Drug Channels News Roundup, June 2026: PBM Shakeout Accelerates, 340B Enters a New Era, Rebate Questions Persist, Mark Cuban Wins Again, and Ge Bai’s HHS Nomination

By Adam J. Fein, Ph.D.

Happy 250th birthday, America! Before you launch your semiquincentennial festivities, Drug Channels offers some fireworks of our own:

• The PBM Shakeout Is Gaining Momentum

• 340B: From Opacity and Expansion to Transparency and Accountability

• Why Do Many Employers Say They Don’t Receive 100% Of Their PBM Rebates?

• Mark Cuban Wins the Generic Price War (Again)

Plus: Congratulations to Ge Bai on her nomination!

P.S. Join my nearly 71,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

PBM Shakeout: How Vertical Integration Is Reshaping What’s Next (VIDEO)

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.

What do you think?

Can’t see the video? Click here to watch the PBM clip.

ADDITIONAL BACKGROUND AND ANALYSIS

For more on the PBM industry, see these articles and reports:

• Watch the full webinar replay and download the complete slide deck.

• The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments

• Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update

• The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

Cathy Kelly at The Pink Sheet also wrote an article about the webinar: PBM Regulation May Bolster Big Three Market Position Versus Smaller Competitors.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

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.

Drug Channels News Roundup, March 2026: Cigna’s 340B Workaround, Merck’s ARPA Surprise, Walgreens’ Automation Bet, Why Rebates Hurt Patients, and a DCI Team Photo

By Adam J. Fein, Ph.D.

Spring is here in always-sunny Philadelphia. The vernal equinox has brought us an unexpected bounty of noteworthy news:

• Cigna’s clever vertical integration move

• Merck cuts drug prices—and Medicaid and 340B pay more

• Walgreens’ big pharmacy technology play

• How plans profit—and patients lose—from highly rebated drugs

Plus: A bonus photo from the Drug Channels Leadership Forum

P.S. Join my nearly 69,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

PBM Industry Update 2026: Trends, Challenges, and What's Ahead.

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.

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

By Adam J. Fein, Ph.D.

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.

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: DCI’s 2025 Update and Competitive Outlook (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. I’ll be joined by special guest Antonio Ciaccia, CEO of 46brooklyn Research, and President of 3 Axis Advisors.

Click here to see the original post from April 2025.

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It's time for Drug Channels’ 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 revised, renovated, and refurbished our infamous illustration of the major vertical business relationships among the largest companies.

Proponents of these vertical integration arrangements argue that they create opportunities to mine healthcare costs. However, these organizations remain highly controversial, due to the potential for anti-competitive behavior. We summarize some of the key issues below.

While some major companies have narrowed their focus or unwound previous integration efforts, ongoing consolidation and selective deconsolidation will continue to reshape the healthcare biome by trying to build something epic, block by block.

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: DCI’s 2025 Update and Competitive Outlook

It's time for Drug Channels’ 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 revised, renovated, and refurbished our infamous illustration of the major vertical business relationships among the largest companies.

Proponents of these vertical integration arrangements argue that they create opportunities to mine healthcare costs. However, these organizations remain highly controversial, due to the potential for anti-competitive behavior. We summarize some of the key issues below.

While some major companies have narrowed their focus or unwound previous integration efforts, ongoing consolidation and selective deconsolidation will continue to reshape the healthcare biome by trying to build something epic, block by block.

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

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.

The Top Pharmacy Benefit Managers of 2024: Market Share and Key Industry Developments

Three’s still company in the world of pharmacy benefit managers.

For 2024, nearly 80% of all equivalent prescription claims were processed by three familiar companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. The names haven’t changed, but shifting relationships and contract shakeups have altered the plot, with Express Scripts stepping into a new lead role.

Below, we break down the latest market share data from Drug Channels Institute (DCI), explore the developments driving these changes, and examine what they signal for the future of the PBM landscape.

For a deeper dive into the state of the industry, join me this Friday, April 4, 2025, for our live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.

P.S. Special launch pricing on our new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers ends today (3/31/25)!

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.

Five Crucial Trends Facing U.S. Drug Wholesalers in 2024 and Beyond

As regular readers of Drug Channels know, U.S. distribution and dispensing channels for prescription drugs are undergoing significant evolution and consolidation as the changing economics of pharmaceuticals challenge conventional business models.

During this period of volatility, the core business model of the Big Three public pharmaceutical distribution companies—Cardinal Health, Cencora, and McKesson—remains intact. Put simply: Buy low, sell high, collect early, and pay late.

But as I explain below, wholesalers continue to position themselves as essential intermediaries by expanding their industry position and strengthening their economic fundamentals.

Read on for five key pricing, pharmacy, provider, and manufacturer trends that are driving the U.S. drug wholesaling industry.

For even more, check out DCI's new 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, the fifteenth edition of our deep dive into wholesale distribution channels.Click here to download a free report overview (including key industry trends, the table of contents, and a list of exhibits)

The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from April 2024.

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Three is still the magic number for pharmacy benefit managers (PBMs).

For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.

Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2024 Update

It's time for Drug Channels’ annual update of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels.

Below you’ll find our latest illustration of the major vertical business relationships among the largest companies along with some of the notable activity since our previous update. These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical efforts.

The companies face renewed scrutiny from the Federal Trade Commission, the Office of Inspector General, and members of Congress. But until anyone takes action, we will continue to live with the golden rule of the drug channel: Whoever has the gold gets to make the rules.

The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead

Three is still the magic number for pharmacy benefit managers (PBMs).

For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.

Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.

Drug Channels News Roundup, March 2024: My $0.02 of CarelonRx/Kroger & CVS, Provider-Owned Pharmacies, Shady AFPs, 340B Deception, and Lilly’s GLP-1 Ad

It’s finally spring in Philadelphia, home of Drug Channels. Along with sunshine and fine weather, the vernal equinox has ushered in a crop of new and noteworthy stories:

• What the CarelonRx/Kroger specialty pharmacy deal means for CVS Health

• Provider-owned specialty pharmacies expand in Medicare

• Payers are not keen on shady alternative funding programs (AFP)

• Hospitals’ association spreads 340B misinformation

Plus, Lilly trolls our nation’s celebrities.

P.S. Join my nearly 54,000 LinkedIn followers for daily links to neat stuff.

What’s ahead for the drug channel? Find out during Drug Channel Implications of the Inflation Reduction Act, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at our April 5 webinar.

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.

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

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.