- Amazon Pharmacy is still coming for retail pharmacy
- Express Scripts revives its long-lost drug trend report
- Prior authorization gold cards: Progress or peril?
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CEO Andy Jassy’s 2024 Letter to Shareholders, Amazon
In his annual letter to shareholders, Amazon CEO Andy Jassy highlighted three ways that Amazon Pharmacy wants to compete with traditional retail pharmacies:
Retail pharmacies need to level up if they want to keep up.
Still, let’s keep things in perspective. DCI estimates that Amazon Pharmacy generated less than $2 billion in 2024 revenue—just 0.3% of the total prescription dispensing market.
Despite loads of investment and 10+ years of effort, Amazon has yet to truly disrupt the existing drug channel for pharmacies and PBMs.
- Clear formulary coverage
- Upfront, transparent out-of-pocket pricing
- No locked-up front-of-store items
Retail pharmacies need to level up if they want to keep up.
Still, let’s keep things in perspective. DCI estimates that Amazon Pharmacy generated less than $2 billion in 2024 revenue—just 0.3% of the total prescription dispensing market.
Despite loads of investment and 10+ years of effort, Amazon has yet to truly disrupt the existing drug channel for pharmacies and PBMs.
Pharmacy in Focus - 2025, Evernorth Research Institute
Back in 2021, I lamented the fact that many PBMs had stopped publishing annual drug trend reports on spending and utilization.
Good news! Express Scripts has revived the annual drug trend report—its first in four years.
For 2024, drug trend—the total change in spending for Express Scripts’ plan sponsor clients—was +8.9%. This growth was comprised of 6.1% increase in unit cost plus 2.8% increase in utilization. Historical data are shown below.
Nearly half (47%) of 2024’s spending increase came from anti-obesity GLP-1 drugs. Consequently, traditional spending grew by 11.7%, while specialty spending grew by only 4.9%. Specialty spending grew slowly due to such factors as biosimilars, non-biological specialty generics, and tighter formulary control.
P.S. Exhibit 84 of DCI's new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers reviews drug trend from CVS Caremark, Prime Therapeutics, and Navitus—the only other PBMs that currently report these data.
Good news! Express Scripts has revived the annual drug trend report—its first in four years.
For 2024, drug trend—the total change in spending for Express Scripts’ plan sponsor clients—was +8.9%. This growth was comprised of 6.1% increase in unit cost plus 2.8% increase in utilization. Historical data are shown below.
[Click to Enlarge]
Nearly half (47%) of 2024’s spending increase came from anti-obesity GLP-1 drugs. Consequently, traditional spending grew by 11.7%, while specialty spending grew by only 4.9%. Specialty spending grew slowly due to such factors as biosimilars, non-biological specialty generics, and tighter formulary control.
P.S. Exhibit 84 of DCI's new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers reviews drug trend from CVS Caremark, Prime Therapeutics, and Navitus—the only other PBMs that currently report these data.
Gold Card Law Analysis, 2019-2024, Aimed Alliance
Good news for physicians and patients: Ten states have enacted "gold card" laws that reduce the burden of prior authorizations. These laws exempt providers from routine prior authorization requirements if they consistently demonstrate high approval rates. That's a welcome reprieve from endless paperwork and administrative hurdles.
Think of a a prior authorization gold card as a credential-based privilege. The provider is considered low-risk and granted streamlined processing. Otherwise, everyone is treated as equally high risk, which creates excessive red tape for those with a proven track record.
Naturally, not everyone’s onboard. Some members of the Drug Channels community shared thoughtful counterpoints on LinkedIn, highlighting the complexity and trade-offs inherent in reform efforts.
Think of a a prior authorization gold card as a credential-based privilege. The provider is considered low-risk and granted streamlined processing. Otherwise, everyone is treated as equally high risk, which creates excessive red tape for those with a proven track record.
Naturally, not everyone’s onboard. Some members of the Drug Channels community shared thoughtful counterpoints on LinkedIn, highlighting the complexity and trade-offs inherent in reform efforts.
Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, Federal Register
The final 2026 Medicare Part D rule now requires plan sponsors to use the acronym “MPPP” (Maximum Patient Out-of-Pocket Prescription Payment). Seems logical to me.
But just last October, CMS explcitly said that plans should not use any acronyms when referring to the program. Here’s a fun paragraph from the Inflation Reduction Act’s implementation guidance:
Regardless of the name, just 179,000 seniors (0.4%) have enrolled in the payment plan program. Looks like the IRA's most complex and bureaucratic program is failing to connect with the people it's supposed to help.
But just last October, CMS explcitly said that plans should not use any acronyms when referring to the program. Here’s a fun paragraph from the Inflation Reduction Act’s implementation guidance:
“As stated in the final part one guidance, the name “Medicare Prescription Payment Plan” should be used in any guidance and communications by Part D sponsors related to this program. CMS is not using “M3P,” “MPPP,” or any other acronym as approved terms for the program and encourages Part D sponsors to use the CMS-developed fact sheet as the basis of their materials for the 2025 plan year.”No, this isn’t the biggest Part D news of the year. But it’s still amusing for Medicare nerds and other fans of bureaucracy.
Regardless of the name, just 179,000 seniors (0.4%) have enrolled in the payment plan program. Looks like the IRA's most complex and bureaucratic program is failing to connect with the people it's supposed to help.
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