Adam J. Fein

𝐃𝐫𝐮𝐠 𝐂𝐡𝐚𝐧𝐧𝐞𝐥𝐬 𝐍𝐞𝐰𝐬 𝐑𝐨𝐮𝐧𝐝𝐮𝐩, 𝐉𝐮𝐧𝐞 2026 Happy 250th birthday, America! Before you launch your semiquincentennial festivities, Drug Channels offers some fireworks of our own: • The PBM Shakeout Is Gaining Momentum • #340B: From Opacity and Expansion to Transparency and Accountability • Why Do Many Employers Say They Don’t Receive 100% Of Their #PBM Rebates? • Mark Cuban @mcuban Wins the Generic Price War (Again) Plus: Congratulations to @GeBaiDC on her nomination! All the details: 👇 drugch.nl/4p1ngxJ

From BlinkRx: 𝗕𝗹𝗶𝗻𝗸𝗥𝘅 𝗜𝗻𝘀𝗶𝗴𝗵𝘁𝘀: 𝗧𝗵𝗲 𝗤𝘂𝗲𝘀𝘁𝗶𝗼𝗻𝘀 𝗠𝗮𝗻𝘂𝗳𝗮𝗰𝘁𝘂𝗿𝗲𝗿𝘀 𝗪𝗶𝘀𝗵 𝗧𝗵𝗲𝘆 𝗛𝗮𝗱 𝗔𝘀𝗸𝗲𝗱 𝗕𝗲𝗳𝗼𝗿𝗲 𝗦𝗲𝗹𝗲𝗰𝘁𝗶𝗻𝗴 𝗮 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗦𝗲𝗿𝘃𝗶𝗰𝗲𝘀 𝗣𝗮𝗿𝘁𝗻𝗲𝗿 Learn more about BlinkRx's patient services solution: drugch.nl/4vUurtH Read the article: drugch.nl/4vveNVR #sponsored

𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐬𝐭 𝐒𝐚𝐥𝐚𝐫𝐢𝐞𝐬 𝐚𝐧𝐝 𝐄𝐦𝐩𝐥𝐨𝐲𝐦𝐞𝐧𝐭 𝐢𝐧 2025: 𝐑𝐞𝐭𝐚𝐢𝐥 𝐃𝐞𝐜𝐥𝐢𝐧𝐞𝐬, 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥 𝐆𝐚𝐢𝐧𝐬 Retail pharmacist employment fell by another 8,200 positions in 2025, bringing employment to its lowest level since DCI began tracking these data in 2010. Meanwhile, hospitals added 3,000 pharmacist jobs and now employ nearly one-third of all practicing pharmacists. The pharmacist workforce continues to shift away from retail and toward hospitals and other clinical settings. Our annual analysis of pharmacist salaries and employment trends is now available on Drug Channels. 👇 drugch.nl/4emPQEI

𝐓𝐡𝐞 𝐏𝐁𝐌 𝐒𝐡𝐚𝐤𝐞𝐨𝐮𝐭 𝐢𝐬 𝐆𝐚𝐢𝐧𝐢𝐧𝐠 𝐌𝐨𝐦𝐞𝐧𝐭𝐮𝐦 Abarca Health and LucyRx just announced their merger. As we discussed in our April webinar, the PBM market is entering a significant consolidation phase. LucyRx has already acquired two smaller competitors in 2024 and 2025. Many smaller PBMs still rely on the Big Three PBMs for critical infrastructure, including claims processing, pharmacy networks, rebate administration, and other core services. At the same time, the growing complexity of state and federal regulation is creating additional operational and compliance burdens. Thanks, CAA! 🙃 Those costs will fall most heavily on smaller PBMs that lack the scale, capital resources, and integrated capabilities of the industry's largest players. Meanwhile, transparency is becoming less of a differentiator. Or, as Syndrome put it in The Incredibles: “When everyone’s super, no one will be.” The result? More pressure on smaller PBMs and, likely, more consolidation across the sector. Here's the announcement: drugch.nl/4uFZJDG

From @InizioEngage: 𝐓𝐡𝐞 𝐃𝐢𝐠𝐢𝐭𝐚𝐥 𝐅𝐫𝐨𝐧𝐭 𝐃𝐨𝐨𝐫 𝐭𝐨 𝐒𝐩𝐞𝐜𝐢𝐚𝐥𝐭𝐲 𝐓𝐡𝐞𝐫𝐚𝐩𝐲 𝐌𝐚𝐲 𝐍𝐨𝐭 𝐁𝐞 𝐚 𝐒𝐩𝐞𝐜𝐢𝐚𝐥𝐭𝐲 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 Learn more about Inizio Engage’s hub services: drugch.nl/4uS5bEn Read the article: drugch.nl/4vInyf8 #sponsored

340𝐁: 𝐅𝐫𝐨𝐦 𝐄𝐱𝐩𝐚𝐧𝐬𝐢𝐨𝐧 𝐚𝐧𝐝 𝐎𝐩𝐚𝐜𝐢𝐭𝐲 𝐭𝐨 𝐓𝐫𝐚𝐧𝐬𝐩𝐚𝐫𝐞𝐧𝐜𝐲 𝐚𝐧𝐝 𝐀𝐜𝐜𝐨𝐮𝐧𝐭𝐚𝐛𝐢𝐥𝐢𝐭𝐲 Will Newton at @340B_Report wrote an excellent summary of DCI's recent webinar on the evolving 340B landscape. Manufacturers increasingly face the risk of triplicate discounts on the same prescription: an upfront 340B discount, an IRA Maximum Fair Price (MFP) refund, and a Medicaid rebate paid to states. During the webinar, I shared several predictions: • The Inflation Reduction Act (IRA) will accelerate efforts to increase visibility into 340B claims and transactions. • CMS and the courts—not Congress—will continue to drive many of the most significant changes to the 340B program. • The Net Pricing Drug Channel (#NPDC) will reduce 340B margins for covered entities and lower fee opportunities for contract pharmacies. • Plan sponsors will intensify efforts to stop rebate losses from 340B contract pharmacy claims. Which of these developments do you think will have the biggest impact on the future of 340B? Read Will's full article: drugch.nl/4aEnGnJ Watch the webinar replay: drugch.nl/june2026

Check out this new Drug Channels article from Bryce Platt. He analyzes one of the many unintended consequences and tradeoffs behind the IRA's Part D redesign. Full article: drugch.nl/4ewatP5

𝐖𝐡𝐲 𝐃𝐨 𝐌𝐚𝐧𝐲 𝐄𝐦𝐩𝐥𝐨𝐲𝐞𝐫𝐬 𝐒𝐚𝐲 𝐓𝐡𝐞𝐲 𝐃𝐨𝐧’𝐭 𝐑𝐞𝐜𝐞𝐢𝐯𝐞 100% 𝐨𝐟 𝐓𝐡𝐞𝐢𝐫 𝐏𝐁𝐌 𝐑𝐞𝐛𝐚𝐭𝐞𝐬? A persistent puzzle in the pharmacy benefit world surfaced again in @psgconsults latest benefit design reports. PBMs frequently state that they pass through 95%+ of manufacturer rebates to their employer clients. Yet employer surveys tell a different story. According to PSG: 📊 Traditional drugs • 66% of employers report receiving 100% of rebates • 34% use other arrangements 📊 Specialty drugs • Only 54% report receiving 100% of rebates • Nearly half use alternative rebate structures What's striking is that we've seen similar results for many years. So what's behind the disconnect? • Are employers defining "100% of rebates" differently than PBMs? • Do guaranteed rebate arrangements create confusion about what is actually being passed through? • Will the Consolidated Appropriations Act's transparency requirements narrow this perception gap? Or is something else going on? 🤔 Download the complete reports: 📘 Trends in Drug Benefit Design Report drugch.nl/4v57nsc 📘 Trends in Specialty Drug Benefits Report drugch.nl/4vM8zRw #PBM #DrugChannels #DrugBenefits #HealthBenefits #SpecialtyPharmacy #EmployerBenefits #HealthcareTransparency

𝐓𝐡𝐞 𝐓𝐨𝐩 15 𝐒𝐩𝐞𝐜𝐢𝐚𝐥𝐭𝐲 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐨𝐟 2025: 𝐏𝐁𝐌-𝐀𝐟𝐟𝐢𝐥𝐢𝐚𝐭𝐞𝐝 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐃𝐨𝐦𝐢𝐧𝐚𝐭𝐞 𝐖𝐡𝐢𝐥𝐞 𝐇𝐞𝐚𝐥𝐭𝐡 𝐒𝐲𝐬𝐭𝐞𝐦𝐬 𝐚𝐧𝐝 𝐈𝐧𝐝𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐭𝐬 𝐆𝐚𝐢𝐧 𝐆𝐫𝐨𝐮𝐧𝐝 (rerun) Three companies now account for two-thirds of specialty pharmacy revenues. Drug Channels Institute’s latest analysis shows that PBM-affiliated specialty pharmacies remain firmly in control—but the market is shifting at the margins: • Health systems are expanding rapidly • A handful of independents are outperforming • Traditional retail players are losing share What’s driving these changes—and where is the market headed next? We break it all down here 👇 drugch.nl/4uliNqM #SpecialtyPharmacy #PBM #Healthcare #DrugChannels #Pharmacy

𝐌𝐚𝐩𝐩𝐢𝐧𝐠 𝐕𝐞𝐫𝐭𝐢𝐜𝐚𝐥 𝐈𝐧𝐭𝐞𝐠𝐫𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐔.𝐒. 𝐃𝐫𝐮𝐠 𝐂𝐡𝐚𝐧𝐧𝐞𝐥𝐬: 𝐃𝐂𝐈’𝐬 2026 𝐔𝐩𝐝𝐚𝐭𝐞 The biggest companies in the U.S. drug channel have spent years building sprawling, vertically integrated empires. But some are starting to unwind them. DCI’s latest update maps the shifting connections across insurers, PBMs, specialty pharmacies, and healthcare services—and reveals who’s still doubling down and who is changing course. 👉 Where integration is expanding 👉 Where it’s quietly retreating 👉 How these shifts affect access, dispensing, and profits See the full analysis (and the complete chart): 👇 drugch.nl/4vvCg8Z

𝐓𝐡𝐞 𝐓𝐨𝐩 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐁𝐞𝐧𝐞𝐟𝐢𝐭 𝐌𝐚𝐧𝐚𝐠𝐞𝐫𝐬 𝐨𝐟 2025: 𝐌𝐚𝐫𝐤𝐞𝐭 𝐒𝐡𝐚𝐫𝐞 𝐚𝐧𝐝 𝐊𝐞𝐲 𝐈𝐧𝐝𝐮𝐬𝐭𝐫𝐲 𝐃𝐞𝐯𝐞𝐥𝐨𝐩𝐦𝐞𝐧𝐭𝐬 (rerun) For 2025, 80% of all equivalent prescription claims were processed by just three companies: • CVS Caremark (CVS Health) • Express Scripts Pharmacy Benefit Services (The Cigna Group) • Optum Rx (UnitedHealth Group) The Big Three still dominate, but the story is more complicated than the headline. Independent PBMs are gaining traction. But even when they win, the Big Three may still profit. Meanwhile, the emerging Net Pricing Drug Channel #NPDC is reshaping how the large PBMs generate profits, structure contracts, and justify their role. Read DCI's full analysis 👇 drugch.nl/4vvAnsX

𝐓𝐡𝐞 𝐓𝐨𝐩 15 𝐔.𝐒. 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐨𝐟 2025: 𝐌𝐚𝐫𝐤𝐞𝐭 𝐒𝐡𝐚𝐫𝐞𝐬 𝐚𝐧𝐝 𝐑𝐞𝐯𝐞𝐧𝐮𝐞𝐬 𝐚𝐭 𝐭𝐡𝐞 𝐁𝐢𝐠𝐠𝐞𝐬𝐭 𝐂𝐡𝐚𝐢𝐧𝐬, 𝐏𝐁𝐌𝐬, 𝐚𝐧𝐝 𝐒𝐩𝐞𝐜𝐢𝐚𝐥𝐭𝐲 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 (rerun) From Drug Channels Institute's 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers: • Total prescription dispensing revenues reached $751 billion in 2025, up 10% vs. 2024. • The top 15 organizations captured nearly three-quarters of total revenues. • The four largest players account for more than half of the U.S. market. • GLP-1 drugs continue to reshape revenue mix and competitive positioning. • Vertically integrated insurer-PBM-pharmacy models are strengthening their dominance. The chart shows who made the list—and how specialty and mail pharmacy revenues are driving the story. Read the full breakdown 👇 drugch.nl/43nb1Sd #pharmacy #PBM #healthcare #drugpricing #specialtypharmacy #healthpolicy

From @RISRxInc: 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐂𝐨𝐩𝐚𝐲 𝐌𝐢𝐬𝐮𝐬𝐞: 𝐓𝐡𝐞 𝐌𝐮𝐥𝐭𝐢-𝐁𝐢𝐥𝐥𝐢𝐨𝐧 𝐃𝐨𝐥𝐥𝐚𝐫 𝐈𝐬𝐬𝐮𝐞 𝐇𝐢𝐝𝐢𝐧𝐠 𝐈𝐧 𝐏𝐥𝐚𝐢𝐧 𝐒𝐢𝐠𝐡𝐭 Request a complimentary analysis from RIS Rx: drugch.nl/49kWbz6 Read the article: drugch.nl/4o4sFDO #sponsored

𝐍𝐞𝐱𝐭 𝐅𝐫𝐢𝐝𝐚𝐲: 𝐃𝐫𝐮𝐠 𝐂𝐡𝐚𝐧𝐧𝐞𝐥𝐬 340𝐁 𝐈𝐧𝐝𝐮𝐬𝐭𝐫𝐲 𝐔𝐩𝐝𝐚𝐭𝐞 2026 The 340B program is at a crossroads. Legal battles. Contract pharmacy restrictions. Rebate-model proposals. Expanding state legislation. New scrutiny of program economics. Taken together, these developments are reshaping one of the most influential—and controversial—parts of the U.S. drug channel. Next Friday, my colleague Tyler Novotny and I will present a live Drug Channels Institute webinar examining what these changes mean for manufacturers, covered entities, pharmacies, PBMs, employers, and other stakeholders. We'll discuss: • Will a 340B rebate model become reality? • How the Net Pricing Drug Channel could reshape 340B economics • The legal, regulatory, and legislative battles reshaping 340B • Exclusive DCI data on the contract pharmacy marketplace and its leading participants • How manufacturers are responding to the changing economics of 340B • What comes next for 340B——and the stakeholders most likely to benefit or be affected If your organization is affected by 340B, this session will help you understand what's changing, why it matters, and what may happen next. 📅 Friday, June 12 🕛 12:00 p.m. – 1:30 p.m. ET Register here: drugch.nl/june2026 P.S. Can't attend live? Every registrant receives access to the full replay and slide deck. #340B #DrugChannels #Healthcare #Pharmacy #PBM #HealthcarePolicy

Like it or not, the Inflation Reduction Act (IRA) is forcing unprecedented visibility into the 340B program. @edsilverman of @statnews broke the story that @EliLillyandCo is requiring #340B hospitals to submit claims data or lose access to 340B discounts. As I told Ed, this is a predictable consequence of the IRA's drug pricing provisions. The law created new pricing obligations for manufacturers, but policymakers never established a reliable way to identify which claims qualify for 340B pricing. Here's the relevant section from his article: "The issue has intensified thanks to the Inflation Reduction Act, which imposes a maximum fair price on drugs paid for by Medicare and obligates drugmakers to pay added inflation rebates in Medicare. But the requirement overlaps with the 340B program. Why? Drugmakers must offer hospitals the lower of the maximum fair price or the 340B price — and pay inflation rebates only on drugs not sold at the 340B price. 'The Inflation Reduction Act is forcing transparency into the notoriously opaque 340B program,' said Adam Fein, who heads the Drug Channels Institute and tracks prescription drug pricing and insurance coverage. 'The IRA’s maximum fair price requirements make it impossible to ignore the long-standing lack of visibility into 340B claims.' He noted, however, that the federal government has not created a mechanism to identify 340B claims, and the HRSA maintains that it lacks the authority to do so. 'The result is a growing compliance dilemma that Congress never intended and regulators have yet to resolve,' he said." Full article: drugch.nl/3RG15Rb

Congratulations to @GeBaiDC on her nomination to be Assistant Secretary of U.S. Department of Health and Human Services. Ge is exceptionally knowledgeable, thoughtful, and dedicated to improving healthcare. She would be a tremendous asset in this important leadership position. drugch.nl/4dTBUC4

𝐓𝐡𝐞 340𝐁 𝐂𝐨𝐧𝐭𝐫𝐚𝐜𝐭 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐌𝐚𝐫𝐤𝐞𝐭 𝐢𝐧 2026: 𝐀 𝐌𝐚𝐭𝐮𝐫𝐢𝐧𝐠 𝐈𝐧𝐝𝐮𝐬𝐭𝐫𝐲 𝐃𝐨𝐦𝐢𝐧𝐚𝐭𝐞𝐝 𝐛𝐲 𝐁𝐢𝐠 𝐂𝐡𝐚𝐢𝐧𝐬 𝐚𝐧𝐝 𝐏𝐁𝐌𝐬 The 340B program was created in 1992 as a narrow policy solution to address an unintended consequence of Medicaid’s best-price provision while supporting core safety-net providers. But Drug Channels Institute's latest exclusive analysis of the 340B contract pharmacy market shows just how dramatically the program’s current operations and economic incentives have diverged from that original intent. In 2026, five publicly traded mega-corporations—Cigna, CVS Health, UnitedHealth Group, Walgreens, and Walmart—are capturing 77% of all 340B contract pharmacy relationships. For the full 2026 market breakdown—including which companies are winning and how the market keeps consolidating—read our latest analysis on Drug Channels: 👇 drugch.nl/4nYd6NT

From @Kalderos: 𝐃𝐫𝐮𝐠𝐬, 𝐃𝐢𝐬𝐜𝐨𝐮𝐧𝐭𝐬 𝐚𝐧𝐝 𝐃𝐚𝐭𝐚: 𝐂𝐫𝐚𝐟𝐭𝐢𝐧𝐠 𝐒𝐮𝐬𝐭𝐚𝐢𝐧𝐚𝐛𝐢𝐥𝐢𝐭𝐲 𝐢𝐧 𝐚𝐧 𝐈𝐦𝐩𝐞𝐫𝐟𝐞𝐜𝐭 𝐒𝐲𝐬𝐭𝐞𝐦 Register for "GTN Oversight: A New Standard of Transparency Is Here" (free 6/23 webinar): drugch.nl/4wPLO0a Read the article: drugch.nl/431OVEI #sponsored

@SBlake2000 @costplusdrugs @AnnalsofIM Apologies for a small typo. It should read "less than 15%." See table from the paper.

@DrugChannels @costplusdrugs @AnnalsofIM Great post. Question: when you say that 5% of generic prescriptions had an OOP of less than $15 -- does that reference the type/name of the drugs, or the proportion of people on them?

𝐌𝐚𝐫𝐤 𝐂𝐮𝐛𝐚𝐧 𝐖𝐢𝐧𝐬 𝐭𝐡𝐞 𝐆𝐞𝐧𝐞𝐫𝐢𝐜 𝐏𝐫𝐢𝐜𝐞 𝐖𝐚𝐫 (𝐀𝐠𝐚𝐢𝐧) 🏆 For a surprising number of generic drugs, paying cash through @costplusdrugs can be dramatically cheaper than using commercial insurance: A new article from @AnnalsofIM found: • For generic prescriptions with out-of-pocket costs above $15, nearly 80% would have been cheaper through Cost Plus Drugs. • For prescriptions with cost sharing above $100, the median patient cost dropped from $140 through insurance to just $25 through Cost Plus. Affordability directly impacts adherence and outcomes. Unfortunately, the warped incentives of the U.S. drug channel mean that many insured patients pay MORE than transparent cash pricing. Small caveat: Less than 5% of generic prescriptions had OOP<$15. Nonetheless, another reminder from Mark Cuban @mcuban that complexity is the enemy of low costs and efficiency. Full article 👇 drugch.nl/3PFwiDs