Vertical Integration Redux: How Pharmaceutical Wholesalers Are Transforming the Buy-and-Bill Market (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: PBM Industry Update: Trends, Challenges, and What’s Ahead.

Click here to see the original post from February 2025.

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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.

This video was excerpted from my recent Drug Channels Outlook 2025 webinar. Click here if you can’t see the video below.

For more on the forces of change affecting drug distribution and the buy-and-bill market, see Chapter 6 of DCI’s recent 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Four Revelations from Minnesota’s First 340B Transparency Report (rerun)

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.

Click here to see the original post from December 2024.

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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.

The Big Three PBMs’ 2025 Formulary Exclusions: Humira, Stelara, Private Labels, and the Shaky Future for Pharmacy Biosimilars (rerun)

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.

Click here to see the original post from January 2025.

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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.

What do you think? I encourage you to share your thoughts with the Drug Channels community on LinkedIn.