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.

Pharmacist Salaries and Employment in 2025: Retail Declines, Hospital Gains

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

It’s time for Drug Channels’ annual look at pharmacist salaries and employment. The latest data might be a tough pill to swallow.

As we predicted, the situation was grim for retail pharmacists. Employment in retail outpatient pharmacies fell by 8,200 positions in 2025, following a drop of 11,700 positions over 2023 and 2024 combined.

Meanwhile, pharmacist employment at hospitals grew by 3,000 positions, after hospitals added more than 11,000 pharmacist jobs in 2023 and 2024. Nearly half of all pharmacists now work outside a traditional retail setting.

Overall pharmacist salaries averaged $140,920, but varied widely across practice settings. Salary growth in many settings, however, did not keep pace with overall inflation.

Our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers documents how and why retail pharmacy economics are under sustained pressure. Since 2018, the two remaining national drugstore chains have collectively closed nearly 3,000 locations, reflecting margin compression and weaker front-end economics.

As always, full salary and employment data appear below for your enjoyment or sorrow. Click here to share your thoughts on the pharmacist job market with the Drug Channels LinkedIn community.

Jump to:

• Pharmacist Employment Trends

• Pharmacist Salary Trends

• Methodology

The Digital Front Door to Specialty Therapy May Not Be a Specialty Pharmacy

Today’s guest post comes from Nareda Mills, President of Patient Solutions at Inizio Engage.

Nareda examines how growing access complexity is reshaping specialty commercialization. She explores the emerging role of Non-Dispensing Pharmacies (NDPs) and argues that by improving coordination, visibility, and patient engagement, they can accelerate time-to-therapy and create a more seamless access experience.

Click here to learn more about Inizio Engage’s hub services.

Read on for Nareda’s insights.

Drug Channels News Roundup, Mid-June 2026: Biosimilar Development Barriers, Hospital Specialty Pharmacy Growth, Medicaid Incentives, Drug Pricing Tradeoffs, and the Prescription-Filling Process

By Bryce Platt, PharmD

Summer officially starts this weekend!

Consider doing a few of your lifting sets (or work meetings) outside.

The healthier you are, the longer you’ll be able to read our news roundups, so everybody wins!

In this issue:

• A Leaky Biosimilar Funnel

• Reasons for Growth in Hospital Specialty Pharmacies

• The Impact of Payment Arrangements on Medicaid Utilization

• Drug Innovation Versus Cost Containment

Extra: The Process of Filling a Pharmacy Prescription

P.S. Join my nearly 36,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

The IRA Fixed One Medicare Part D Distortion—But Patients Now Face New Tradeoffs

By Bryce Platt, PharmD

For years, Medicare Part D plans often preferred high-list/high-rebate branded multiple sclerosis (MS) drugs over lower-cost generics. That was rational behavior inside an irrational system.

The Inflation Reduction Act (IRA) offers one example of how incentives can change behavior in the system. New research in JAMA Health Forum reveals a significant reversal in Medicare Part D formulary coverage for MS drugs. After years of plans favoring brand-name drugs over generics, 2025 formularies shifted to near-universal generic coverage.

However, in return patients got narrower formularies, higher upfront costs, and way more taxpayer dollars spent than expected.

While this wasn’t the case for all drug classes, in MS, the IRA Part D redesign has forced plans to care more about net drug spending. Below, we analyze the formulary data and explain why the coverage patterns changed so abruptly—and what new tradeoffs have emerged.

Minnesota’s 340B Hospitals Make One Billion More From 340B Than They Spend on Uncompensated Care (rerun)

This week, we’re rerunning some popular posts while we prepare for today’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Bryce Platt, PharmD

Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.

In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.

The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.

As you’ll see below, our analysis describes a 340B program that generates financial gains far in excess of any contribution back to the people of the state. There is also no clear accountability for how those dollars are used.

The Top 15 Specialty Pharmacies of 2025: PBM-Affiliated Pharmacies Dominate While Health Systems and Independents Gain Ground (rerun)

This week, we’re rerunning some popular posts while we prepare for tomorrow’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

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By Adam J. Fein, Ph.D.

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

For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.

However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.

Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.