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...
Abracadabra! Small pharmacies have ghosted Medicare Part D’s preferred networks—no farewell party, no breakup text, just a quiet exit.
A few months ago , DCI highlighted how the largest pharmacy chains are participating as preferred cost sharing pharmacies in the 2025 stand-alone prescription drug plan (PDP) networks. Today, we update our exclusive analysis of how smaller pharmacies are participating via their pharmacy services administrative organizations (PSAOs).
As you will see below, the largest PSAOs have almost fully abandoned PDPs’ preferred networks in 2025. Plans from Humana, WellCare, and UnitedHealthcare will again not have any independent pharmacies participating via PSAOs as preferred pharmacies.
Thanks to the Inflation Reduction Act (IRA), the PDP market is vanishing. Looks like the presence of smaller pharmacies in preferred networks will not be far behind.
Today’s guest post comes from Angie Franks, CEO at Kalderos
Angie describes the compliance challenges that stakeholders face in managing the complex interactions of the 340B Drug Pricing Program, the Medicaid Drug Rebate Program, and IRA’s Maximum Fair Price and inflation rebate provisions. She explains how clean, comprehensive claims data can resolve these issues.
Valentine’s Day is almost here! So, it’s time for our romantic review of plan sponsors’ sweetheart: the accumulators and maximizers that divert manufacturers’ copay support payments away from patients—and toward plans and PBMs.
As of late 2024, more than 40% of commercially insured lives were in plans that utilize a copay accumulator or a maximizer. Thanks to a potent combination of payer savings and PBM profits, maximizers are now more beloved than copay accumulators. Check out the data below.
DCI estimates that that plans and their vendors receive about $6.5 billion of manufacturers’ copayment support funds. Given the money at stake, plans will keep wooing this money away from patients. Will legislators let this love continue to bloom? Read on and let me know what you think.
Today’s guest post comes from Richard Faris, Chief Strategy & Growth Officer at PANTHERx Rare Pharmacy.
Richard outlines the key factors for commercialization success when a manufacturer launches treatments for rare and orphan diseases. He explains the key considerations for choosing a specialty pharmacy network design, selecting the right pharmacy partners, and establishing patient services HUBs.
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.
Informa Connect's Access USA March 18-20, 2025, Pre-Event Workshops on March 17
Drug Channels readers save 10%* on their registration with code 25AUSA10
Three events. One roof. The future of patient access.
There’s a lot to discuss, and Access USA is ready to deliver: policy updates, PBM reform, commercialization strategies and more!
Meet with hundreds of key stakeholders across the access landscape and benchmark with, learn from and network with leaders paving the way in patient access. Choose your preferred event and prepare to walk away inspired and armed with the knowledge necessary to drive change forward.
Which event is for you?
PAP 2025 Download Agenda This forum gathers experts to share strategies for program optimization, navigate policy change and adapt to market dynamics to transform patient outcomes and maximize medication access. Benchmark your PAP program against leaders in industry and explore best practices to empower patients, champion affordability and accelerate access.
Hub and Specialty Pharmacy Models Download Agenda As the patient services landscape undergoes massive transformation, unite with industry to talk hub optimization and sustainability. In a time where flexibility in your hub program is a must, ensure you have all the tools to remain agile in this fluctuating landscape. This event is your insider playbook to driving efficiency in hub operations for improved access and adherence.
Rare Disease Summit Download Agenda While the industry has seen heightened focus surrounding rare drug development, we’ve only scratched the surface. Connect with key stakeholders to drive therapeutic progress, propel commercial strategies and inspire impactful advocacy. Generate solution-focused approaches surrounding access, commercialization, funding, partnering and more, as you unify in areas of unmet medical need at this inspiring summit.
What attendees are saying:
"Excellent conference! Content is always up-to-date and relevant… I attend yearly and always learn about topics impacting our industry."
"Valuable insights related to access and coverage relative to the impact of government policies and regulations… a window into the critical factors that impact manufacturers, supporting vendors and patient advocacy organizations."
"This event was exactly what I needed... the ability to connect with others on a more granular level guarantees that you will have some much-needed takeaways to share as well as networking with industry leaders!"
*Cannot be combined with other offers or used toward a current registration. 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).
Before you overturn any cars, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron:
Touchdown! How Mark Cuban would quarterback the U.S. healthcare system
Trick Play: Patients and plans get sacked by a gross spending-to-net bubble
Defensive line: A comeback for pharmacy students
Offensive line: Apexus dances in the end zone, while a 340B hospital tackles a patient
Plus, Super Antonio runs downfield in the Mushroom Kingdom.
P.S. I recently passed 60,000 LinkedIn followers. If you haven’t done so already, follow along for my daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.
Today’s guest post comes from Scott Genone, Chief Product Officer at CareMetx.
Scott shares key takaways from CareMetx’s recent survey of over 100 industry leaders. He outlines four trends that will define the future of patient services.
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.
Drug Channels readers save 10% on their registration with code 25DC10
When it comes to patient affordability, it’s difficult to imagine a more complex time for our industry. Navigating policy updates, disarming AFPs, considering compliance risks – There are countless barriers to medication access and it remains our responsibility as an industry to ensure patients have access to the life-changing therapies they need.
How are we ensuring our programs are helping those who need it most? How does PAP 2025 help us reach this goal?
PAP 2025 will unite stakeholders from across the industry for vital collaboration focused on transforming patient outcomes. The experts are coming together to define best practices for PAP programs and answer top-of-mind questions for access professionals, including:
What can we do to catch, block and disarm AFPs?
How are we improving health equity to bridge the gaps in healthcare?
Are we effectively showcasing resources to empower patients?
What is the potential impact of the new administration on health policy?
Event highlights:
Customizable Content: Benefit from add-on workshops, dedicated tracks, breakout discussions and more to customize your experience and strategize on your specific needs.
Expert-Led Sessions: Uniting manufacturers, foundations, clinics and more, benchmark your program with leaders to see how you can improve your program to accelerate access.
Actionable Takeaways: Uncover tangible solutions for your organization to streamline programs, optimize operations and improve patient outcomes.
Networking: Robust networking opportunities with an expected 700+ access professionals to expand your network and establish powerful partnerships.
Featured speakers:
Judd Caulfield, Takeda Pharmaceuticals – Expert in healthcare policy, sharing insights on upcoming regulatory changes, IRA response and the impact on access programs.
Shanelle Gabriel, Starting Something Productions, Inc – Well-versed in advocacy work, sharing a powerful patient journey of resilience, creativity and the role of art in patient engagement.
Rachel Thorpe, Otsuka Patient Assistance Foundation – Thought-leader in PAP innovation, diving into methods for patient empowerment.
Liz Austin, Genentech – A veteran in patient assistance, discussing strategies to safeguard and preserve patient access amid the era of PBM reform.
Jacob Foster, Criminal Division, U.S. Department of Justice – On the front lines of policy changes and enforcement, sharing the most recent and impactful cases related to patient assistance and where they are heading next.
*Cannot be combined with other offers, promotions or applied to an existing registration. 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 is from Dorothy Gemmell, Chief Commercial Officer and President, Manufacturer Solutions, at GoodRx.
Dorothy highlights five trends to watch in 2025. She then describes how GoodRx's Cash Point-of-Sale Solution can help brands improve gross-to-net (GTN) while also making medications more affordable for patients.
