC’s PBM Report, GoodRx & Humira, Averon = CVS + Cardinal, IRA vs. 340B, and My Favorite Chart

Bello! The hot and hazy days of summer are here. Go for a swim to cool off and then enjoy this refreshing selection of articles chosen by Drug Channels para tu.

• Did the FTC’s compelling interim report prove its case?

• GoodRx joins the Humira biosimilar price war with Boehringer Ingelheim

• Averon revealed to be a new buying group for biosimilars for CVS Health and Cardinal Health

• Why the IRA will be bad news for 340B hospitals

Plus, the June 2024 update to my all-time favorite chart. Muak muak muak!

P.S. Join my more than 57,000 LinkedIn followers for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Have you requested an invite to the inaugural Drug Channels Leadership Forum? Attendance will be highly limited, so apply now. Full agenda coming in early September!