Drug Channels delivers timely analysis and provocative opinions 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...
Football season is officially back. Personally, my signal is hearing my uncle curse about bad calls from 1,000 miles away, but you may have already seen a game.
This news roundup is short enough to fit into an ad break or two. *Caveat: may lead to rabbit holes that take much longer than an ad break.
Drug Channels Institute is proud to host the 2027 Drug Channels Leadership Forum, which will take place from March 15–17, 2027, in Miami. Request your invitation to this invite-only gathering of senior leaders from across the drug channel ecosystem. You must request an invitation to be considered for attendance. We will begin sending invitations in mid-October.
The 340B Drug Pricing Program continues to redefine the meaning of "skyrocketing."
For 2025, discounted purchases under the 340B program reached an astounding $100 billion—23% higher than in 2024.
The gross-to-net difference between list prices and discounted 340B purchases—a proxy for funds available to covered entities—also grew, to $79.5 billion (+$12.0 billion).
Hospitals again accounted for 87% of 340B purchases.
340B purchases are now more than 70% larger than Medicaid’s net prescription drug spending. The program now accounts for nearly one-fifth of the total U.S. gross-to-net bubble.
During DCI’s June webinar, I predicted that the 340B program would move from an era of expansion and opacity to one of transparency and accountability.
But given the latest growth figures, I worry that reform of this undermanaged, out-of-control program may never happen. Has the program become too big to reform?
Read on for our full analysis—and consider whether 340B will ever face its true day of reckoning.
Whether you support or oppose the current structure of 340B, it is becoming harder to ignore that the debate is expanding beyond manufacturers and hospitals. Employers, health plans, and policymakers are beginning to ask who ultimately finances the program—and what those economics mean for benefit costs and premiums.
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.
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.
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.
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
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. 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.
Click here to register. 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). Prefer check or ACH? Click here to request an invoice.
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.
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:
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.
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.
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.
Special launch pricing discounts will be valid through April 6, 2026.
This report—our seventeenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. If you make strategic decisions in this industry, this report is essential reading.
WHAT’S INSIDE
Nearly 1,300 endnotes, most of which have hyperlinks to source materials
If you preordered, you should have received an email with download instructions last week. Didn’t get it? Contact us at dcisupport@hmpglobal.com, and we’ll take care of it.
Our goal is simple: help you understand how the drug channel really works—and where it’s going.
That's why DCI reports are widely used by nearly every company involved in the drug channel:
Pharmaceutical manufacturers
Wholesalers, pharmacists, and pharmacy owners
Payers, insurers, and plan sponsors
Hospitals, benefit managers, and managed care executives
Policy analysts, investors, consultants, and more
In other words, this report helps you understand what your customers, partners, and competitors are reading—and how they’re thinking.
The chart below illustrates the depth and breadth of the 2026 edition. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.
FUN FACTS ABOUT THE 2026 EDITION
The 12 chapters are self-contained—you don't need to read them in order. (Really!) Use the report as a reference guide or read it end-to-end. It’s designed as both a foundational resource and a deep dive into the latest trends and developments.
There are tons of internal hyperlinks to help you navigate and focus on what matters most to you.
We’ve updated all market and industry data with the most current insights, including our annual analyses of the largest pharmacies, specialty pharmacies, and PBMs.
One of the available licenses gives you the option to download an additional PowerPoint file with images of all 270 exhibits—making it easier to share insights with your team. (Note: All license versions include exhibits within the text.)
There are a staggering 1,284 endnotes (!), most of which have direct hyperlinks to original source materials. This allows you to validate, explore, and go deeper.
We have reluctantly removed all corny jokes and pop culture references. So, no memes and absolutely no references to SpongeBob SquarePants.
Thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me. We look forward to helping you succeed in the evolving U.S. drug channel.
On March 24, 2026, Drug Channels Institute will release The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our seventeenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. If you make strategic decisions in this industry, this report belongs on your desk.
12 chapters, 500+ pages, 270 exhibits, and nearly 1,300 endnotes. No other resource matches the scope, depth, and rigor of this resource.
We are offering you the opportunity to preorder the thoroughly updated, revised, and expanded 2026 edition at special discounted prices. Preordering guarantees early access and locks in the lowest available price. Those who preorder will receive a download link before March 30.
Special preorder and launch pricing discounts will be valid through April 6, 2026. After that date, prices increase. Secure your discount now.
The report was researched and written by the Drug Channels Institute team, led by Adam J. Fein, Ph.D. As shown below, the 2026 edition delivers unmatched depth and breadth. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.
The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers contains the most current market and industry data available, including DCI’s annual analyses of the market positions of the largest pharmacies, specialty pharmacies, and PBMs. Throughout the report, we have added new industry data, deepened our coverage of many topics, and expanded our analysis of emerging trends.
This definitive, nonpartisan report will aid pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospital executives, pharmacy buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and anyone else who wants to understand and benefit from this ever-changing industry. If your organization competes, negotiates, invests, or sets policy in this market, this report will sharpen your strategy.
There are many notable updates in this 2026 edition, including:
A new Section 4.3.4. analyzes manufacturers’ direct-to-patient (DTP) websites and TrumpRx within the broader context of patient-paid prescriptions.
A new Section 5.5. deconstructs the three largest PBMs’ gross profits. Some of this material previously appeared in Chapter 11.
Material in Section 7.1., Section 9.1., and Section 9.3. reflects the PBM legislative reforms contained within the Consolidated Appropriations Act, 2026 (P.L. 119-75), which became law in February 2026.
Material in Section 8.4. and Section 9.3. incorporates implications of the 2026 settlement between Express Scripts and the Federal Trade Commission.
A new Section 6.3.3. reviews research on how the IRA’s implementation has affected out-of-pocket spending by Medicare Part D beneficiaries.
A new Section 11.2.4. analyzes pharmacies’ dispensing profits under the Inflation Reduction Act of 2022 (IRA).
A new Section 12.1.4. evaluates the potential implications of most favored nation (MFN) and tariff policies on the drug channel.
In Section 12.3.1., our illustration of major vertical business relationships among drug channel businesses now incorporates affiliated third-party administrators (TPAs) and administrative services only (ASO) platforms.
We have also improved our presentation of material about the IRA and the 340B Drug Pricing Program.
Thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me. We look forward to supporting your team’s success in 2026.
Despite the recent storm, winter—or at least February—is almost over. Before we thaw out, here’s a brisk tour of the forces reshaping the drug channel. In this issue:
Super Bowl LX is almost here! Time for some blowout beer and snack commercials, occasionally interrupted by an actual football game. DCI’s hometown Philadelphia Eagles will not be going to the big game, so the city’s light poles will remain Crisco-free and upright.
While you wait for kickoff, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron:
