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...
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.
Happy Thanksgiving, everyone! Before you stretch your stomach, stretch your mind with some fresh food for thought from across the drug channel. In this issue:
What else should you expect for 2026? Find out during my upcoming live video webinar, Drug Channels Outlook 2026, on December 12, 2025, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up. As always, we are offering special discounts if you want to bring your whole team.
During my recent video webinar—What’s Next for Retail Pharmacy: Data, Debate, and Disruption—Antonio Ciaccia of 46brooklyn Research joined me to explore the data, trends, and strategic shifts driving a major shakeout in the retail pharmacy sector.
In the short video excerpt below, I break down five key economic forces putting intense pressure on U.S. drugstores. This clip offers just a glimpse of our broader conversation, which also covered PBMs, wholesalers, the evolving competitive landscape, and more.
I hope everyone enjoyed the Thanksgiving holiday. Now that you’ve stretched your stomach, it's time to stretch your mind with some food for thought. In this issue:
A reality check on Express Scripts’ purported “cost-based” pharmacy network
Mark Cuban explains how and why the PBM market will change
Why two drug prices are better than one
Pharmacists sing the retail pharmacy shakeout blues
Plus, two Philly legends meet at a cardiology conference!
P.S. Join my more nearly 49,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter/X, where I have more than 17,000 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)
Autumn is here! Curl up with your favorite pumpkin-spiced blog and savor these stories harvested from the great Drug Channels patch:
A must-read report on hidden sources of PBMs’ profits
How generic drugs drive specialty pharmacy profits
CVS Health’s unadvertised 2022 drug trend report
A shocking look at how PBMs set prescription prices
Plus, Dr. Glaucomflecken teaches us about our insurance benefits.
P.S. Join my more than 45,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter/X, where I have more than 16,900 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)
In my March video webinar, I explored how the rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market.
Below, I follow the dollar when a patient uses a discount card to pay for a generic drug prescription.
As you’ll see, a discount card can save money for consumers by leveraging several quirks of U.S. retail pharmacy pricing. Such cards also enable novel profit streams for both pharmacy benefit managers (PBMs) and the card vendors themselves.
In my most recent video webinar, I explored how the rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market.
Below, I follow the dollar when a patient uses a discount card to pay for a generic drug prescription.
As you’ll see, a discount card can save money for consumers by leveraging several quirks of U.S. retail pharmacy pricing. Such cards also enable novel profit streams for both pharmacy benefit managers (PBMs) and the card vendors themselves.
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Friday's webinar will include my latest thoughts on a key trend discussed in todays rerun: how plan sponsors are incorporating patient-paid prescriptions—cash-pay prescriptions and discount cards—within pharmacy benefits.
Last week, GoodRx announced that it would become the exclusive prescription discount card provider for the commercial beneficiaries of Cigna’s Express Scripts. Links below.
The rise of discount card pricing within pharmacy benefit plans is a positive development. Patients get access to market prices that can be lower than their PBM’s contracted rate. All out-of-pocket spending with a discount card counts toward a patient's deductibles, and all prescription activity gets captured.
However, I suspect few people understand that placing discount cards within the pharmacy benefit enables a PBM to monetize a new fee stream from the card vendor. Below, I walk through this booming business and highlight some of the conflicts and contradictions underneath the coconuts.
This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.
The rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market. Join Dr. Fein as he helps you and your team deepen their understanding of this important issue and its crucial implications. He will draw from exclusive information found in DCI's new 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
During the event, Dr. Fein will cover a wide range of topics, including:
What’s driving the boom in patient-paid prescriptions
The warped economics of the generic prescription channel
Cash-pay prescriptions vs. discount cards
Why Usual & Customary (U&C) prices matter
The latest market data on the discount card market and its key participants
The complex economics of discount cards
How PBMs profit from—and are challenged by—patient-paid prescriptions
Pharmacy strategies and reactions
Why and how plans are placing discount cards within pharmacy benefits
Commentary on GoodRx, Mark Cuban Cost-Plus Drug Company, and more
Outlook for disruption of the pharmacy benefit market
Controversies and unresolved questions
And more!
PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience questions.
As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.
Read on for full details on pricing and registration. PRICING OPTIONS
You can register for this unique educational opportunity for only $380 per viewing device. Within 24 hours of your purchase, you will receive an email from Zoom with a unique link to access the webinar replay video.
We are offering substantial discounts for multiple registrations from the same organization. We know that many of you may still be working from home, so rates for multiple registrations are as low as $265 per device—a 30% savings. An unlimited number of people may watch at one location if they can watch from a single device.
Click here to order. 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.)
Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.
We use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.
Prior to the event, every registrant will receive an email from Zoom with a link to access the event and add it to their calendar. Every registrant will also receive reminder emails from Zoom one week, one day, and one hour before the event.
This event is part of The Drug Channels 2023 Video Webinar Series. If you have already purchased the full series, you should have received an email from no-reply@zoom.us with your unique link to access the event.
Organizations that purchased corporate access for The Drug Channels 2023 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.
The era of artificial-intelligence chatbots has arrived! I am pleased to report that this month’s Drug Channels news roundup was most definitely not written by ChatGPT. No promises about future articles. (See our forecast to the right.)
In this issue:
Mark Cuban explains his anti-PBM strategy
What physicians think about Humira biosimilars
States go after PBMs
HHS is confused about 340B transparency
Plus, The Onion tests your knowledge of United Healthcare’s policies.
Here at our worldwide headquarters in Philadelphia, Eagles Super Bowl fever has landed. The police are already getting extra Crisco for the light poles. (Yes, really.)
Before you start training to gorge at your game day party, tackle this month’s selection of notable news stories, intercepted for you from the Drug Channels gridiron:
Offsides: My $0.02 on the latest moves by Amazon and OptumRx
Trick play: OptumRx attacks alternative funding programs
Offensive line: Shocking Wall Street Journal expose of 340B abuses
Touchdown! Accumulators and maximizers go mainstream
Last week, GoodRx announced that it would become the exclusive prescription discount card provider for the commercial beneficiaries of Cigna’s Express Scripts. Links below.
The rise of discount card pricing within pharmacy benefit plans is a positive development. Patients get access to market prices that can be lower than their PBM’s contracted rate. All out-of-pocket spending with a discount card counts toward a patient's deductibles, and all prescription activity gets captured.
However, I suspect few people understand that placing discount cards within the pharmacy benefit enables a PBM to monetize a new fee stream from the card vendor. Below, I walk through this booming business and highlight some of the conflicts and contradictions underneath the coconuts.
As we explain below, this accelerating adoption also boosts profits for pharmaceutical wholesalers and specialty distributors—particularly when these channel participants can influence which biosimilar version a provider utilizes.
Below, we share our estimates for wholesalers’ gross margins for brand-name, generic, and biosimilar drugs. We then explain the channel dynamics behind biosimilar and generic drugs’ profits. We estimate that for 2022, generics and biosimilars accounted for only about 15% of wholesalers’ U.S. drug distribution revenues, but 77% of total gross profits from U.S. drug distribution.
I can’t recall any period in my life when our country has been so divided and polarized. Through the Drug Channels Institute, I strive to provide you with fact-based and balanced coverage—along with links to source materials so you can make up your own mind.
So before you launch your July 4 festivities and/or a civil war, Drug Channels humbly offers some data fireworks for our troubled nation:
More evidence of slow growth in drug spending for 2021
Fresh data on skyrocketing PBM formulary exclusions
Employers still hoarding rebates
Pharmacy pricing in the era of GoodRx
Plus, Dr. Glaucomflecken continues his humorous assault on insurance prior authorizations.
In the video below, I discuss how generic drug pricing and the rise of patient-paid, discount card prescriptions pose a risk to pharmacy benefit plans and the PBM business. I also highlight the odd relationship between Prime Therapeutics, Amazon Pharmacy, Express Scripts, and five Blues plans.
The chart below illustrates the depth and breadth of the 2022 edition. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.
[Click to Enlarge]
12 chapters, 430+ pages, 216 charts/exhibits/data tables, 800+ endnotes: There is nothing else available that comes close to this report.
If you would like to pay by corporate purchase order or check, please email Tamra Feldman. If you preordered the report, you should have already received an email with download instructions last week. Please contact us if you did not receive the email.
Licenses for our DCI reports are regularly purchased by nearly every company involved in the drug channel: pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospitals, buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and more. So, you can find out what your customers, partners, and competitors are reading.
FUN FACTS
The 12 chapters are self-contained and 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.
As always, we have updated all market and industry data with the most current information available, including our annual analyses of the market positions of the largest pharmacies, specialty pharmacies, and PBMs. Many sections and chapters have been expanded and/or reorganized to better cover the latest industry developments. For more details, see the "What’s New in the 2022 Report" section of the report's overview.
We are offering the option to download an additional PowerPoint file with images of all 216 exhibits. This popular option helps you share the insights and data with others in your organization.
There are a staggering 814 (!) endnotes, most of which have hyperlinks to original source materials. These source materials offer a handy way to build your knowledge base beyond what’s included in the full report.
As usual, I have reluctantly stripped out the corny jokes and pop culture references. Sorry, There are therefore zero memes in the 2022 edition.
Punctuation nerds will enjoy our all-new approach to hyphens and semicolons.
If you have any questions (before or after reading the report), please email me.
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:
Mark Cuban!
Novo Nordisk confronts the gross-to-net bubble
CVS Health finally acknowledges its profits from the 340B program
Charlotte Morabito at CNBC has put together “Why Pharmacies Overcharge,” an entertaining and provocative video on the pharmacy industry and its generic prescription pricing.
It’s definitely worth your time. I especially enjoyed the cool visualizations of Drug Channels Institute’s industry data. Links below.
The video covers the history of pharmacy, from the “Soda Fountain Era” to “Lick, Stick, and Pour” to the rise of PBMs and GoodRx.
It also includes a wide variety of expert perspectives, including $0.02 from your friendly neighborhood blogger at Drug Channels. See the list below.
The generic prescription market is being disrupted—but not by the big, bad spaceman from Seattle.
Instead, consider how GoodRx is affecting patients, payers, and PBMs.
Below I summarize the latest financial results for GoodRx’s discount card business. We estimate that the company accounted for $4.1 billion in U.S. prescription revenues for 2021. That’s about six times its 2016 figure.
GoodRx and its discount card competitors profit by incentivizing people to bypass their own insurance plans. Meanwhile, our crazy pharmacy pricing system deters pharmacies from pursuing consumer-driven pricing and PBMs from undercutting their own clients.
Consequently, discount cards could become the force that upends PBMs’ pharmacy benefit economics, plan sponsors’ decisions, and the entire generic market. Should PBMs continue to profit from discount cards’ rapid growth…while ignoring the risk that this growth could undermine the value of their benefit management services?
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Friday's webinar will include my latest thoughts on a key trend discussed in todays rerun: how plan sponsors are incorporating patient-paid prescriptions—cash-pay prescriptions and discount cards—within pharmacy benefits.
