Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 100,000 subscribers and followers. Learn more...
Three’s still company in the world of pharmacy benefit managers.
For 2024, nearly 80% of all equivalent prescription claims were processed by three familiar companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. The names haven’t changed, but shifting relationships and contract shakeups have altered the plot, with Express Scripts stepping into a new lead role.
Below, we break down the latest market share data from Drug Channels Institute (DCI), explore the developments driving these changes, and examine what they signal for the future of the PBM landscape.
Today’s guest post comes from Josh Marsh, Vice President and General Manager, Sonexus™ Access and Patient Support at Cardinal Health.
Josh discusses how patient support programs are evolving, including the shift toward outsourcing individualized hub functions. He lists five characteristics pharmaceutical companies should look for when evaluating outsourced support for long-term program success.
Spring has officially arrived in sunny downtown Philadelphia—the proud home base of Drug Channels. As you can see on the right, we celebrated in Miami at the Drug Channels Leadership Forum.
The vernal equinox also brought a surprising surge of industry updates and noteworthy news you won’t want to miss:
Blue Shield of California provides a puzzling update to its PBM unbundling effort
The Stelara biosimilar price war begins
My reaction to Optum Rx’s pharmacy reimbursement announcement
A valuable Follow the Dollar primer
Plus, Dr. Glaucomflecken reviews UnitedHealth Group's vertical integration strategy.
Paula and I are beyond grateful to everyone who took the stage to share their insights and to all who participated in making this event so impactful. (Even Paula got on the main stage!) The event was packed with thought-provoking discussions, candid insights, and dynamic exchanges. The HMP Global team delivered a truly first-class experience for the nearly 350 lucky attendees.
You can find attendees’ photos by searching “#DCLF2025” on LinkedIn. (Be sure to use quotation marks and then sort by “Latest.”)
BTW, you won’t see any news stories about the DCLF. That’s because the media were not invited and the sessions were not recorded. You had to be in the room where it happened.😉
The DCLF will return in March 2026.
P.S. A special shoutout to the phenomenal HMP Global team. Your hard work and dedication made this event unforgettable!
Pricing & Contracting USA arrives at an important moment for our industry. As you work to navigate the evolving healthcare landscape, this annual event brings together 60+ expert speakers from 70+ companies to lead the critical discussions that will drive comprehensive market strategy, uniting Medicaid, Policy, Pricing, Contracting & Reporting thought leaders.
With 52 sessions across 6 workshops and 5 tracks, this event features:
Wholesaler/Manufacturer Team-to-Team Meet-and-Greets: Direct industry collaboration
Executive Programming: Fireside Chat with External Counsel, Closed Door Executive Strategy Summit and Luncheon
Interactive Sessions: Speed Networking, AI Lunch and Learn
Strategic Working Groups: Medicaid Working Group Report, 80 Minute Industry Strategy Working Group
The Hottest Topics: Covering Government pricing, contracting and reporting fundamentals, MDRP, the Medicaid Final Rule, State Drug Price Transparency, PDAB, Medicaid, VA and IRA penalties, PBM evolution and regulation, 340B challenges, GTN, PhRMA, GPO Management, specialty distribution and cold chain, AI and automation and more.
Featuring confirmed speakers from: Pfizer, AstraZeneca, Novo Nordisk, Sanofi, Gilead Sciences, McKesson, Regeneron, UCB, PhRMA, CSL Behring, OIG, United Therapeutics, Alkermes, Averitas Pharma and many more.
Join us where Medicaid, Commercial & Government Teams will collaborate to drive a successful market strategy!
View the agenda for Pricing & Contracting USA to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pricing-contracting-usa for further details and to register. Drug Channels readers will save 10% off when they use code 25DRCH10 and register prior to April 30, 2025.*
*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post comes from Greg Skalicky, President of EVERSANA.
Greg discusses some of the challenges manufacturers face with product commercialization, patient access and adherence, and negotiating partnerships with pharmacy benefit managers (PBMs). He introduces us to EVERSANA DIRECT Commercialization™, a direct-to-patient change/model.
Order before March 31, 2025 to receive special discounted pricing!
Now in its 16th edition, this report remains the most comprehensive, fact-based resource for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. It serves as the ultimate guide to the complex web of interactions within U.S. prescription drug channels.
What's inside?
12 chapters, 540+ pages, and 268 exhibits
Nearly 1,200 endnotes with hyperlinks to source materials
You can pay online using Visa, MasterCard, American Express, Discover, and PayPal. If you prefer to pay by corporate check or ACH, click here to request an invoice.
Our reports are widely used by nearly every company involved in the drug channel:
Pharmaceutical manufacturers
Wholesalers, pharmacists, pharmacy owners
Hospitals, benefit managers, and managed care executives
Policy analysts, investors, consultants, and more
So, this report helps you understand what your customers, partners, and competitors are reading.
The chart below illustrates the depth and breadth of the 2025 edition, with chapter numbers corresponding to each channel flow.
FUN FACTS ABOUT THE 2025 EDITION
The 12 chapters are self-contained—you don't need to read them in order. (Really!)
There are tons of internal hyperlinks to help you navigate and focus on what matters most to you.
We’ve updated all market and industry data with the most current insights, including our annual analyses of the largest pharmacies, specialty pharmacies, and PBMs.
You have the option to download an additional PowerPoint file with images of all 268 exhibits—making it easier to share insights with your team. (Note: All license versions include exhibits within the text.)
There are a staggering 1,163 endnotes (!), most of which have direct hyperlinks to original source materials, giving you a deeper knowledge base beyond what’s in the report.
Sadly, I had to remove all corny jokes and pop culture references. So, no memes and absolutely no references to SpongeBob SquarePants.
If you have any questions (before or after reading the report), just email me.
Today’s guest post comes from Jordan Armstrong, Vice President of Business Development at AssistRx.
Jordan discusses the uptick in direct-to-consumer (DTC) models for life sciences organizations looking to navigate market challenges and improve patient access. He goes on to describe some potential risks and complexities associated with these models.
To learn about AssistRx’s technology solutions designed to simplify the patient experience and reduce channel costs, meet with AssistRx at the Drug Channels Leadership Forum, Informa Connect’s Access USA, and/or the Asembia Summit.
For 2024, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $683 billion, up 9% from the 2023 figure. GLP-1 agonist drugs remained the most significant driver of prescription revenue at retail pharmacies, accounting for more than 80% of dispensing revenue growth for 2024.
The table below—one of 268 in our new report—cues up DCI's first look at the 15 largest organizations that battled for those revenues. For a sneak peek at the complete report, click here to download our free 30-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits). We’re offering special discounted pricing if you order before March 31, 2025.
Today’s guest post is from Divya Iyer, SVP Go-to-Market (GTM) Strategy at GoodRx.
Divya argues that patient support programs (PSPs) struggle with awareness and accessibility, preventing patients from fully benefiting from the financial and educational resources available to them. Divya discusses how integrating digital solutions from GoodRx can enhance engagement, streamline access to therapy, and improve patient outcomes.
Last week, President Trump signed yet another executive order, this time promising to make healthcare pricing more transparent.
While this marks another federal push for disclosure, states have already been quite active in this space. Since 2017, 24 states have passed 38 laws targeting healthcare transparency, with a strong focus on unraveling the complex economics of pharmacy benefit managers (PBMs).
But has all this legislation actually provided clarity—or just more red tape?
Below, I analyze four state reports on manufacturers’ rebate and fee payments to PBMs. The findings are dispiriting: mandated disclosures have yielded little actionable, reliable data. Lawmakers got to pat themselves on the back for “transparency,” but the data tell a different story. Federal efforts haven’t been much better.
Dr. Adam J. Fein, president of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s new live video webinar:
This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.
Join industry expert Adam J. Fein, Ph.D., for an exclusive deep dive into the latest trends, data, and strategies shaping the pharmacy benefit management (PBM) industry. Drawing from the brand-new 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, Dr. Fein will provide invaluable insights to help you and your team stay informed about this rapidly evolving market.
Dr. Fein will share his expert analysis on critical industry developments, including:
The competitive landscape of major PBMs, with exclusive market share data from DCI
Key business trends among leading PBMs and their impact on the market
PBMs’ expanding role in specialty pharmacy and how it’s reshaping the industry
Exclusive insights into the Federal Trade Commission’s interim reports and the future of its investigation
The evolving role of independent PBMs and their market positioning
How health-system-owned PBMs are changing the game
Fresh data on plan sponsors’ perspectives on their PBM partners
Key takeaways from PBMs’ 2025 commercial formularies
The latest shifts in PBM compensation models
The risks and rewards of PBM-affiliated private-label products and GPOs
Legislative and business implications of the 340B Drug Pricing Program
State and federal PBM regulations: What’s ahead?
Emerging controversies, challenges, and threats to watch in the industry
And much more!
As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.
This 90-minute video webinar will feature a dedicated Q&A session, where attendees can unmute and engage directly with Dr. Fein. Don't miss this unique opportunity to gain actionable insights and have your burning questions answered in real time!
Register now to stay informed and ahead of the curve on the PBM industry!
PRICING OPTIONS
Take advantage of this exclusive educational opportunity for just $420 per viewing device. Once you register, you'll receive a unique Zoom access link within 24 hours—making it easy to add the event to your calendar and ensure you don’t miss out.
SPECIAL DISCOUNTS FOR GROUPS!
We understand that many professionals are working remotely, so we’re offering substantial savings for multiple registrations from the same organization:
Register multiple devices for as low as $295 each—a 30% discount!
Unlimited attendees can watch together at a single physical location (one registered device required).
Please contact Paula Fein (paula@drugchannels.net) to register a group for one fixed price.
Important Reminder: Each device at a single physical location must have its own registration. The webinar may not be recorded, streamed, or shared across different locations, devices, or sites.
Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)
Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.
We will use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.
The day after the event, every registrant—whether they attended the live event or not—will receive an email from Zoom with information on how to access a video replay of the full event and download Dr. Fein's complete slide deck.
This event is part of The Drug Channels 2025 Video Webinar Series. If you already purchased access to the 2025 Drug Channels Video Webinar Series, then you should have received an email from Zoom with a link to access the April 4, 2025, event.
Organizations that purchased corporate access for The Drug Channels 2025 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.
Each registration for a DCI webinar is valid for a single device at a single physical location. Each device at a physical location requires its own registration. Attendees are not permitted to record, stream, share, or project a DCI webinar to other sites or locations. Purchasers who violate this limitation by recording, streaming, sharing, or projecting a DCI webinar to other sites, devices, or locations will be liable for the full cost of all locations that viewed the webinar. DCI reserves the right to prohibit purchasers who violate our terms from attending future DCI webinars.
Today’s guest post comes from Scott Genone, Chief Product Officer at CareMetx.
Scott shares key findings from CareMetx’s recent survey of over 100 industry leaders. He explains how such advanced technologies as AI and machine learning will reshape patient services and improve the experience for both patients and healthcare providers.
On March 18, 2025, Drug Channels Institute will release The 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our sixteenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. This unique, encyclopedic resource is your ultimate guide to the complex web of interactions within U.S. prescription drug channels.
12 chapters, 500+ pages, 268 exhibits, nearly 1,200 endnotes: There is nothing else available that comes close to this valuable resource.
We are providing you with the opportunity to preorder this thoroughly updated, revised, and expanded 2025 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before March 18.
Winter—or at least February—is almost over. Celebrate the imminent return of spring with our selection of noteworthy news from around the drug channel. In this issue:
How Part D plan sponsors responded to pharmacy DIR changes
Troubling new data on copay accumulators in marketplace plans
DCI’s latest vertical integration visualization
How the IRA will hurt physician practices
Plus, cartoon cats explain the 340B Drug Pricing Program.
Today's guest post comes from Thomas Luby, Sr. Vice President, Business Development at PHIL.
Thomas discusses the challenges brands face as they manage gross-to-net (GTN) performance while simultaneously enhancing patient access and adherence. He lists the key performance indicators that can help brands improve GTN.
Abracadabra! Small pharmacies have ghosted Medicare Part D’s preferred networks—no farewell party, no breakup text, just a quiet exit.
A few months ago , DCI highlighted how the largest pharmacy chains are participating as preferred cost sharing pharmacies in the 2025 stand-alone prescription drug plan (PDP) networks. Today, we update our exclusive analysis of how smaller pharmacies are participating via their pharmacy services administrative organizations (PSAOs).
As you will see below, the largest PSAOs have almost fully abandoned PDPs’ preferred networks in 2025. Plans from Humana, WellCare, and UnitedHealthcare will again not have any independent pharmacies participating via PSAOs as preferred pharmacies.
Thanks to the Inflation Reduction Act (IRA), the PDP market is vanishing. Looks like the presence of smaller pharmacies in preferred networks will not be far behind.
Today’s guest post comes from Angie Franks, CEO at Kalderos
Angie describes the compliance challenges that stakeholders face in managing the complex interactions of the 340B Drug Pricing Program, the Medicaid Drug Rebate Program, and IRA’s Maximum Fair Price and inflation rebate provisions. She explains how clean, comprehensive claims data can resolve these issues.
Valentine’s Day is almost here! So, it’s time for our romantic review of plan sponsors’ sweetheart: the accumulators and maximizers that divert manufacturers’ copay support payments away from patients—and toward plans and PBMs.
As of late 2024, more than 40% of commercially insured lives were in plans that utilize a copay accumulator or a maximizer. Thanks to a potent combination of payer savings and PBM profits, maximizers are now more beloved than copay accumulators. Check out the data below.
DCI estimates that that plans and their vendors receive about $6.5 billion of manufacturers’ copayment support funds. Given the money at stake, plans will keep wooing this money away from patients. Will legislators let this love continue to bloom? Read on and let me know what you think.
Today’s guest post comes from Richard Faris, Chief Strategy & Growth Officer at PANTHERx Rare Pharmacy.
Richard outlines the key factors for commercialization success when a manufacturer launches treatments for rare and orphan diseases. He explains the key considerations for choosing a specialty pharmacy network design, selecting the right pharmacy partners, and establishing patient services HUBs.
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.
Informa Connect's Access USA March 18-20, 2025, Pre-Event Workshops on March 17
Drug Channels readers save 10%* on their registration with code 25AUSA10
Three events. One roof. The future of patient access.
There’s a lot to discuss, and Access USA is ready to deliver: policy updates, PBM reform, commercialization strategies and more!
Meet with hundreds of key stakeholders across the access landscape and benchmark with, learn from and network with leaders paving the way in patient access. Choose your preferred event and prepare to walk away inspired and armed with the knowledge necessary to drive change forward.
Which event is for you?
PAP 2025 Download Agenda This forum gathers experts to share strategies for program optimization, navigate policy change and adapt to market dynamics to transform patient outcomes and maximize medication access. Benchmark your PAP program against leaders in industry and explore best practices to empower patients, champion affordability and accelerate access.
Hub and Specialty Pharmacy Models Download Agenda As the patient services landscape undergoes massive transformation, unite with industry to talk hub optimization and sustainability. In a time where flexibility in your hub program is a must, ensure you have all the tools to remain agile in this fluctuating landscape. This event is your insider playbook to driving efficiency in hub operations for improved access and adherence.
Rare Disease Summit Download Agenda While the industry has seen heightened focus surrounding rare drug development, we’ve only scratched the surface. Connect with key stakeholders to drive therapeutic progress, propel commercial strategies and inspire impactful advocacy. Generate solution-focused approaches surrounding access, commercialization, funding, partnering and more, as you unify in areas of unmet medical need at this inspiring summit.
What attendees are saying:
"Excellent conference! Content is always up-to-date and relevant… I attend yearly and always learn about topics impacting our industry."
"Valuable insights related to access and coverage relative to the impact of government policies and regulations… a window into the critical factors that impact manufacturers, supporting vendors and patient advocacy organizations."
"This event was exactly what I needed... the ability to connect with others on a more granular level guarantees that you will have some much-needed takeaways to share as well as networking with industry leaders!"
*Cannot be combined with other offers or used toward a current registration. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Before you overturn any cars, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron:
Touchdown! How Mark Cuban would quarterback the U.S. healthcare system
Trick Play: Patients and plans get sacked by a gross spending-to-net bubble
Defensive line: A comeback for pharmacy students
Offensive line: Apexus dances in the end zone, while a 340B hospital tackles a patient
Plus, Super Antonio runs downfield in the Mushroom Kingdom.
P.S. I recently passed 60,000 LinkedIn followers. If you haven’t done so already, follow along for my daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.
Today’s guest post comes from Scott Genone, Chief Product Officer at CareMetx.
Scott shares key takaways from CareMetx’s recent survey of over 100 industry leaders. He outlines four trends that will define the future of patient services.
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.
