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.

Pharmacy Shakeout: Why U.S. Drugstores Are Disappearing

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.

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

2024 Gross-to-Net Realities at 9 Top Drugmakers: A New Era of Market Access

It’s time for Drug Channels’ annual update on drug pricing trends at the largest pharmaceutical manufacturers.

This year’s review includes the following nine companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Johnson & Johnson, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data below.

These data highlight divergent trends reshaping the gross-to-net bubble:

• Rebates, discounts, and other fees reduced the selling prices of brand-name drugs at the biggest drugmakers to less than half of their list prices.

• When accounting for all list price reductions, average brand-name drug prices declined at three manufacturers and increased at six others.

• Gross-to-net difference in price changes ranged from −12.8% to +6.3%, reflecting significant differences in the manufacturers’ portfolio mix and pricing strategies.

As I noted in last week’s gross-to-net bubble analysis, manufacturers’ evolving market access strategies increasingly aim to offset—or circumvent—growing pricing pressure from both commercial and government payers. Drug pricing flat earthers (#DPFE) will be challenged by falling net prices, while policy wonks will be amazed at the unintended consequences unleashed by our crazy system.

So, journey with me to Bikini Bottom as we again delve into the murky waters of gross-to-net drug pricing. Click here to share your thoughts with the Drug Channels community.

Gross-to-Net Bubble Hits $356B in 2024—But Growth Slows to 10-Year Low

Is the gross-to-net bubble—the ever-widening gap between brand-name drug sales at list prices and their net revenues after rebates and discounts—finally beginning to deflate?

Drug Channels Institute (DCI) estimates that the gross-to-net reductions for all brand-name drugs reached $356 billion in 2024, a 7% increase over the previous year. Yet despite this record total, the bubble expanded at the slowest rate in at least a decade.

In our analysis below, we highlight five key forces driving this shift. Among them: manufacturers’ evolving market access strategies, which increasingly aim to offset—or circumvent—growing pricing pressure from both commercial and government payers.

Meanwhile, many patients remain adrift in the drug channel’s murky waters. As for SpongeBob SquarePants—the longtime mascot of the gross-to-net bubble here at Drug Channels—he’s still with us…but may be eyeing the exit.

The Stelara Biosimilar Price War: How PBM-Affiliated Private Labels Are Reshaping the Market

The 2025 launch of biosimilars to Johnson & Johnson’s Stelara (ustekinumab) marks another turning point in pharmacy benefit dynamics. But unlike the chaotic rollout of Humira biosimilars, pharmacy benefit managers (PBMs) came prepared.

Private label strategies, aggressive pricing, and exclusive formulary deals have transformed what might have been a slow-crawling biosimilar introduction into a full-on pricing war. As with Humira, the reality of biosimilar economics is far messier—and more revealing—than the policy narratives suggest.

In this post, I examine how the major PBMs—and some of the smaller ones—are handling Stelara biosimilars, what’s changed since the Humira experience, and why their strategies reflect the growing dominance of private-label rebating schemes.

As always, with great pricing power comes great responsibility. Excelsior!

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

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

• Where the Rebates Really Go

• Another Year of Explosive Growth for the 340B Program

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

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

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

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

Transparency vs. Reality: Troubling Lessons from PBM Disclosure Laws (rerun)

This week, I’m rerunning some popular posts while I prepare for today’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 March 2025.

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Last week, President Trump signed yet another executive order, this time promising to make healthcare pricing more transparent.

While this marks another federal push for disclosure, states have already been quite active in this space. Since 2017, 24 states have passed 38 laws targeting healthcare transparency, with a strong focus on unraveling the complex economics of pharmacy benefit managers (PBMs).

But has all this legislation actually provided clarity—or just more red tape?

Below, I analyze four state reports on manufacturers’ rebate and fee payments to PBMs. The findings are dispiriting: mandated disclosures have yielded little actionable, reliable data. Lawmakers got to pat themselves on the back for “transparency,” but the data tell a different story. Federal efforts haven’t been much better.

Should we continue down the path of government-mandated reporting, or should plan sponsors be left to negotiate their own deals? 

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.

The Top 15 Specialty Pharmacies of 2024: How PBMs, Health Systems, and Independents Are Shaping the Market (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’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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Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.

DCI has identified nearly 1,900 dispensing locations with specialty pharmacy accreditation. Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates.

As in prior years, pharmacies linked to the three largest pharmacy benefit managers (PBMs) accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. We also explore how these pharmacies contribute to PBMs’ profitability—and spotlight the growing influence of provider- and health system-owned dispensing channels.

Once again, “specialty” mostly means affiliated with a PBM.

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

This week, I’m rerunning some popular posts while I prepare for Friday’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 March 2025.

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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.

The Top 15 U.S. Pharmacies of 2024: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’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 March 2025.

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Next week, Drug Channels Institute (DCI) will release our 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 16th edition of our popular and comprehensive examination of the entire U.S. drug pricing, reimbursement, and dispensing system.

For 2024, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $683 billion, up 9% from the 2023 figure. GLP-1 agonist drugs remained the most significant driver of prescription revenue at retail pharmacies, accounting for more than 80% of dispensing revenue growth for 2024.

The table below—one of 268 in our new report—cues up DCI's first look at the 15 largest organizations that battled for those revenues. For a sneak peek at the complete report, click here to download our free 30-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits).

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

The 340B Drug Pricing Program has emerged as a growing source of profits for pharmacies and pharmacy benefit managers (PBMs).

Drug Channels Institute’s latest exclusive analysis of the 2025 market reveals a highly concentrated market structure increasingly dominated by a handful of major players:

• About 32,000 pharmacy locations—nearly 60% of the entire U.S. pharmacy industry—function as contract pharmacies for the hospitals and federal grantees that participate in the 340B program.

• The 340B contract pharmacy has become increasingly concentrated with five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via Optum Rx), Walgreens, and Walmart.

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

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

Drug Channels News Roundup, May 2025: MFN Controversy, Plan Sponsors ♥️ Rebates, PBM Profits, and Fun in Congress

Summer unofficially began over the weekend. To mark the occasion, here are a few hot items, freshly seared on the Drug Channels grill:

• Reactions from the Drug Channels community to the Most Favored Nation (MFN) pricing policy

• A reality check on whether plan sponsors truly want rebate reform

• What plan sponsors should know about the evolving profit models of pharmacy benefit managers (PBMs)

Plus: A special moment for DCI on Capitol Hill.

P.S. Join my 63,000+ LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the DCI community.

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

Don’t miss DCI’s June 20, 2025, webinar, 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. Join us!

How Large PBMs Make Money Today: A 2025 Drug Channels Update

During my PBM Industry Update: Trends, Challenges, and What’s Ahead video webinar, I explored the latest trends, emerging data, and strategic shifts transforming the pharmacy benefit management (PBM) industry.

In the video clip below, I explain how PBM compensation models continue to evolve:

• Traditional profit sources, such as mail dispensing of nonspecialty drugs and retained rebates, have become less significant.

• Retail network spreads now account for a small portion of large PBMs’ overall profits.

• Specialty dispensing profits, manufacturer administrative fees, and revenues from group purchasing organizations (GPOs) have emerged as major contributors to PBM profitability.

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

Understanding how PBMs generate profits is key to navigating the evolving drug channel landscape. Watch the full webinar replay and download the complete slide deck to explore these dynamics in more depth.

For a more comprehensive analysis of the forces transforming PBMs, see DCI’s 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

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

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

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

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

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

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

Drug Channels News Roundup, April 2025: Amazon Rx Update, Express Scripts’ Spend Trends, Gold Cards, and CMS Acronym Absurdity

Spring has officially arrived at Drug Channels' worldwide headquarters in beautiful downtown Philadelphia. (Photo proof at right.) So, scurry over to this month’s curated crop of noteworthy news:

• Amazon Pharmacy is still coming for retail pharmacy

• Express Scripts revives its long-lost drug trend report

• Prior authorization gold cards: Progress or peril?

Plus, MPPP or not MPPP? That is the question.

P.S. Join nearly 63,000 of your peers who follow me on LinkedIn for daily insights, links to neat stuff, and sharp commentary from the ever-engaged DCI community.

Live from Asembia’s AXS25 Summit: The DCI team is on-site! Swing by booth #1601 at 4 p.m. today for our “Ask Adam Anything” (#AAA) session.

Smaller Pharmacies, Bigger Impact: Inside Manufacturers’ Specialty Networks in 2025

Last week, we examined the growing concentration of specialty drug dispensing revenues among the largest pharmacies. See The Top 15 Specialty Pharmacies of 2024: How PBMs, Health Systems, and Independents Are Shaping the Market.

Today, we dive deeper. Drawing from DCI’s new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, we explore how pharmaceutical manufacturers structure their specialty pharmacy networks—and how smaller, independent pharmacies have emerged as dominant players in exclusive networks.

In DCI’s latest analysis, we find specialty pharmacies affiliated with the largest PBMs still play an outsized role in limited networks. But like a certain striped-hatted cat, smaller pharmacies unaffiliated with PBMs show up where few expect them. They dominate exclusive networks and maybe even cleaning up any messes left by Things 1, 2, and 3.

Read on for DCI’s updated profile of specialty networks—and consider why smaller players are showing the good tricks that they know.

The Top 15 Specialty Pharmacies of 2024: How PBMs, Health Systems, and Independents Are Shaping the Market

Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.

DCI has identified nearly 1,900 dispensing locations with specialty pharmacy accreditation. Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates.

As in prior years, pharmacies linked to the three largest pharmacy benefit managers (PBMs) accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. We also explore how these pharmacies contribute to PBMs’ profitability—and spotlight the growing influence of provider- and health system-owned dispensing channels.

Once again, “specialty” mostly means affiliated with a PBM.

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

Master the Hidden Economics of Pharmaceuticals—In Under an Hour—with DCI's New eLearning Modules

In today’s fast-moving pharmaceutical marketplace, insight is everything. Whether you're building trust with customers, launching new products, or guiding internal teams, understanding the economic forces that shape drug distribution, reimbursement, and pricing is essential.

At Drug Channels Institute (DCI), we know how critical this knowledge is—and how hard it can be to find credible, up-to-date training that fits into a busy professional’s schedule. That’s why we created our DCI eLearning Modules: a suite of six interactive, expertly narrated courses that deliver must-know insights in 45 minutes or less.

Interested? Contact us to learn how to bring these modules to your team.

View a video about DCI's eLearning modules.

Why Professionals Choose DCI eLearning

These modules were built from the ground up for pharmaceutical professionals—from seasoned experts to newcomers looking to understand the industry's complex web of relationships. Each course distills our signature Drug Channels expertise into engaging, bite-sized lessons that are ideal for:

• Sales and field teams: seeking clearer context for their customer conversations

• Market access, training, and internal strategy groups: who need to understand payer and channel dynamics

• Any professional: ready to level up their understanding of pharmaceutical economics

Each module features:

• Interactive graphics and animations for improved retention

• Expert voice-over narration to guide you through complex topics

• References to key DCI reports for optional deep dives

• iPad compatibility for learning on the go

The modules are available only via a site-wide license, giving your entire organization access through your internal learning platform. We also offer licenses to our secure hosted learning environment—no internal setup required! (Sorry, individual licenses are not currently available.)

What You’ll Learn: A Snapshot of Each Module

1. Follow the Dollar: How Funds Flow in the Distribution and Reimbursement Channels

This foundational course breaks down the financial and product flows in U.S. pharmaceutical distribution. You'll learn how money and medicines move between manufacturers, wholesalers, pharmacies, PBMs, and payers—and how each relationship affects costs and outcomes.

2. The Economics of Retail, Mail, and Specialty Pharmacies

Gain a clear-eyed view of how different pharmacy channels generate revenue and manage costs. Understand reimbursement dynamics, cost estimation methods, and how profitability varies across drug types and dispensing models.

3. The Business of Specialty Pharmacy

Specialty drugs are revolutionizing care—and reshaping the pharmacy business. This module explores how these products are distributed, covered by insurance, and supported through value-added services.

4. The Economics of Provider-Administered Specialty Drugs

Navigate the unique dynamics of provider-administered drugs, from buy-and-bill systems to ASP reimbursement. Understand how coverage types, care sites, and financial relationships affect access and profitability.

5. Understanding Pharmacy Benefit Managers

PBMs wield enormous influence—but many professionals may not fully understand their true impact. Learn how PBMs operate, where they make money, and how they interact with manufacturers, payers, and pharmacies.

6. Pharmaceutical Wholesalers: Business Strategies and Financial Economics

Take a deep dive into how wholesalers operate, generate profits, and provide critical services. You’ll come away understanding the difference between full-line wholesalers and specialty distributors—and why that matters for your strategy.

Want a sneak peek? Request access to our sample module today.

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Bottom line: If you or your team work in any part of the pharmaceutical value chain, DCI’s eLearning modules will make you smarter, faster. They’re the shortest path to mastering the industry's most important (and most misunderstood) topics.

Visit our eLearning page to get started.

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

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.