Drug Channels News Roundup, February 2026: Mark Cuban on FTC-ESI, What Patients Really Want, QALYs vs. MFN, 340B’s Site of Care Shift, and New Faces at DCI

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:

• Mark Cuban’s $0.02 on the FTC-ESI settlement

• What patients want from health insurance

• Why the QALY paradox could block MFN

• How 340B drives hospital vertical integration

Plus: Meet the expanding Drug Channels Institute team!

P.S. Join my more than 68,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

The Future of Buy-and-Bill Market Access: Five Drivers of Wholesalers’ Vertical Integration with Physician Practices (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: Drug Channels Outlook 2026 .

Click here to see the original post from October 2025.

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Vertical integration continues to reshape U.S. healthcare, as detailed in DCI’s new 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Our latest analysis shows how the Big Three companies—Cencora, Cardinal Health, and McKesson—are extending their reach far beyond drug distribution, building influence throughout the drug channel.

In recent years, these companies have spent more than $16 billion to acquire management service organizations (MSOs) that oversee physician practices in such specialties as gastroenterology, oncology, ophthalmology, and urology.

Below, we highlight the largest MSO transactions and explore five ways wholesalers benefit from ownership in their downstream physician customers. Ultimately, these strategies may allow wholesalers to exert unprecedented control over market access for provider-administered drugs—if they can figure out how to realize this power.

Today’s post is adapted from Section 6.3.2. in DCIs 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

The Future of Buy-and-Bill Market Access: Five Drivers of Wholesalers’ Vertical Integration with Physician Practices

Vertical integration continues to reshape U.S. healthcare, as detailed in DCI’s new 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Our latest analysis shows how the Big Three companies—Cencora, Cardinal Health, and McKesson—are extending their reach far beyond drug distribution, building influence throughout the drug channel.

In recent years, these companies have spent more than $16 billion to acquire management service organizations (MSOs) that oversee physician practices in such specialties as gastroenterology, oncology, ophthalmology, and urology.

Below, we highlight the largest MSO transactions and explore five ways wholesalers benefit from ownership in their downstream physician customers. Ultimately, these strategies may allow wholesalers to exert unprecedented control over market access for provider-administered drugs—if they can figure out how to realize this power.

Today’s post is adapted from Section 6.3.2. in DCIs 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Special launch pricing discounts are available through October 27, 2025.

NOW AVAILABLE: The 2025–26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

I am pleased to announce Drug Channels Institute’s new 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available for purchase and immediate download.

• Download a free 25-page report overview—including key industry trends, “What's New,” Table of Contents, and List of Exhibits

• Review pricing/license options and download the full 2025-26 report

Special launch pricing is available through October 27, 2025.

This report—our sixteenth edition—remains the most comprehensive, data-driven resource for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.

With 9 chapters, more than 400 pages, 187 exhibits, and over 850 endnotes, this report is unmatched in scope and depth. There’s simply no other resource like it.

Order today to secure your copy of this fully updated, revised, and expanded 2025-26 edition at special discounted prices.

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover). Click here to contact us if you prefer to pay by corporate check or ACH.

INSIDE THE 2025-26 REPORT

The 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Widely regarded as the industry standard, this encyclopedic resource offers a definitive guide to wholesale distribution’s role in the complex web of U.S. prescription drug channels.

The chart below illustrates the vertical integration and broad reach of the three largest companies in U.S. pharmaceutical distribution. The numbers in the chart correspond to the report chapter that explains and analyzes the specific business segment.

[Click to Enlarge]

WHAT’S INSIDE AND WHAT’S NEW

• The most current financial and industry data on pharmaceutical distribution and the major companies. See pages 9 and 10 of the free report overview for details on the notable new material in this latest edition.

• Updated analyses of strategies, market positions, and executive compensation for the Big Three—Cencora, Cardinal Health, and McKesson. We review each company’s business segments and underlying business profitability, based upon our proprietary economic models. This allows you to assess differences among the public companies’ organizational structure and financial performance.

• Self-contained chapters that do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific interests and priorities.

• The option to download an additional PowerPoint file with images of all 178 exhibits. This popular option helps you share the insights and data with others in your organization. (The exhibits appear within the text for all license versions.)

• 760 (!) endnotes, most of which have direct hyperlinks to original source materials for deeper learning.

• No SpongeBob Squarepants, corny jokes, or pop culture references, all of which have been reluctantly removed.

Thank you for your continued interest in our research. Please email me (afein@drugchannels.net) with any questions before purchasing.

We look forward to sharing this year’s insights with you.

Preorder Now: DCI’s 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

On October 14, 2025, Drug Channels Institute will release our 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our sixteenth edition—is the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.

With 9 chapters, 400+ pages, 187 exhibits, and 850+ endnotes, this report is unmatched in scope and depth. There is no other resource like it.

Preorder today to secure this fully updated, revised, and expanded 2025-26 edition at special discounted prices. Preorders ensure early access. You’ll receive the report before its October 14 release date.

• Download a free 25-page pre-publication report overview—including key industry trends, “What's New,” Table of Contents, and List of Exhibits

• Review pricing/license options and place a preorder

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover). Click here to contact us if you would like to pay by corporate check or ACH.

Special preorder and launch pricing discounts will be valid through October 27, 2025. Act now to maximize savings.

The chart below highlights the three largest companies’ vertical alignment and diverse roles within the U.S. healthcare system. The numbers in the chart indicate the report chapter that corresponds to, explains, and analyzes each business.

[Click to Enlarge]

The 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Widely regarded as the industry standard, this encyclopedic resource offers a definitive guide to wholesale distribution’s role in the complex web of U.S. prescription drug channels.

Our 2025-26 edition contains the most current financial and industry data about the distribution of pharmaceuticals and the major companies that handle these products. As always, we have updated all market and industry data with the most current information available. The report also updates our annual analyses of the strategies, market positions, and executive compensation of the three largest companies: Cencora, Cardinal Health, and McKesson.

We review each wholesaler’s business segments and underlying business profitability, based upon our proprietary economic models. This information allows you to assess differences among the public wholesalers’ business organizations, strategies, and financial performance. Where appropriate, financial data have been restated based on updated disclosures.

See pages 9 and 10 of the free report overview for details on the notable new material in this latest edition.

Thank you for your continued interest in our research. Please email me (afein@drugchannels.net) with any questions before purchasing. We look forward to sharing this year’s insights with you.

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.

How the IRA’s Part B Coinsurance Inflation Adjustments Can Raise Seniors’ Drug Costs

The Inflation Reduction Act (IRA) is triggering increases in Medicare beneficiaries’ spending on their Part B drugs.

Though CMS touts that the IRA’s inflation-based coinsurance adjustments will "lower out-of-pocket costs," the results have been more complicated. Below, we update and expand on our previous analysis.

We find that a growing number of Part B drugs now have inflation-adjusted coinsurance rates that are rising, not falling. In many cases, the rate dips temporarily before snapping back to the standard 20%.

Even more troubling, these fluctuations have led to unexpected increases in patients’ out-of-pocket expenses—even when a drug’s price was declining.

These unpredictable coinsurance shifts are another example of the IRA’s unintended consequences. Rather than enjoying stable or reduced costs, some seniors are finding themselves on a financial rollercoaster.

What’s Next for Retail Pharmacy: Data, Debate, and Disruption.

Don’t miss DCI’s next webinar on June 20, 2025 (12:00–1:30 p.m. ET), featuring Dr. Adam J. Fein and Antonio Ciaccia. We’ll unpack the good, the bad, and the ugly of the pharmacy industry—and explore what it means for you. This dynamic session will blend expert insights and real-time debate. Hope you can join us!

Vertical Integration Redux: How Pharmaceutical Wholesalers Are Transforming the Buy-and-Bill Market (rerun)

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

Click here to see the original post from February 2025.

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ICYMI, the largest three pharmaceutical wholesalers—Cardinal Health, Cencora, and McKesson—are using vertical integration to build significant market positions in businesses beyond drug distribution.

In the video clip below, I review the vertical integration status of the largest three pharmaceutical wholesalers, illustrated in the chart below.

[Click to Enlarge]

I also:

• Explain how wholesalers have strengthened their position in buy-and-bill channels for provider-administered drugs through vertical integration with their downstream customers.

• Discuss how and why private equity roll-up activity has provided wholesalers with strategic opportunities to acquire ownership stakes in practice management companies.

• Outline the market access implications for provider-administered biosimilars in the buy-and-bill market.

This video was excerpted from my recent Drug Channels Outlook 2025 webinar. Click here if you can’t see the video below.

For more on the forces of change affecting drug distribution and the buy-and-bill market, see Chapter 6 of DCI’s recent 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Vertical Integration Redux: How Pharmaceutical Wholesalers Are Transforming the Buy-and-Bill Market (Video)

ICYMI, the largest three pharmaceutical wholesalers—Cardinal Health, Cencora, and McKesson—are using vertical integration to build significant market positions in businesses beyond drug distribution.

In the video clip below, I review the vertical integration status of the largest three pharmaceutical wholesalers, illustrated in the chart below.

[Click to Enlarge]

I also:

• Explain how wholesalers have strengthened their position in buy-and-bill channels for provider-administered drugs through vertical integration with their downstream customers.

• Discuss how and why private equity roll-up activity has provided wholesalers with strategic opportunities to acquire ownership stakes in practice management companies.

• Outline the market access implications for provider-administered biosimilars in the buy-and-bill market.

This video was excerpted from my recent Drug Channels Outlook 2025 webinar. Click here if you can’t see the video below.

For more on the forces of change affecting drug distribution and the buy-and-bill market, see Chapter 6 of DCI’s recent 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

White Bagging Update 2024: Providers’ Pushback Preserves Buy-and-Bill (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s Drug Channels Outlook 2025 live video webinar. During the webinar, I'll share some thoughts on how vertical integration will affect the buy-and-bill channel.

Click here to see the original post from September 2024.

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Time for DCI’s annual update on the channels for provider-administered drugs. Below, I review the latest data on 2024 trends and compare them to the pre-pandemic figures.

For 2024, payers report that specialty pharmacies—via white and clear bagging—have displaced buy-and-bill for a meaningful share of commercial covered lives utilizing provider-administered oncology drugs. However, provider pushback has limited specialty pharmacies' share gains, so that buy-and-bill remains the most common channel for these products.

Payers’ adoption of white bagging—and provider’s push back—reflect the ongoing battle for oncology margin in U.S. drug channels. Let’s hope that patients don’t get caught in the crossfire.

P.S. Today’s article is adapted from Chapter 3 of DCI’s forthcoming 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, which will be available to preorder next week at special introductory pricing.

Transparency Shocker: Biosimilars Are Getting Cheaper—But Hospitals and Insurers Can Make Them Expensive

Here on Drug Channels, we have long highlighted the boom in provider-administered biosimilars. In contrast to the pharmacy market, adoption of these biosimilars is growing, prices are dropping, and formulary barriers continue to fall.

Novel transparency information reveals that this good news doesn’t always translate into savings. Below, we rely on a unique data set from Turquoise Health to examine how much four national commercial health plans—Aetna, Anthem, Cigna, and UnitedHealthcare—paid hospitals for Avastin and its two most significant biosimilar competitors.

As we demonstrate, health plans pay hospitals far above acquisition costs for biosimilars. What’s more, plans can pay hospitals more for a biosimilar than for the higher-cost reference product. The U.S. drug channel system is warping hospitals’ incentives to adopt biosimilars, while simultaneously raising costs for commercial plans.

The namesake of my alma mater once said: “Sunlight is said to be the best of disinfectants.” What would happen if we disinfected the entire channel?

Drug Channels News Roundup, October 2024: Humira Price War Update, PA vs. Providers, IRA vs. Physicians, My AI Podcast, New DCI Jobs, and Dr. G on Copayments

Eeek! It's time for Drug Channels’ Halloween roundup of terrifying tales to share with your ghoulish fiends. This month’s tricks and treats:

• Spooky! Blue Shield of California frightens away the gross-to-net bubble with its Humira biosimilar strategy

• Vampiric! Prior authorization sinks its fangs into providers’ time

• Wicked! How the IRA will put a stake through specialty physician practices

• Eerie! Google’s monstrous AI podcasts leave me petrified

• Zoinks! Join the vampire hunters at Drug Channels Institute

Plus, Dr. Glaucomflecken tells us a frightening tale of copayments.

P.S. Stretch out your arms and join the ever-growing zombie horde who shamble after me on LinkedIn. You’ll find my ghostly rantings along with commentary from the undead hordes in the DCI community.

Another IRA Surprise: Part B Coinsurance Inflation Adjustments Are Increasing Patient Costs (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.

The article below highlights an underappreciated consequence of the Inflation Reduction Act’s inflation rebates for Medicare Part B drugs. Last night, I posted an updated analysis showing that the volatility in seniors' coinsurance rates continues. For the fourther quarter of 2024, coinsurance rates for 51 drugs increased, while rates for only 19 drugs decreased. What's more, rates for 17 drugs returned to their original 20% level. Click here to see our original post from May 2024.

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Contrary to what you may have heard, the Inflation Reduction Act’s (IRA) inflation rebates for Medicare Part B drugs do not always save money for seniors.

As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.

Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.

Drug Channels News Roundup, September 2024: Inside JNJ’s Gross-to-Net Bubble, Optum Rx’s Private Label Biosimilars, Where Biosimilars Boom, Accumulators vs. Patients, and Steve Collis Retires

Autumn is here! Curl up with your favorite pumpkin-spiced blog and savor these acorns that we’ve squirrelled away for you:

• Johnson & Johnson Innovative Medicines gives a peek inside its $43 billion gross-to-net bubble

• Optum Rx joins the private label biosimilar bandwagon

• Biosimilars boom for provider-administered drugs

• Fresh evidence of how copay accumulators hurt patients

Plus, words of wisdom from Cencora's soon-to-be-former CEO Steve Collis.

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

There’s still time to request an invite to the inaugural Drug Channels Leadership Forum. Attendance will be highly limited. We have already begun extending invitations, so apply now to be considered. Click here to view the full agenda.

Available for Preorder: The 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

On October 8, 2024, Drug Channels Institute will release our 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our fifteenth edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.

9 chapters, 350+ pages, 178 exhibits, 750+ endnotes: There is nothing else available that comes close to this valuable resource.

We are providing you with the opportunity to preorder this thoroughly updated, revised, and expanded 2024-25 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before October 8.

• Review pricing/license options and place a preorder

• Download a free pre-publication report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits)

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to contact us if you would like to pay by corporate check or ACH.

Special preorder and launch pricing discounts will be valid through October 23, 2024.

Read on for more details.

White Bagging Update 2024: Providers’ Pushback Preserves Buy-and-Bill

Time for DCI’s annual update on the channels for provider-administered drugs. Below, I review the latest data on 2024 trends and compare them to the pre-pandemic figures.

For 2024, payers report that specialty pharmacies—via white and clear bagging—have displaced buy-and-bill for a meaningful share of commercial covered lives utilizing provider-administered oncology drugs. However, provider pushback has limited specialty pharmacies' share gains, so that buy-and-bill remains the most common channel for these products.

Payers’ adoption of white bagging—and provider’s push back—reflect the ongoing battle for oncology margin in U.S. drug channels. Let’s hope that patients don’t get caught in the crossfire.

P.S. Today’s article is adapted from Chapter 3 of DCI’s forthcoming 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, which will be available to preorder next week at special introductory pricing.

Another IRA Surprise: Part B Coinsurance Inflation Adjustments Are Increasing Patient Costs

Contrary to what you may have heard, the Inflation Reduction Act’s (IRA) inflation rebates for Medicare Part B drugs do not always save money for seniors.

As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.

Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.

The Battle for Oncology Margin: How Private Equity Enables Vertical Integration by Pharmaceutical Wholesalers (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s Drug Channels Outlook 2024 live video webinar. Click here to see the original post from October 2023.

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In case you haven’t noticed, private equity firms have displaced hospitals and health systems as the major acquirers of community oncology practices. These financial firms have assembled significant oncology practice management companies that are primed for purchase by drug channel participants.

Below, I review recent M&A trends and then examine the strategic objectives behind the acquisition of private-equity-backed OneOncology by AmerisourceBergen (Cencora) and another financial buyer. As I explain, AmerisourceBergen (Cencora) gains significant strategic advantage from this transaction, which echoes a historical McKesson deal.

The Federal Trade Commission’s (FTC) has a newfound interest in the roll-up transactions that are creating practice management companies. Nonetheless, I expect this consolidation activity to continue—enabling a new round of vertical integration in the drug channel.

FYI: Today’s article is adapted from Section 6.3. (Future Trends for Buy-and-Bill Channels) of our new our 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, now available to download at special launch pricing.

White Bagging Update 2023: Saving Money or Shifting Costs? (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday's Drug Channels Outlook 2024 live video webinar. Click here to see the original post from September 2023.

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Time for our annual update on the channels for provider-administered drugs.

For 2023, specialty pharmacies—via white, brown, and clear bagging—retained a meaningful share of the distribution channels for provider-administered oncology drugs. Despite the concerted efforts of insurers such as UnitedHealthcare and Elevance Health, however, buy-and-bill remains the most common channel for these products. Below, I review the latest data on trends over the past five years.

Strategies for white and brown bagging reflect the broader battle over oncology margins—and plans’ attempts to shift costs to providers, patients, and manufacturers. The persistence of buy-and-bill reflects this channel’s legacy infrastructure as well as providers’ push back on white bagging mandates. But perhaps patients and manufacturers will start paying more attention to the higher costs from white bagging.

FYI: The material in today’s article is adapted from Chapter 3 of our forthcoming 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, now available to preorder at special introductory pricing.