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...
It’s time to pay attention to the money behind the 340B curtain.
Minnesota just released the industry‘s first ever mandated financial report on the 340B Drug Pricing Program. Below, I do a wicked deep dive into the data and highlight crucial implications about spending, profits, pharmacies, plans, patients, program integrity, and more.
There are important limitations to these data. But Minnesota’s report marks a valuable first step on the yellow brick road to the wonderful world of transparency. I suspect similar reports are gonna be popular.
For 2025, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (United Health Group)—have again each excluded hundreds of drugs from their standard formularies. You can find our updated counting below.
As you’ll see below, the combination of formulary exclusion and private labels is creating an increasingly confusing and crowded biosimilar marketplace.
For 2025, the Big Three PBMs shifted national formularies to favor their private-label biosimilars over Humira and its many biosimilar competitors. In fact, nearly all marketed Humira biosimilars are excluded from the larger PBMs’ 2025 formularies. Meanwhile, Stelara—this year’s big pharmacy benefit biosimilar launch—remains on the PBMs’ formularies, but will share space with PBMs’ private label products.
Like it or not, PBMs’ financial benefits from their private-label product align with the benefits to plan sponsors and patients. But the PBMs’ strategies, combined with the warped incentives baked into the Inflation Reduction Act, raise questions about the viability of the biosimilar marketplace.
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.
Today’s guest post comes from Josh Marsh, Vice President and General Manager, Sonexus™ Access and Patient Support at Cardinal Health.
Josh discusses how patient support programs are evolving, including the shift toward outsourcing individualized hub functions. He lists five characteristics pharmaceutical companies should look for when evaluating outsourced support for long-term program success.
Spring has officially arrived in sunny downtown Philadelphia—the proud home base of Drug Channels. As you can see on the right, we celebrated in Miami at the Drug Channels Leadership Forum.
The vernal equinox also brought a surprising surge of industry updates and noteworthy news you won’t want to miss:
Blue Shield of California provides a puzzling update to its PBM unbundling effort
The Stelara biosimilar price war begins
My reaction to Optum Rx’s pharmacy reimbursement announcement
A valuable Follow the Dollar primer
Plus, Dr. Glaucomflecken reviews UnitedHealth Group's vertical integration strategy.
Paula and I are beyond grateful to everyone who took the stage to share their insights and to all who participated in making this event so impactful. (Even Paula got on the main stage!) The event was packed with thought-provoking discussions, candid insights, and dynamic exchanges. The HMP Global team delivered a truly first-class experience for the nearly 350 lucky attendees.
You can find attendees’ photos by searching “#DCLF2025” on LinkedIn. (Be sure to use quotation marks and then sort by “Latest.”)
BTW, you won’t see any news stories about the DCLF. That’s because the media were not invited and the sessions were not recorded. You had to be in the room where it happened.😉
The DCLF will return in March 2026.
P.S. A special shoutout to the phenomenal HMP Global team. Your hard work and dedication made this event unforgettable!
Pricing & Contracting USA arrives at an important moment for our industry. As you work to navigate the evolving healthcare landscape, this annual event brings together 60+ expert speakers from 70+ companies to lead the critical discussions that will drive comprehensive market strategy, uniting Medicaid, Policy, Pricing, Contracting & Reporting thought leaders.
With 52 sessions across 6 workshops and 5 tracks, this event features:
Wholesaler/Manufacturer Team-to-Team Meet-and-Greets: Direct industry collaboration
Executive Programming: Fireside Chat with External Counsel, Closed Door Executive Strategy Summit and Luncheon
Interactive Sessions: Speed Networking, AI Lunch and Learn
Strategic Working Groups: Medicaid Working Group Report, 80 Minute Industry Strategy Working Group
The Hottest Topics: Covering Government pricing, contracting and reporting fundamentals, MDRP, the Medicaid Final Rule, State Drug Price Transparency, PDAB, Medicaid, VA and IRA penalties, PBM evolution and regulation, 340B challenges, GTN, PhRMA, GPO Management, specialty distribution and cold chain, AI and automation and more.
Featuring confirmed speakers from: Pfizer, AstraZeneca, Novo Nordisk, Sanofi, Gilead Sciences, McKesson, Regeneron, UCB, PhRMA, CSL Behring, OIG, United Therapeutics, Alkermes, Averitas Pharma and many more.
Join us where Medicaid, Commercial & Government Teams will collaborate to drive a successful market strategy!
View the agenda for Pricing & Contracting USA to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pricing-contracting-usa for further details and to register. Drug Channels readers will save 10% off when they use code 25DRCH10 and register prior to April 30, 2025.*
*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post comes from Greg Skalicky, President of EVERSANA.
Greg discusses some of the challenges manufacturers face with product commercialization, patient access and adherence, and negotiating partnerships with pharmacy benefit managers (PBMs). He introduces us to EVERSANA DIRECT Commercialization™, a direct-to-patient change/model.
Order before March 31, 2025 to receive special discounted pricing!
Now in its 16th edition, this report remains the most comprehensive, fact-based resource for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. It serves as the ultimate guide to the complex web of interactions within U.S. prescription drug channels.
What's inside?
12 chapters, 540+ pages, and 268 exhibits
Nearly 1,200 endnotes with hyperlinks to source materials
You can pay online using Visa, MasterCard, American Express, Discover, and PayPal. If you prefer to pay by corporate check or ACH, click here to request an invoice.
Our reports are widely used by nearly every company involved in the drug channel:
Pharmaceutical manufacturers
Wholesalers, pharmacists, pharmacy owners
Hospitals, benefit managers, and managed care executives
Policy analysts, investors, consultants, and more
So, this report helps you understand what your customers, partners, and competitors are reading.
The chart below illustrates the depth and breadth of the 2025 edition, with chapter numbers corresponding to each channel flow.
FUN FACTS ABOUT THE 2025 EDITION
The 12 chapters are self-contained—you don't need to read them in order. (Really!)
There are tons of internal hyperlinks to help you navigate and focus on what matters most to you.
We’ve updated all market and industry data with the most current insights, including our annual analyses of the largest pharmacies, specialty pharmacies, and PBMs.
You have the option to download an additional PowerPoint file with images of all 268 exhibits—making it easier to share insights with your team. (Note: All license versions include exhibits within the text.)
There are a staggering 1,163 endnotes (!), most of which have direct hyperlinks to original source materials, giving you a deeper knowledge base beyond what’s in the report.
Sadly, I had to remove all corny jokes and pop culture references. So, no memes and absolutely no references to SpongeBob SquarePants.
If you have any questions (before or after reading the report), just email me.
Today’s guest post comes from Jordan Armstrong, Vice President of Business Development at AssistRx.
Jordan discusses the uptick in direct-to-consumer (DTC) models for life sciences organizations looking to navigate market challenges and improve patient access. He goes on to describe some potential risks and complexities associated with these models.
To learn about AssistRx’s technology solutions designed to simplify the patient experience and reduce channel costs, meet with AssistRx at the Drug Channels Leadership Forum, Informa Connect’s Access USA, and/or the Asembia Summit.
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). We’re offering special discounted pricing if you order before March 31, 2025.
Today’s guest post is from Divya Iyer, SVP Go-to-Market (GTM) Strategy at GoodRx.
Divya argues that patient support programs (PSPs) struggle with awareness and accessibility, preventing patients from fully benefiting from the financial and educational resources available to them. Divya discusses how integrating digital solutions from GoodRx can enhance engagement, streamline access to therapy, and improve patient outcomes.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: 
