The State of Patient Access: What Industry Leaders Reveal in a New Survey About Hub Models, Technology, and the Road Ahead

Today’s guest post comes from Scott Genone, Chief Product Officer at CareMetx.

Scott shares findings from CareMetx’s 2026 Patient Services Report, based on a survey of more than 100 patient access decision-makers across biopharma, consulting, and specialty care. The results reveal an industry in transition. Hybrid hub models are becoming the norm, technology enablement remains uneven, and interoperability is emerging as a critical gating factor for meaningful progress.

To learn more, download CareMetx's 2026 Patient Services Report.

Read on for Scott’s insights.

Medicare Part D Pharmacy Networks in 2026: Supermarkets Dominate as Drugstores Stall and Independents Walk Away

The Centers for Medicare & Medicaid Services (CMS) has just released its initial 2026 data on enrollment in Medicare Part D prescription drug plans (PDPs).

DCI’s exclusive analysis shows that 83% of seniors remain enrolled in PDPs with preferred pharmacy networks—essentially unchanged from 82% in 2025, but sharply lower than the 99% peak in 2023. Meanwhile, the number of major Part D plans offering preferred networks has fallen to a record-low eight.

The new enrollment data reveal a clear shift in competitive positioning: Albertsons and Publix are now preferred in every major plan. Walgreens is holding strong. Walmart—the company that invented the Part D preferred network model—has slipped to the middle of the preferred pack.

Meanwhile, smaller pharmacies have fully abandoned PDPs’ preferred networks in 2026.

At the same time, the IRA’s expansion of the Low-Income Subsidy (LIS) means a growing share of beneficiaries have little financial incentive to use a preferred pharmacy at all. Add in the PBM reforms in the Consolidated Appropriations Act of 2026, and the preferred network model will gradually lose relevance.

The Key to a Better Patient Experience: Improved GTN

Today’s guest post comes from Gerard Rivera, CEO and Co-Founder of RIS Rx.

Gerard reframes patient affordability as a clinical issue rather than a purely financial one. He argues that real-time precision, earlier intervention, and coordinated escalation can reduce gross-to-net failures and improve the patient experience.

To learn more about RIS Rx’s approach, request a RIS Rx savings snapshot.

Read on for Gerard’s insights.

Copay Accumulators and Maximizers in 2025: Popular, Profitable, and Problematic

Valentine’s Day is almost here! It’s the perfect time for our annual update on plan sponsors’ enduring sweetheart: copay accumulators and maximizers—the benefit designs that divert manufacturers’ copay support away from patients and toward plans and PBMs.

As of late 2025, about four in ten commercially insured lives were enrolled in plans using a copay accumulator or a maximizer. Patients who rely on single-source, brand-name specialty drugs for autoimmune conditions, multiple sclerosis, and oncology are increasingly likely to encounter these designs. The data below illustrate how widespread these programs have become—and where their impact is most acute.

The potent combination of payer savings and PBM profits continues to attract plan sponsors, while patients remain caught in the middle of a complex and often opaque struggle among insurers, PBMs, and drugmakers. While a growing number of states have acted to restrict these tools, the states' reach remains limited.

Copay accumulators and maximizers exemplify many of the worst features of our crazy drug channel and add troubling complexity to benefit designs that already feature multiple tiers, copayments, coinsurance, deductibles, exclusions, and more. In this Valentine’s story, patients are still not the ones being courted.

In an Uncertain 340B Environment, Kalderos Offers a Clear Path Forward

Today’s guest post comes from Angie Franks, Chief Executive Officer at Kalderos.

Angie examines the growing uncertainty surrounding the 340B program and explains why comprehensive reform remains unlikely in the near term. She argues that claims-level transparency must serve as the foundation for a sustainable path forward. She describes Truzo, Kalderos’ solution for manufacturers and covered entities to work in real time to gain visibility into 340B drug discounts.

To learn more, schedule a meeting with the Kalderos legal team.

Read on for Angie’s insights.

The FTC Blows Up Express Scripts’ PBM Model—and Launches the Net Pricing Drug Channel

Earlier today, the Federal Trade Commission (FTC) announced an extraordinary settlement with Express Scripts that fundamentally reshapes its pharmacy benefit management (PBM) business—and by extension, the entire drug channel.

The settlement addresses virtually every warped incentive that we have been covering on Drug Channels for the past 20 years. I summarize them below, but it’s worth reading the full document (links below) to appreciate just how completely the FTC has dismantled the existing PBM business model.

One small caveat: Plan sponsors could provide a loophole for business-as-usual. (See Section XI.)

But as I predicted in the Drug Channels Outlook 2026 webinar, we are entering the Net Pricing Drug Channel (NPDC) era.

William Gibson once said: “The future is already here–it's just not evenly distributed.” That future just arrived for one of the biggest PBMs. Get ready.

Latest CMS Data Reveal Six Trends Reshaping U.S. Drug Spending

The boffins at the Centers for Medicare & Medicaid Services (CMS) recently dropped the latest National Health Expenditure (NHE) data, which track all U.S. spending on healthcare. (Links below.)

We spent an astounding $5,278,588,000,000 on healthcare in 2024. Yes, that’s $5.3 trillion!

Retail outpatient prescription drugs accounted for less than 9% of that total. More than half of net outpatient drug spending was paid by federal, state, and local government programs. Below, we delve into the spending trends, which reveal the impact of the Inflation Reduction Act (IRA) on Medicare spending, the boom in healthcare marketplaces, and the post-pandemic bust in Medicaid.

Contrary to what you might read, the government’s data show that drug spending growth was not driven by purportedly “skyrocketing” drug prices. In reality, nearly all of the increase in drug spending reflected higher utilization—more people treated, more prescriptions dispensed, and shifts among drugs dispensed—rather than higher net prices.

Prices may grab headlines, but utilization—and taxpayers—are driving the spending story. When prices stop being signals, markets stop being markets.

From Cost Center to Insights Center: How Patient Support Will Go Beyond the Call in 2026

Today’s guest post comes from Brok Vandersteen, Vice President of Business Development at AssistRx.

Brok argues that in 2026, traditional patient support program (PSP) models must evolve beyond task execution to deliver actionable insights, adaptive access strategies, and measurable ROI. He outlines four key considerations for transforming PSPs from cost centers into insight-driven engines of value.

To explore how life sciences organizations are rethinking patient support in 2026, download the AssistRx white paper: How Tech + Talent Delivers Patient Support Programs that Go Beyond the Call.

Read on for Brok’s insights.

Drug Channels News Roundup, January 2026: Cuban vs. Optum, McKesson’s Biosimilar Play, States vs. Accumulators, 340B Windfalls, and Ozempic Ads

Super Bowl LX is almost here! Time for some blowout beer and snack commercials, occasionally interrupted by an actual football game. DCI’s hometown Philadelphia Eagles will not be going to the big game, so the city’s light poles will remain Crisco-free and upright.

While you wait for kickoff, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron:

• Mark Cuban takes on Optum’s Patrick Conway in a fiery debate

• McKesson makes its private-label biosimilar move

• State anti-accumulator laws keep gaining ground

• 340B hospitals are still specialty drug profiteers

Plus: Will Ozempic's new ad campaign make us nostalgic for 2006?

P.S. Join my more than 67,000 LinkedIn followers for daily links to neat stuff, along with sharp, thoughtful commentary from the DCI community.

New Drug Launches in a Self-Pay World: Why Access Strategy Matters as Much as Innovation

Today’s guest post comes from Laura Jensen, Chief Commercial Officer and President, Pharma Solutions at GoodRx.

Laura argues that patient self-pay has evolved from a temporary bridge to a core access strategy for new drug launches. She examines how manufacturer-funded self-pay offers can be operational from day one.

Click here to learn more about GoodRx’s access and affordability solutions.

Read on for Laura’s insights.

The Big Three PBMs’ 2026 Formulary Exclusions: MFP, Private Label Biosimilars, and Direct-to-Patient Threats for PBMs

For 2026, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (United Health Group)—have once again excluded hundreds of drugs from their standard formularies. Our updated counts appear below.

The 2026 lists highlight how formulary preferences for Humira and Stelara are dominated by private-label biosimilars affiliated with the same parent companies that operate the three largest PBMs. Many of the preferred products feature lower list prices, signaling growing tension between traditional rebate-driven formularies and emerging net-price-based competition.

These developments matter because the pricing system that underpins PBMs’ formulary leverage is weakening. The gross-to-net bubble is deflating and the industry is moving toward what we call the Net Pricing Drug Channel (NPDC).

As low list prices, direct-to-patient distribution, and cost-plus reimbursement models gain traction, formulary exclusions will no longer deliver the economic power they once did. These changes threaten PBMs’ leverage—and profits.

As usual, Mark Cuban is leading the way. AbbVie itself now appears to be following. Consider this year’s formulary review a preview of what market access looks like when the rebate game starts to unwind.

The Net Pricing Revolution in the Drug Channel: What’s Deflating the Gross-to-Net Bubble

As I highlighted last week, we are entering the Net Pricing Drug Channel (NPDC) era—a market environment in which net prices, not list prices, determine access, economics, and competitive strategy. This shift represents a structural change in how value is created and captured across the U.S. drug channel.

The NPDC will:

• Reward simpler pricing models

• Penalize rebate-heavy strategies

• Expose business models built on gross-to-net arbitrage

• Force channel participants to rethink how they add value when money flows more transparently through the system

The short video below, excerpted from my recent Drug Channels Outlook 2026, explains why this shift is accelerating.

It walks through the key forces now deflating the gross-to-net bubble and explains how manufacturers and other channel participants are responding.

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

For a deeper, data-driven look at the trends, market forces, and policy developments shaping the U.S. drug channel in 2026 and beyond, watch the full webinar replay and download the complete slide deck.

UPCOMING 2026 LIVE VIDEO WEBINARS

The Drug Channels 2026 Video Webinar Series

During 2026, DCI will be hosting three live, interactive video webinars focused on the issues that matter most as they’re happening—policy shifts, market trends, and major company moves. Click here to register.

ADDITIONAL BACKGROUND AND ANALYSIS

For more context on the emergence of the Net Pricing Drug Channel and the slowdown in the gross-to-net bubble’s growth, see these Drug Channels articles:

• U.S. Brand-Name Drug Prices Fell in 2025 as the Net Pricing Drug Channel Emerges

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

• List Price Reductions Will Deflate the Gross-to-Net Bubble–and Threaten Pharmacy and 340B Profits from IRA-Negotiated Drugs