Who Will Pay for Prescription Drugs in 2034? Medicare's Surprising Rise in the Latest Government Forecasts

By Adam J. Fein, Ph.D. and Greis Kapexhiu

In late June, the boffins at the Centers for Medicare & Medicaid Services (CMS) released the latest projections for U.S. spending on healthcare. (See links below.) These data provide the latest official, nonpartisan look at the future of U.S. healthcare spending.

Notably, overall U.S. spending on drugs dispensed by retail and mail pharmacies will remain about 9% of overall healthcare spending.

However, the new forecasts reflect the reality that the Congressional Budget Office (CBO) finally acknowledged last week: The Inflation Reduction Act’s (IRA) Part D provisions will cost much more than CBO had initially estimated.

Below, we outline the factors that led to the dramatic revision to Medicare spending, along with insights on the shrinking role of private insurance and consumer out-of-pocket spending.

Taxpayers—primarily via Medicare and Medicaid—now account for a majority of U.S. prescription drug spending, outstripping the share financed via employer-sponsored insurance.

Like it or not, everyone in the drug channel should prepare to deal with the government programs as increasingly important transaction partners—along with the biggest vertically integrated insurers, PBMs, specialty pharmacies, and healthcare services that administer these programs.

The Industry Doesn't Have an Access Collaboration Problem. It Has an Accountability Problem.

Today's guest post comes from Jen Norton, President, Market Access & Value at EVERSANA.

Jen examines why fragmented ownership across development, regulatory, pricing, distribution, and field functions undermines access at launch. She argues that naming a single accountable owner for the access outcome can close "access debt" earlier, reduce pre-launch friction, and turn coverage into real patient access.

Learn more about EVERSANA's approach to access.

Read on for Jen's insights.

Drug Channels News Roundup, Mid-July 2026: Biosimilar Launch Strategy, Part D Spending Trends, Rural 340B Hospitals, What Employers Can Do About 340B, and Drug Channel Villains

By Bryce Platt, PharmD

Summer's in full swing, but the drug channel didn't take a break.

What better way to spend the summer than reading about new pharmacy resources in the Drug Channels News Roundup?

In this issue:

• The New Biosimilar Launch Playbook

• Factors Adding to Part D Cost Trends

• Rural vs. Non-rural 340B Hospitals

• The Employer 340B Playbook

Extra: Who are the Villains in the Drug Channel?

P.S. Join my nearly 40,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

Direct-to-Patient: Transforming the Manufacturer Access Model

Today's guest post comes from Chip Parkinson, CEO at Gifthealth.

Chip discusses how Direct-to-Patient (DTP) models can transform the manufacturer access model for prescription therapies. He argues that a tech-plus-touch, end-to-end approach can improve patient access, protect manufacturer economics, and increase brand trust and loyalty.

Learn more about Gifthealth.

Read on for Chip's insights.

2025 Gross-to-Net Realities at Eight Top Drugmakers: The Net Pricing Drug Channel Emerges

By Adam J. Fein, Ph.D.

Every year, Drug Channels reviews drug pricing trends at the largest pharmaceutical manufacturers. This year's disclosures provide early evidence that the economics of the U.S. drug channel—and the strategies manufacturers use to secure market access—are beginning to change.

We review the following eight companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data in the appendix.

Our review found:

• Brand-name drug list prices continued to rise modestly, while mandatory and voluntary rebates, discounts, and fees reduced net prices at seven of the eight manufacturers.

• The average gross-to-net price difference was –5.5%, reflecting an average list price increase of 3.7% and an average net price decline of 1.8%.

• For the three manufacturers that disclosed these data, rebates, discounts, and other fees reduced the selling prices of brand-name drugs to less than half of their list prices.

Sanofi's latest and historical disclosures provide one of the clearest illustrations yet of the drug channel's changing economics. Since 2020, the company's estimated U.S. biopharmaceutical sales have grown far faster than rebate payments. As a result, the share of its gross sales returned to payers as rebates declined from 51% to 39%.

Taken together, this year's manufacturer disclosures suggest that the gross-to-net bubble is growing more slowly—and even deflating in parts of the market. Meanwhile, the Net Pricing Drug Channel (NPDC) is becoming visible in manufacturers’ pricing disclosures and financial statements.

Direct-to-Consumer Shouldn't Always Mean Direct-To-Mail-Order: Why Fulfillment Choice Matters

Today's guest post comes from Divya Iyer, SVP, Head of Revenue, Pharma Direct at GoodRx.

Divya examines why direct-to-consumer strategies shouldn't default to mail-order as the endpoint for every program. She argues that preserving patient choice between retail pickup and home delivery can reduce friction, improve therapy initiation, and strengthen the overall patient experience.

To learn more about GoodRx's Pharma Direct solution, visit GoodRx Pharma Direct.

Read on for Divya's insights.

The 340B Program Hit $100 Billion in 2025: Has It Become Too Big to Reform?

By Adam J. Fein, Ph.D.

The 340B Drug Pricing Program continues to redefine the meaning of "skyrocketing."

• For 2025, discounted purchases under the 340B program reached an astounding $100 billion—23% higher than in 2024.

• The gross-to-net difference between list prices and discounted 340B purchases—a proxy for funds available to covered entities—also grew, to $79.5 billion (+$12.0 billion).

• Hospitals again accounted for 87% of 340B purchases.

• 340B purchases are now more than 70% larger than Medicaid’s net prescription drug spending. The program now accounts for nearly one-fifth of the total U.S. gross-to-net bubble.

During DCI’s June webinar, I predicted that the 340B program would move from an era of expansion and opacity to one of transparency and accountability.

But given the latest growth figures, I worry that reform of this undermanaged, out-of-control program may never happen. Has the program become too big to reform?

Read on for our full analysis—and consider whether 340B will ever face its true day of reckoning.

Click here to share your thoughts on the latest 340B data with the Drug Channels community on LinkedIn.

Medicare Embraces Site-Neutral Payments. Why Haven't Employers?

By Bryce Platt, PharmD

Provider-administered drugs are one of the fastest-growing and least-managed cost drivers for commercial plan sponsors.

Despite that, recent data from the Pharmaceutical Strategies Group show that only 35% of commercial plan sponsors currently have a site of care (SOC) program in place for specialty pharmacy. That result is surprising given the size of the savings at stake.

Medicare has figured this out and started site-neutral payments over a decade ago, but the employers who fund the bulk of commercial health spending largely haven't.

The evidence supporting SOC management is no longer the story. The real question is why so many commercial plans continue paying hospital prices when lower-cost alternatives already exist.

When Access Tightens, Prior Authorization Execution Becomes the Differentiator

Today's guest post comes from Megan Wetzel, Vice President of Product, Access and Affordability at CoverMyMeds.

Megan examines how prior authorization execution has become a strategic differentiator for biopharma brands as formulary changes and expanding utilization management put more pressure on access. She argues that building consistent, scalable prior auth execution can reduce therapy delays, improve determination time, and strengthen brand performance across the product lifecycle.

To learn more about CoverMyMeds' prior authorization solution, download their case study: From Decline to Growth: How One Brand Expanded Access in Late Lifecycle.

Read on for Megan's insights.

The Hidden Cost of 340B for Employers and Health Plans

By Adam J. Fein, Ph.D.

For years, the controversy surrounding the 340B Drug Pricing Program has centered on hospitals, manufacturers, and contract pharmacies.

But employers and health plans have become major participants in the program's economics—even though many don't realize it.

The short video below—excerpted from DCI’s recent 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders webinar—explains why.

In eight minutes, I discuss:

• How retrospective identification of contract pharmacy claims can eliminate manufacturer rebates for commercial plans while increasing plan costs

• What PBMs’ growing role in the 340B contract pharmacy market means for pharmacy benefits

• Why the economics differ from what many employers believe is happening at the pharmacy counter

• What newly reported Minnesota data reveal about who ultimately funds hospitals' 340B net profits

Whether you support or oppose the current structure of 340B, it is becoming harder to ignore that the debate is expanding beyond manufacturers and hospitals. Employers, health plans, and policymakers are beginning to ask who ultimately finances the program—and what those economics mean for benefit costs and premiums.

Click here to share your thoughts with the Drug Channels community on LinkedIn.

Can’t see the video? Click here to watch the 340B clip.

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.

BlinkRx Insights: The Questions Manufacturers Wish They Had Asked Before Selecting a Patient Services Partner

Today’s guest post comes from Geoffrey Chaiken and Matthew Chaiken, Co-founders of BlinkRx.

Geoffrey and Matthew examine the important role of patient services providers. They suggest several questions manufacturers can ask when evaluating a patient services partner’s technology infrastructure, pharmacy network design, data visibility, and operational capabilities.

Click here to learn more about BlinkRx’s patient services solution.

Read on for Geoffrey and Matthew’s insights.