Drug Channels News Roundup, November 2025: PBM Revolution, Cuban’s Stelara Challenge, Express Scripts’ Price Games, U.S. Drug Spending Reality, and the AFP Reckoning

Happy Thanksgiving, everyone! Before you stretch your stomach, stretch your mind with some fresh food for thought from across the drug channel. In this issue:

• Employers finally claim to want a PBM revolution

• Mark Cuban accelerates the Stelara biosimilar price war

• How Express Scripts’ private labels inflate generic drug prices

• U.S. drug spending: still middle of the pack

Plus: Has the day of reckoning arrived for shady alternative funding vendors?

P.S. Join my more than 66,000 LinkedIn followers for daily links to neat stuff, along with sharp and thoughtful commentary from the DCI community.

What else should you expect for 2026? Find out during my upcoming live video webinar, Drug Channels Outlook 2026, on December 12, 2025, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up. As always, we are offering special discounts if you want to bring your whole team.

The $700 Copay That Changed Everything

Today’s guest post comes from Stephen Hom, EVP, Chief Commercial Officer, and Co-Founder of RIS Rx.

Stephen argues that patient affordability remains one of the most critical—and often overlooked—barriers to treatment adherence. Drawing on his experience as a community pharmacist, he suggests that cost isn’t just a financial issue—it’s a clinical one.

To learn about RIS Rx’s Benefit Patient Solution (BPS) and other tools, request your savings snapshot.

Read on for Stephen’s insights.

Medicare Part D 2026: Preferred Networks Vanish as the PDP Market Collapses

As I’ve been warning for years, the Inflation Reduction Act of 2022 (IRA) has nearly obliterated the stand-alone Medicare Part D prescription drug plan (PDP) market.

DCI’s exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals:

• The number of PDPs has plummeted by 55% since the IRA’s passage, to a record low of 360 plans for 2026.

• Preferred cost-sharing pharmacy networks are disappearing, with their share falling to the lowest level since 2014. That’s a post-IRA net loss of 505 plans with these networks.

• Just five companies—Aetna, Health Care Service Corporation, Humana, UnitedHealthcare, Wellcare—will account for 94% of all PDPs in 2026. In recent years, four major plan sponsors—Cigna, Clear Spring Health, Elevance Health, and Mutual of Omaha—have exited the PDP market.

See the charts below and our analysis of the remaining national players, along with updated data on preferred networks in Medicare Advantage prescription drug (MA-PD) plans.

Even with the demonstration program handouts, the Part D market is increasingly fragile: fewer choices, greater concentration, and massive disruption for beneficiaries.

Thanks, IRA! 🙃

What else should you expect for 2026? Find out during my upcoming live video webinar, Drug Channels Outlook 2026, on December 12, 2025, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up. As always, we are offering special discounts if you want to bring your whole team.

Drug Channels Outlook 2026: Live Webinar with Adam J. Fein, Ph.D., on PBMs, Part D, DTC Strategies, Drug Policy Trends, and More

2026 is shaping up to be another transformative year for the U.S. drug channel. Join Adam J. Fein, Ph.D.—president of Drug Channels Institute (DCI) and author of Drug Channels—for his exclusive live video webinar:

Drug Channels Outlook 2026
Live Broadcast:
Friday, December 12, 2025
12:00 p.m. to 1:30 p.m. ET

Register Now

Gain the latest data, forecasts, and policy insights to plan confidently for the year ahead. Our Outlook webinars are trusted annually by thousands of industry leaders for data-driven market insight. This 90-minute online event—part of The Drug Channels 2025 Video Webinar Series—streams live from the Drug Channels studio in beautiful downtown Philadelphia.

Jump to: What You Will Learn  •  Pricing Options  •  Important Things To Know

---

What You’ll Learn

Start the new year with clarity and confidence. Dr. Fein—one of the industry’s most trusted voices—will share an essential briefing on the trends, market forces, and policy developments that will shape the U.S. drug channel in 2026 and beyond.

• Market & Policy Outlook: GLP-1 disruption; expectations for Medicare Part D; first-year implications of Medicare’s MFP implementation
• PBMs & Payers: Profit model evolution, transparency pressures, and the future of discount cards, TrumpRx, and direct-to-patient strategies
• Industry Integration: The evolving biosimilar market, wholesaler influence, and vertical integration trends for patient- and provider-administered drugs
• Regulatory & Legislative Changes: The future of the 340B Drug Pricing Program and state/federal PBM oversight

And much more!

As always, Dr. Fein will clearly distinguish objective facts and data from his interpretations. This 90-minute video webinar will include a dedicated Q&A session, where attendees can unmute and engage directly with Dr. Fein.

Reserve Your Spot

Read on for pricing, group discounts, and other details.

---

Hubs, AI, and the New Era of Revenue Protection in Patient Access

Today’s guest post comes from Steve Randall, Chief Technology Architect at ConnectiveRx.

Steve examines how artificial intelligence (AI) is reshaping the role of patient support hubs in the specialty drug ecosystem. As policy, payer, and gross-to-net pressures mount, he argues that the hub model must evolve from a service function into a revenue-protection strategy—one that uses “embedded AI” to enhance, not replace, human judgment.

To learn more, download ConnectiveRx’s free eBook: 8 Questions Patient Access Leaders Should Ask About AI—But Aren’t. 

Read on for Steve’s insights.

As Pharma Faces Financial Pressure, Pharmacy Delivers Measurable Impact

Today’s guest post comes from Lara Loveman, VP of Pharma Solutions at Outcomes.

Lara discusses how shifting market forces and evolving reimbursement models are reshaping pharmaceutical marketing strategies. She suggests that pharmacist-led interventions—particularly in chronic disease management—can both protect pharmaceutical investment and drive better health outcomes.

Click here to learn about Outcomes’ pharmacist-led interventions solution.

Read on for Lara’s insights.

Cigna’s Rebate-Free Pharmacy Model: Three Realities Behind Its Latest Push to Pop the Gross-to-Net Bubble

On Monday, Cigna announced that it would be abandoning traditional manufacturer rebates and moving to a new, “rebate-free” approach—essentially a point-of-sale (POS) rebate model paired with a cost-plus pharmacy reimbursement framework. Here’s the press release.

Moving manufacturers’ rebates and discounts to the point of dispensing is a big win for patients, who can share in the savings that pharmacy benefit managers (PBMs) negotiate with drugmakers. It's a practical, patient-friendly step toward shrinking the gross-to-net bubble that has inflated out-of-pocket costs for years.

Yet as always, the fine print matters. Below are three crucial considerations that reveal why this move might be less revolutionary than it first appears—and why it may not be widely adopted by plan sponsors. Perhaps these will spark some questions for Cigna's management about the company's increasingly opaque profit model during tomorrow’s third-quarter earning call.

This isn’t the first time that Express Scripts has tried to alter how its plan sponsors manage their pharmacy benefits. After reading the analysis below, you can decide whether this latest attempt is true reform—or the triumph of hope over experience.

Drug Channels News Roundup, October 2025: Vertical Integration Woes, AFPs Gone Wild, Part D’s Decline, 340Bloat, and Dr. G’s ACIP Haunting

Eeek! It’s time for the Drug Channels Halloween roundup of terrifying tales from the dark corners of the healthcare system. Gather your favorite demon hunters and help maintain the Honmoon. This month’s tricks and treats include:

• Vampiric! How vertically integrated insurers can drain the lifeblood from the U.S. healthcare system

• Boo! Chilling stories of the shady alternate funding programs that haunt patients

• Creepy! Why the Part D market is headed for an early grave

• Grotesque! The monstrous expansion of 340B

Plus: Dr. Glaucomflecken returns from the underworld to summon the ACIP séance.

P.S. Join the ever-growing zombie horde that lurches after me and enjoy haunting commentary from the restless spirits of the DCI community.

Express Scripts’ new “rebate-free pharmacy benefit” model materialized too late for this month’s roundup. But I ain’t afraid of no rebates, so I’ll be bustin’ it soon on Drug Channels.

Let’s Be DIRECT: We Have an Access and Affordability Problem to Solve

Today’s guest post comes from Mark Thierer, Chief Executive Officer of EVERSANA.

Mark explains how combining direct-to-patient and direct-to-payer strategies can improve transparency, streamline access, and better align key stakeholders. He introduces EVERSANA DIRECT, the company’s new approach to market access.

To learn more, visit eversana.com/DIRECT.

Read on for Mark’s insights.

The Future of Buy-and-Bill Market Access: Five Drivers of Wholesalers’ Vertical Integration with Physician Practices

Vertical integration continues to reshape U.S. healthcare, as detailed in DCI’s new 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Our latest analysis shows how the Big Three companies—Cencora, Cardinal Health, and McKesson—are extending their reach far beyond drug distribution, building influence throughout the drug channel.

In recent years, these companies have spent more than $16 billion to acquire management service organizations (MSOs) that oversee physician practices in such specialties as gastroenterology, oncology, ophthalmology, and urology.

Below, we highlight the largest MSO transactions and explore five ways wholesalers benefit from ownership in their downstream physician customers. Ultimately, these strategies may allow wholesalers to exert unprecedented control over market access for provider-administered drugs—if they can figure out how to realize this power.

Today’s post is adapted from Section 6.3.2. in DCIs 2025-26 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Special launch pricing discounts are available through October 27, 2025.

Informa Connect’s Trade and Channel Strategies

Informa Connect’s Trade and Channel Strategies
December 9-11, 2025 | W Philadelphia
Exclusive Offer—Use promo 25DC10 to save 10%*

The stakes have never been higher. With seismic shifts in distribution models, health policy and market access strategies, falling behind on critical trends could mean losing your competitive edge. If you’re a trade, channel, market access or brand professional, Informa Connect’s Trade and Channel Strategies is your must-attend event to stay ahead of the curve.

Why attend?
Informa Connect’s Trade and Channel Strategies celebrates two decades of excellence—Experts will explore the evolution of the landscape, unravel its complexities and showcase innovative pharmacy and distribution models shaped by shifting market dynamics. Walk away with actionable strategies to tackle the latest industry challenges.

Why now?
The US marketplace is in upheaval, with disruptions at both the pharmacy counter and across the supply chain. Policy changes, market fluctuations and new entrants, like GLP-1 therapies are reshaping the landscape. Traditional models are being replaced by innovative alternatives, leaving companies struggling to adapt. This conference offers critical insights into these changes and equips you to thrive in this evolving environment.

What can you expect?
The event features a stellar lineup of industry leaders, including Bill Roth of IntegriChain, who will deliver the keynote address, Navigating Disruption in Today’s Trade and Channel Marketplace. Other notable speakers include:

• Christine Hummel, US Head, Trade & Channel Management, Sanofi
• Ramita Tandon, Chief Biopharma Officer, Walgreens
• Peter A. Arakelian, Head of Channel & Oncology Enterprise Accounts, EMD Serono
• Martine Avello, Director, Channel and Distribution, BioMarin Pharmaceutical Inc
• Thomas Scalone, Director, Trade Strategy and Operations, Bristol Myers Squibb
• Stephanie Wirkes, Head of Distribution and Strategy Execution, Bayer
• And more!

Program highlights:

• Navigate Regulatory Changes: Stay on top of DSCSA serialization, IRA impacts and PBM reforms that are reshaping the industry
• Master Distribution Models: Explore the direct-to-patient revolution, limited distribution networks and innovative cold chain solutions for specialty pharmaceuticals
• Optimize Market Access: Learn strategies to balance GTN optimization, payer negotiations and patient affordability
• Leverage Technology: Discover how AI, digital tools and analytics are transforming trade strategies

What attendees are saying:
“For those of us responsible for navigating and developing specific strategy around this ever-changing marketplace in distribution channel management, this was a bullseye.”
“Most valuable conference of the year to understand pharmacy and distribution related topics. There is no second.”
“One of the best conferences I have ever attended. The speaker selection and topic covered from a strategic and tactical approach were extremely relevant to our business.”

Exclusive Offer—Download the agenda and register today–Use your exclusive promo 25DC10 to save 10%*

*Cannot be combined with other offers, promotions or applied to existing 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).

Why Site of Care Is the Hidden Barrier in Neurology’s Bright Pipeline

Today’s guest post comes from from Chad Zerangue, Founder of InfuseFlow and Senior Director, Enterprise Provider Sales at CareMetx.

Chad explains how barriers to access for infused therapies—including site-of-care changes and financial clearance delays—often cause patients to disengage before receiving the first dose. He shares one patient’s story illustrating the need for a strong patient services partner with coordinated systems and digital handoffs.

To learn more, download CareMetx’s latest guide: Don’t Risk Your Launch in the First 120 Days.

Read on for Chad’s insights.