Brand drug list prices rose 3.7% in 2025, but net prices fell 1.8%. The GTN bubble is estimated to be $416 billion for 2025. --- We’re revisiting Adam Fein's analysis this week as we put the finishing touches on the 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Grab your copy here! drugch.nl/wholesale --- Adam breaks down gross-to-net pricing trends across eight large brand-name manufacturers for 2025 in the blog rerun this morning. Nearly every manufacturer in this analysis had net price growth at or below U.S. consumer inflation of 2.6%. Among the three manufacturers that disclosed average discount data, the average reduction from list price was 51.7%. The gross-to-net bubble is still expanding, but at its slowest rate on record. Sanofi's numbers are particularly insightful as the most detailed and show the beginning of the Net Pricing Drug Channel (#NPDC). Read the full analysis here 👉🏻 drugch.nl/3TIjC0n

DCLF 2027 brings senior drug channel leaders together for candid conversations on: • Policy, pricing & reform • Emerging business models • Affordability, economics & cross-channel alignment 📍 Miami | March 15–17 Request an invitation:hmp-global.swoogo.com/dclf27 #DCLF2027

I’m speaking at AVBCC tomorrow in NYC, so let's consider how oncology reimbursement would work on the NBA champs' basketball court. 🏀 --- What if the New York Knicks were paid like oncologists? The basketballs could become a pretty lucrative part of the business... 🏀 Paid to shoot. Under fee-for-service, delivering a treatment generates payment even if it doesn’t produce the hoped-for outcome. 💰 Upgrade the basketball. When drug reimbursement includes a percentage-based add-on, a higher-priced drug can generate a larger dollar add-on. Medicare generally pays ASP + 6% for most separately payable Part B drugs. 🧾 The team also sells the basketballs. Under buy-and-bill, the practice purchases the drug and bills for it, alongside payment for administering it. Drug reimbursement becomes part of the practice’s economics. 📦 Someone else brings the ball. With white bagging (or variations), a specialty pharmacy supplies and bills for the drug. The practice still administers it, but loses the drug billing opportunity. 🏥 Layup payment depends on the court. The same service can receive higher payment in a hospital outpatient department than in a physician’s office. 💊 Ownership changes access to discounts. Qualifying hospital outpatient practices can access 340B pricing. Some drugs are priced at a penny. --- The financial return on a treatment can change with the drug’s sourcing and the practice’s ownership, even when the clinical task stays the same. That would completely change the game for the Knicks’ front office. If you’re at AVBCC, say hello! -Bryce Platt, PharmD

Retail pharmacist employment fell by 8,200 positions in 2025, hitting the lowest point since 2010. Hospitals added 3,000 pharmacist jobs. --- We’re revisiting Adam Fein and Greis Kapexhiu's analysis this week as we put the finishing touches on the 2026-27 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Grab your copy here! drugch.nl/wholesale --- Retail pharmacist employment is at its lowest level since Drug Channels began tracking these figures in 2010. Pharmacy closures continue to shrink retail opportunities, while hospitals expand their in-house specialty pharmacy operations. The salary differences are substantial too. Pharmacists averaged $140,920 across all settings, compared with about $151k in hospitals and $167k in physician offices. However, retail pharmacists had faster salary growth in 2025 than hospital pharmacists. Fewer retail positions, but higher pay for those still employed. Read their full analysis 👉🏻 drugch.nl/4hwkY7J

A net price model improves plan economics by about $1.25 PMPM versus traditional POS rebates due to the time value of money to the plan. --- A new Milliman white paper compares three ways commercial plans can handle manufacturer rebates: 💵 Retrospective rebates (most common now): The plan receives rebates after claims are filled, typically three to six months later. This gives the plan flexibility, but members don’t see the rebate when they pay at the pharmacy. 🏪 Traditional point-of-sale (POS) rebates: Estimated rebate value is applied at the pharmacy counter. Members may pay less, but the plan typically funds the arrangement through a fee or reduced POS rebate, and later reconciliation is still needed. 📉 Net price model: The manufacturer passes the rebate value through as a lower drug price at the counter. The plan avoids the separate funding cost in the traditional POS model. --- In Milliman’s illustrative high-deductible plan, member cost sharing fell about 15% under both the traditional POS and net price models. The transition also changes plan cash flow: ↳ In Year 1, modeled plan liability was about 3.5% lower with traditional POS rebates and 5% lower with the net price model. ↳ By Year 2, modeled plan liability under both POS approaches was ~8%-9% higher than under the retrospective model once the prior-year rebates had run out (remember the retrospective rebates were still flowing in for part of year 1). ↳ The net price model’s advantage over traditional POS rebates came from the time value of money: about $1.25 PMPM. The math for the increased plan liability matches our breakdown on rebates in a past blog: drugch.nl/3W5SoSb The exact increase in plan liability under the net price model is the reduced OOP cost for the patient at the pharmacy. --- These are illustrative results based on specific assumptions, including a 7.5% interest rate, 25% rebates, 20% coinsurance, and a six-month rebate delay. They show why comparing only the drug’s net cost can miss the value of timing and cash flow. Are there any other models that give plan sponsors the best balance of member savings, predictability, and long-term cost? 🔗 Source: Milliman milliman.com/en/insight/pbm-…

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A new analysis found we spent $244 billion on 340B (2025). 340B drugs accounted for an estimated 26.5% of ALL U.S. net pharmaceutical spending. --- A new BRG analysis estimates that patients and payers spent $244.3 billion on medicines purchased through 340B in 2025. The estimate includes both the $102.1 billion covered entities spent to acquire those drugs and the difference between acquisition cost and total reimbursement from payers = $142.2 billion in 340B drug margin. 340B margin more than doubled from 2021 to 2025. Closely aligned with what we found for 340B in Minnesota (blog drugch.nl/4e533DS), commercial and Medicare plans account for the majority (88%) of 340B margin. --- The $142.2 billion is the estimated margin between total reimbursement ($244.3B) and acquisition cost ($102.1B). That margin may be retained by covered entities or paid to contract pharmacies and other partners. These are estimates, not a comprehensive accounting of reported transactions--the analysis uses assumptions about drug discounts, reimbursement, and payer mix. There is no comprehensive public reporting on the program’s margin or how it is used, so analytical estimates like these are the best available. --- 340B prescriptions represented more than 26% of all U.S. net drug spending in 2025, up from 17.6% in 2021. At this size, I think it's fair to ask which patients benefit, how much of the margin supports care, and who ultimately receives it. What data should be required to answer those questions? 🔗 Source: Berkeley Research Group (funded by PhRMA) media.thinkbrg.com/wp-conten…

All 50 states regulate PBMs. Federal rules are coming in 2028. Plans already doubt they will have major impacts. --- In September, I wrote about why pharmacists still call PBMs their biggest problem despite all 50 states now regulating them in some way. A new Pharmaceutical Strategies Group survey shows the buyers of PBM services also have doubts. PSG asked plan sponsors to rate how much impact they expect recent PBM regulatory, legislative, and enforcement activity to have, on a scale from 1 (no impact) to 4 (major impact): ↳ PBM transparency: mean score 2.7/4 ↳ PBM customer experience: mean score 2.5/4 Most respondents landed in "minor to moderate impact." --- That skepticism lines up with what the University of Washington researchers heard from pharmacists in the study I covered in September: linkedin.com/posts/bryceplat… Enforcement has been inconsistent, and PBMs are finding loopholes, so a decade of state laws hasn't resulted in major impact yet. Federal PBM provisions in the 2026 Consolidated Appropriations Act won't fully phase in until 2028-2029, but plan sponsors are already unsure if it will be impactful. What's needed to make sure enforcement results in the intended change for plans? Sources: 🔗 PSG 2026 PBM Customer Satisfaction Report psgconsults.com/industry-rep… 🔗 Pharmacy benefit manager policy and pharmacy stakeholder perceptions of financial pressures and closures academic.oup.com/healthaffai…

From @AssistRx: Patient Support Strategy by Lifecycle Stage: Launch, Growth, Maturity, and Loss of Exclusivity Download the AssistRx lifecycle playbook suite: drugch.nl/4hp9MbQ Read the article: drugch.nl/4jw2dm7 #sponsored

PBM overall satisfaction increased slightly in 2026. Big 3 PBM customers are stabilizing. Non-Big 3 customers are the ones losing ground. --- A new Pharmaceutical Strategies Group customer satisfaction survey tracked overall PBM ratings by plan sponsor type and PBM size over the last decade. Overall PBM satisfaction has been sliding for years, from a high of 8.2 in 2021 to 7.1 in 2025 (a decade low). 2026 had a slight rise to 7.2. Progress! Break that out by PBM size and you might be surprised: 📈 Big 3 PBM customers: satisfaction increased slightly, from 6.8 in 2025 to 7.1 in 2026 📉 Non-Big 3 PBM customers: satisfaction dropped from 7.9 in 2025 to 7.3 in 2026 Non-Big 3 customers are still more satisfied overall, but it's getting closer. Net Promoter Score (NPS) has the same trend: ↳ Big 3 PBM customers' NPS dropped substantially in 2025, then stabilized in 2026 at -22. ↳ Non-Big 3 customers' NPS declined from 16 in 2025 to 4 in 2026 --- Non-Big 3 PBMs built part of their reputation on being the more "satisfying" PBM option. The difference in satisfaction is shrinking, but not because the Big 3 improved dramatically--it's because non-Big 3 customers are becoming less satisfied. What do you think has been causing this drop in non-Big 3 PBM satisfaction? 🔗 Source: PSG 2026 PBM Customer Satisfaction Report psgconsults.com/industry-rep…