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...
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.
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.
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.
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:
Join Dr. Adam J. Fein, president of Drug Channels Institute (DCI), for three new video webinars during 2026. These live, interactive events are designed for executives who need timely insight into the rapidly changing U.S. drug channel. They will be broadcast via Zoom from the Drug Channels Video studio in beautiful downtown Philadelphia.
During these events, Dr. Fein will address the latest issues confronting the U.S. drug channel. Topics will be determined based on what’s happening—trends, policy changes, company announcements, and more. He’ll share DCI’s latest market data to help you stay on top of new developments. You will be able to use these events as both a capstone of your current learning and a touchpoint for the future.
EVENT SCHEDULE
The three events are scheduled for 12:00 p.m. to 1:30 p.m. ET on the following dates:
April 10, 2026
June 12, 2026
December 11, 2026 (Drug Channels Outlook 2027)
Topics will be finalized closer to each date to reflect breaking trends, policy changes, and major company announcements—so the content stays timely, relevant, and immediately useful.
PRICING OPTIONS
Register for all three events for $1,080 per viewing device (or $360 per viewing device for a single event). We understand that many professionals are working remotely, so we’re offering substantial savings for multiple registrations from the same organization. What's more, an unlimited number of attendees can watch together at a single physical location with one registered device.
Important Reminder: Each device at a single physical location must have its own registration. The webinars may not be recorded, streamed, broadcast, or shared across different locations, devices, or sites.
Click here to register. 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.)
Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover). Prefer check or ACH? Click here to request an invoice.
IMPORTANT THINGS TO KNOW
Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.
We 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 downloads the Zoom client software/app.
Prior to each event, every registrant will receive an email from Zoom with a link to access the event and add it to their calendar. They will also receive reminder emails one week before and one hour before each event.
During each webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions.
Can’t attend the live event? After each event, every registrant will receive an email with information on how to view a replay of the Zoom video recording. Every registrant will also be able to download a PDF of the full slide deck.
Each registration for a DCI webinar is valid for a single device at a single physical location. Each device at a physical location and the viewer(s) at that location requires its own registration. Attendees are not permitted to record, stream, share, or project a DCI webinar to other sites. Purchasers who violate this limitation by recording, streaming, sharing, or projecting a DCI webinar to other sites are liable for the full cost of all locations that viewed the webinar. DCI reserves the right to ban purchasers who violate our terms from attending future DCI webinars.
Today’s guest post is from Dr. Richard Faris, Chief Commercial and Clinical Officer at PANTHERx Rare.
Richard examines key considerations in launching rare disease therapies. He argues that targeted reach, tighter relationships, and data-driven collaboration can improve success for both patients and manufacturers.
It's time for Drug Channels’ annual examination of U.S. brand-name drug pricing.
For 2025, brand-name drugs’ average list prices grew by only 3.5%, but net prices declined. When manufacturers’ rebates and discounts are factored in, drugs’ average net prices—both before and after inflation—fell. Details and additional commentary below.
As I have been predicting, the gross-to-net bubble is deflating due to the combined impacts of government actions and consumer behavior.
For 2024 and 2025, manufacturers reduced the wholesale acquisition cost (WAC) list prices for more than 20 brand-name drugs. For 2026, manufacturers will cut prices on at least 15 more drugs, which will reduce gross brand-name revenues by $35 to $40 billion. List prices are dropping by –25% to –85%.
The data leave no doubt: the bubble is finally leaking air. We are entering the Net Pricing Drug Channel (#NPDC)—a market environment in which net prices, not list prices, drive access, economics, and strategy.
The NPDC will reward simplicity, punish rebate dependence, and force every channel participant to rethink how money actually moves. Time to get ready.
Once again, Drug Channels Institute (DCI) is proud to host this invite-only gathering of senior leaders across the drug channel ecosystem. You must request an invitation to be considered for attendance. Our final wave of invitations will begin in mid-January.
Our 2026 speaker lineup brings together a diverse group of C-suite executives, policymakers, and industry thought leaders—ensuring every session delivers candid, high-value insights you won’t hear anywhere else.
WHO SHOULD ATTEND
DCLF is a strategic, invite-only gathering for leaders from across the healthcare and pharmaceutical landscape, including:
To maintain the event’s strategic focus, attendance from industry suppliers (e.g., technology, consulting, financial services, etc.) is available only through sponsorship. Each sponsorship level includes a limited number of attendee badges, ensuring a highly curated and balanced group of participants.
WHAT TO EXPECT
Expect another year of bold, candid discussions—this is not a conference of scripted presentations. We’ve enhanced the 2026 agenda with new formats and even more opportunities for direct, high-impact exchanges among attendees.
At DCLF, there are no exhibit halls, no press, no recordings, and no distractions—just substance and strategy.
You can expect:
Provocative panels with C-suite executives
Off-the-record insights and open Q&A sessions
Meaningful peer-to-peer dialogue in an intimate setting
If you want to be in the room where it happens, there’s no substitute for being there in person.
As always, thank you for welcoming Drug Channels into your inboxes, browsers, and apps. I’m continually inspired by the diverse and thoughtful people who follow, share, and challenge our work. Our DCI community now includes more than 110,000 subscribers and followers across the industry. If you haven't already done so, you can stay connected by signing up for an email subscription or following me on LinkedIn.
We loved bringing you our analysis and curated links throughout 2025, and we hope you enjoyed engaging with us—and with one another—across the DCI community.
Stay tuned! In addition to our second Drug Channels Leadership Forum, we have several exciting announcements coming your way in 2026.
Wishing you and your family health and happiness,
Adam and the DCI team
Whoa. The 340B Drug Pricing Program has once again given new meaning to the word “skyrocketing.”
For 2024, discounted purchases under the 340B program reached a record $81.4 billion—an astounding $15.1 billion (+23%) higher than 2023. The gross-to-net difference between list prices and discounted 340B purchases—a proxy for funds available to covered entities—also grew, to $66.4 billion (+$6.0 billion). Hospitals again accounted for 87% of 340B purchases.
How big is the program? 340B purchases are now more than 50% larger than Medicaid’s net prescription drug spending. The program now accounts for nearly one-fifth of the total U.S. gross-to-net bubble.
But thanks to the Inflation Reduction Act (IRA), 340B’s day of reckoning is coming soon. I expect 2026 to be the first year of structural 340B pressure as the Centers for Medicare & Medicaid Services (CMS) continues its regulatory takeover of the 340B program. What’s more, I expect the program’s out-of-control growth rate to slow and for some long-overdue transparency to enter this notoriously opaque program.
Read on for our full analysis—and why the 340B swell may finally be breaking.
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Drug Channels outlook 2026. I'll be discussing why and how the gross-to-net bubble will be deflating.
Is the gross-to-net bubble—the ever-widening gap between brand-name drug sales at list prices and their net revenues after rebates and discounts—finally beginning to deflate?
Drug Channels Institute (DCI) estimates that the gross-to-net reductions for all brand-name drugs reached $356 billion in 2024, a 7% increase over the previous year. Yet despite this record total, the bubble expanded at the slowest rate in at least a decade.
In our analysis below, we highlight five key forces driving this shift. Among them: manufacturers’ evolving market access strategies, which increasingly aim to offset—or circumvent—growing pricing pressure from both commercial and government payers.
Meanwhile, many patients remain adrift in the drug channel’s murky waters. As for SpongeBob SquarePants—the longtime mascot of the gross-to-net bubble here at Drug Channels—he’s still with us…but may be eyeing the exit.
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.
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This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: 
This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: 