I'm pausing BlueSky posting until further notice. Find me on LinkedIn for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community. drugch.nl/AJF-LinkedIn

Here's a brief video recap of the inaugural Drug Channels Leadership Forum. #DCLF2025 See you again in March 2026! youtu.be/c-adcFF-eKM?...

Anti-accumulator impact accelerates: Per Avalere 16% of U.S. commercial lives (31 million people) now subject to the 21 state laws that ban #copay #accumulators. ==> drugch.nl/4bHgOoS

Good read on the shifting Medicare Part D landscape. That said, the headline might be a little too optimistic. Even with the broader Medicare Advantage slowdown, MA-PD plans are still growing faster than stand-alone PDPs. drugch.nl/4iHbHra (no paywall)

Hmm. "FTC turmoil raises #PBM probe questions" Source: Politico drugch.nl/4kOAzPK

NOW AVAILABLE: The 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers #PBMs Full details ==> drugch.nl/pharmacy 12 chapters, 540+ pages, 268 exhibits, ~1,200 endnotes: Nothing else comes close! *** Special discounts thru 3/31/25***

NOW AVAILABLE: 𝐓𝐡𝐞 2025 𝐄𝐜𝐨𝐧𝐨𝐦𝐢𝐜 𝐑𝐞𝐩𝐨𝐫𝐭 𝐨𝐧 𝐔.𝐒. 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐚𝐧𝐝 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐁𝐞𝐧𝐞𝐟𝐢𝐭 𝐌𝐚𝐧𝐚𝐠𝐞𝐫𝐬 #𝐏𝐁𝐌𝐬 12 chapters, 540+ pages, 268 exhibits, ~1,200 endnotes: Nothing else comes close! ==> drugch.nl/pharmacy ** Special discounts thru 3/31/25**

Hello, #Miami! Drug Channels Institute has landed at the Drug Channels Leadership Forum #DCLF2025. Paula and I look forward to learning and connecting with new and old friends.

ICYMI: CVS Health $CVS is launching small-format #pharmacies (drugch.nl/3DDd0sa). Why? - Prescriptions now dominate retail #pharmacy revenue (GLP-1s=90% via retail) - Front-End Decline: Walmart, Target, and Amazon have eroded sales. (Locking up products hasn’t helped!) Chart via drugch.nl/pharmacy

Positively shocking! Joe Walker WSJ exposes how small #PBMs and certain start-ups are enabling for-profit employers to grab #340B discounts. As one pundit noted: "It's a blatant abuse of the 340B program." The 340B loopholes just keep expanding... www.wsj.com/health/healt... (no paywall link)

Competition Wins Again Over Price Controls: #Stelara biosimilars are launching with list prices 80%+ lower than reference product. IRA's "maximum fair price" #MFP only offers a 66% discount off WAC. Biosimilars arrived will save money vs. gov't "negotiated" price. Source: Bourgoin Insights Group

Stelara #biosimilar price war update: Teva's Anda will sell #biosimilar to Navitus Health Solutions #PBM for 96% off WAC of reference product. Humira was just the warm up. Look out below! drugch.nl/43Hdd8o

Battle of the billionaires: Should we fix U.S. #healthcare with Mark Cuban's free market approach or John Arnold's top-down central planning? Or both? Fascinating debate. Wish I could have been there to witness this conversation! buff.ly/THbaPrs @mcuban.bsky.social @johnarnoldfndtn.bsky.social

𝐓𝐡𝐞 𝐓𝐨𝐩 15 𝐔.𝐒. 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐨𝐟 2024: 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. Read more: drugch.nl/3DmHdvI

Hmm. Per Doug Hoey NCPA , the "glaring flaws in the Medicare Drug Price Negotiation Program" will financially hurt small #pharmacies, while mandating that "independent pharmacies serving Medicare Part D patients participate, even if doing so drives them out of business." Thanks, IRA!

Neat analysis from IQVIA Institute for Human Data Science: More restrictive #pharmacist authority to vaccinate ==> fewer vaccinations Full report: buff.ly/4bkbpUy

Deductible realities: A patient with a deductible funds the entire drug channel, while her "insurance" collects money. No wonder patient-paid prescriptions (cash-pay & disocnt cards) continue to grow. Source: Follow The Dollar report from PhRMA buff.ly/K78g33M

Another scoop: @bobjherman.bsky.social confirms UnitedHealth Group's $UNH rumored acquistion of CPS (which helps #340B #hospitals set up specialty #pharmacies). UNH also bought PharmScript, a long-term-care pharmacy. Bob has become the #1 reporter covering UNH. 👏👏👏 buff.ly/QKF9ITj

Per new American Medical Association prior authorization (PA) survey: Patient pay out of pocket for #prescriptions while fighting with #insurers. Good news for discount cards and cash-pay #pharmacies? Also: MDs still dislike #PAs & think they hurt patients.

Follow the dollars! #BecauseOf340B, Lantus #340B utilization dropped when Sanofi cut its price by 78%, while demand for high-list Toujeo U-300 grew. "Clearly, 340B profit margins are influencing hospital formularies and prescribing decisions." 🤑 buff.ly/haxKv2d

𝐓𝐫𝐚𝐧𝐬𝐩𝐚𝐫𝐞𝐧𝐜𝐲 𝐯𝐬. 𝐑𝐞𝐚𝐥𝐢𝐭𝐲: 𝐓𝐫𝐨𝐮𝐛𝐥𝐢𝐧𝐠 𝐋𝐞𝐬𝐬𝐨𝐧𝐬 𝐟𝐫𝐨𝐦 𝐏𝐁𝐌 𝐃𝐢𝐬𝐜𝐥𝐨𝐬𝐮𝐫𝐞 𝐋𝐚𝐰𝐬 drugch.nl/3F5F9bS Mandated disclosures about #PBM economics have yielded little actionable, reliable data. Should we continue down the path of gov't-mandated reporting, or should plan sponsors be left to negotiate their own deals?

I'm proud to announce DCI's new live video webinar: #𝐏𝐁𝐌 𝐈𝐧𝐝𝐮𝐬𝐭𝐫𝐲 𝐔𝐩𝐝𝐚𝐭𝐞: 𝐓𝐫𝐞𝐧𝐝𝐬, 𝐂𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞𝐬, 𝐚𝐧𝐝 𝐖𝐡𝐚𝐭'𝐬 𝐀𝐡𝐞𝐚𝐝 Friday, April 4, 2025 | p.m. to p.m. ET Register: drugch.nl/april2025

Insightful: Deborah Williams and Anthony DiGiorgio argue that #340B's warped incentives shift oncology practices toward higher-cost hospital settings, crowd out private payer discounts & rebates, & raises #healthcare costs for private payers. Source: Journal of Clinical Pathways buff.ly/3Xf11ru

Good point from Association for Accessible Medicines: #IRA negotiations target brand-name #drugs that have #generic or #biosimilar competitors already approved or seeking approval by FDA. Like it or not, #IRA will alter future investment incentives for such products. ==> buff.ly/4igxHsF

FYI: #GrossToNetBubble is alive and well. Here are UCB #drug pricing for 2024: List prices: +5.0% Net prices: -7.8% Avg. reduction from list price: -54.1% #DPFE #facts buff.ly/3EQGG5l

FYI: #GrossToNetBubble is alive and well. Here are UCB #drug pricing for 2024: List prices: +5.0% Net prices: -7.8% Avg. reduction from list price: -54.1% #DPFE #facts buff.ly/3EQGG5l

ICYMI: Blue Shield of California's unbundled #PBM model promised "$500 million in medication savings.” New caveat: It "won’t always mean lower prices for each specific #prescription #drug." Sorry, your $1 Rx may now cost $15. 👇Complexity is the enemy of low costs and efficiency! drugch.nl/41CjsZI

Available for preorder: 𝐓𝐡𝐞 2025 𝐄𝐜𝐨𝐧𝐨𝐦𝐢𝐜 𝐑𝐞𝐩𝐨𝐫𝐭 𝐨𝐧 𝐔.𝐒. 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐚𝐧𝐝 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐁𝐞𝐧𝐞𝐟𝐢𝐭 𝐌𝐚𝐧𝐚𝐠𝐞𝐫𝐬 12 chapters, 560+ pages, 267 exhibits, ~1,200 endnotes 👇 Free 30-page overview: drugch.nl/2025overview Full details: drugch.nl/pharmacy *** Special preorder discounts ***

Warped incentives update: Stelara #biosimilars launching at deeply discounted WAC list prices. Will plan sponsors pop the #GrossToNetBubble and adopt? More #PBM private labels coming soon...or maybe not given JNJ/Samsung lawsuit? Source: drugch.nl/3Xkbi5Q

Drug Channels News Roundup, February 2025: - Part D vs. #Pharmacies - #Accumulator Madness - #Wholesaler Vertical Integration - #IRA vs. #physicians - A #340B Cartoon ==>

Even Optum Rx $UNH admits it: "Utilization, not price, is the leading driver of specialty spending." Ergo, controlling "drug spending" means limiting usage of beneficial #drugs that treat small patient populations. Source: OptumRx's #PBM history

An illuminating and humorous overview of #340B #Drug #Pricing Program from Preston Alexander. Worth reading.

Nice roundup of #PBM formularies and coverage of #Humira #biosimilars in 2024 vs. 2025. Source: AIS Health

𝐄𝐱𝐜𝐢𝐭𝐢𝐧𝐠 𝐔𝐩𝐝𝐚𝐭𝐞: 𝐄𝐱𝐭𝐫𝐚 𝐒𝐩𝐚𝐜𝐞𝐬 𝐍𝐨𝐰 𝐎𝐩𝐞𝐧 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐃𝐫𝐮𝐠 𝐂𝐡𝐚𝐧𝐧𝐞𝐥𝐬 𝐋𝐞𝐚𝐝𝐞𝐫𝐬𝐡𝐢𝐩 𝐅𝐨𝐫𝐮𝐦 Due to an overwhelming response, we've expanded our meeting space. To secure your spot, you'll need to request an invitation and receive approval. ==> drugch.nl/DCLF

Via @Avalere: #Medicare Part D Coverage of MS Drugs Declined in 2025. PDPs have worse coverage than MA-PD plans, esp. for brand-name drugs w/o generics. Thanks, #IRA! Source: https://buff.ly/3ELTGsZ

Interesting GAO review of TRICARE #pharmacy network (managed by Express Scripts $CI). - About 15K independent #pharmacies left network in 2022. Fewer than 6K rejoined. - 98% of beneficiaries still w/in 15 minute drive of network pharmacy Source: https://buff.ly/4b59OBR

Thought-provoking interview with Rep. Jake Auchincloss, who has dug further into #healthcare, Baumol’s cost disease, and #PBMs than most others in Congress. ==> https://buff.ly/4i2REmu <== FWIW, I find the term "middleman" to be needlessly pejorative and therefore unhelpful.

𝐕𝐚𝐧𝐢𝐬𝐡𝐢𝐧𝐠 𝐀𝐜𝐭: 𝐖𝐡𝐲 𝐒𝐦𝐚𝐥𝐥 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐄𝐱𝐢𝐭𝐞𝐝 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐏𝐚𝐫𝐭 𝐃 𝐍𝐞𝐭𝐰𝐨𝐫𝐤𝐬 𝐟𝐨𝐫 2025 DCI's exclusive analysis of how smaller pharmacies are participating via their pharmacy services administrative organizations #PSAOs drugch.nl/3D7EaXT

Surprise? PDPs use coinsurance more than MA-PD plans for high-list, high-rebate #GrossToNetBubble products. Result: Seniors pay a big share of net prices for so-called "preferred" #drugs. Luckily, #IRA is tanking the PDP market 😑 Source: https://buff.ly/435aCoi

Worth reading: Sayeh Nikpay and her colleagues review Minnesota's #340B reporting law. They also succinctly explain why transparency is needed for this out-of-control program. Source: JAMA Health Forum https://buff.ly/4jYb2TH (ICYMI, my $0.02 on MN report here: https://buff.ly/41iV8vY)

Outstanding #340B op-ed from William Sarraille: "[A]fter three decades in which struggling, financially needy patients have been increasingly ignored, we can refocus this program on what matters – the patient." 👏 👏 👏

Ugh. Many patient unfriendly plans on ACA marketplaces: - 40% of plans (39 states) have copay accumulators - Many plans didn't put plan documents online during open enrollment - Many plans don't comply w/state laws restricting accumulators (!) Source: The AIDS Institute drugch.nl/3CMkhpi

𝐖𝐡𝐲 𝐏𝐥𝐚𝐧 𝐒𝐩𝐨𝐧𝐬𝐨𝐫𝐬 𝐚𝐧𝐝 𝐏𝐁𝐌𝐬 𝐀𝐫𝐞 𝐒𝐭𝐢𝐥𝐥 𝐅𝐚𝐥𝐥𝐢𝐧𝐠 𝐇𝐚𝐫𝐝 𝐟𝐨𝐫 𝐂𝐨𝐩𝐚𝐲 𝐌𝐚𝐱𝐢𝐦𝐢𝐳𝐞𝐫𝐬 drugch.nl/42QGOM6 h/t MMITNetwork

Removing #pharmacy #DIR reduced #pharmacy reimbursement by -1.6%, while expanding AWP-to-gross-prescription-cost spread. Looks like Part D plans reduced pharmacy reimbursement to offset loss of post-sales rebates from pharmacies to plans. Source: Milliman https://buff.ly/3Q7OHFE

Watch out! The #IRA will crush buy-and-bill margins for #physicians. Per Avalere, ASP widely used by comm'l plans, but will be cut by MFPs. I guess manufacturers will be expected to shovel money into buy-and bill market to keep providers viable. ==>

Go birds! 🦅

Uh oh. Many biologic #drugs that will lose patent protection will have no #biosimilars in the development pipeline. Greatest risk for biologics with low sales. My $0.02: #IRA uncertainty doesn't help! Source: @IQVIA https://buff.ly/4hmLUUL

Interesting: Study of #oncology #drugs finds that Medicare Advantage "may reduce the use of high-cost drugs when there is an interchangeable alternative to more expensive option." Note diff btw colorectal vs. NSCLC (fewer low-cost options) Source: JAMA Health Forum https://buff.ly/4jB1HBb

Econ 101: Fresh evidence that hospital consolidation raises healthcare costs. Healthcare prices are higher vs. Medicare when (1) hospitals are larger and consolidated and (2) insurers are smaller and fragmented. Source: Health Affairs https://buff.ly/3ClWcWe

Some people have asked for a standalone graphic of vertical integration by the Big Three pharmaceutical wholesalers. Here you go! Source: https://buff.ly/4hGtyxL