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 โ 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 IRAโs 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: https://t.co/XTgpm2X6EJ
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.
https://t.co/EQKgdLa1aJ
๐๐ก๐ 340๐ ๐๐จ๐ง๐ญ๐ซ๐๐๐ญ ๐๐ก๐๐ซ๐ฆ๐๐๐ฒ ๐๐๐ซ๐ค๐๐ญ ๐ข๐ง 2026: ๐ ๐๐๐ญ๐ฎ๐ซ๐ข๐ง๐ ๐๐ง๐๐ฎ๐ฌ๐ญ๐ซ๐ฒ ๐๐จ๐ฆ๐ข๐ง๐๐ญ๐๐ ๐๐ฒ ๐๐ข๐ ๐๐ก๐๐ข๐ง๐ฌ ๐๐ง๐ ๐๐๐๐ฌ
The 340B program was created in 1992 as a narrow policy solution to address an unintended consequence of Medicaidโs 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 programโs current operations and economic incentives have diverged from that original intent.
In 2026, five publicly traded mega-corporationsโCigna, CVS Health, UnitedHealth Group, Walgreens, and Walmartโare capturing 77% of all 340B contract pharmacy relationships.
For the full 2026 market breakdownโincluding which companies are winning and how the market keeps consolidatingโread our latest analysis on Drug Channels:
๐
https://t.co/Mt1u9E5woD
From @Kalderos: ๐๐ซ๐ฎ๐ ๐ฌ, ๐๐ข๐ฌ๐๐จ๐ฎ๐ง๐ญ๐ฌ ๐๐ง๐ ๐๐๐ญ๐: ๐๐ซ๐๐๐ญ๐ข๐ง๐ ๐๐ฎ๐ฌ๐ญ๐๐ข๐ง๐๐๐ข๐ฅ๐ข๐ญ๐ฒ ๐ข๐ง ๐๐ง ๐๐ฆ๐ฉ๐๐ซ๐๐๐๐ญ ๐๐ฒ๐ฌ๐ญ๐๐ฆ
Register for "GTN Oversight: A New Standard of Transparency Is Here" (free 6/23 webinar): https://t.co/r6LgQtn05c
Read the article: https://t.co/zzMtTW8Tur
#sponsored
๐๐๐ซ๐ค ๐๐ฎ๐๐๐ง ๐๐ข๐ง๐ฌ ๐ญ๐ก๐ ๐๐๐ง๐๐ซ๐ข๐ ๐๐ซ๐ข๐๐ ๐๐๐ซ (๐๐ ๐๐ข๐ง) ๐
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:
โข For generic prescriptions with out-of-pocket costs above $15, nearly 80% would have been cheaper through Cost Plus Drugs.
โข 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
๐
https://t.co/hX4yHnakiR
๐๐ซ๐ฎ๐ ๐๐ก๐๐ง๐ง๐๐ฅ๐ฌ ๐๐๐ฐ๐ฌ ๐๐จ๐ฎ๐ง๐๐ฎ๐ฉ, ๐๐๐ฒ 2026: My $0.02 on Optum Rxโs Transparency, Must-Read 340B History, PBM Unbundling Update, PA Delays, and Vegas Fun
Summer unofficially kicked off last weekend. So fire up the grill and enjoy these noteworthy delicacies, seared to perfection on the Drug Channels barbeque:
โข Why Optum Rx Is Accelerating Its Transparency Strategy
โข The Most Important 340B Paper Youโll Ever Read
โข Blue Shield of Californiaโs PBM Unbundling Plan Meets Reality
โข Prior Authorization: Administrative Complexity = Delayed Care
Plus: The Drug Channels Institute team takes on Las Vegasโwith stickers!
Read all the juicy details here:
๐
https://t.co/HessWVWC3i
๐๐ก๐ ๐๐จ๐ฌ๐ญ ๐๐ฆ๐ฉ๐จ๐ซ๐ญ๐๐ง๐ญ 340๐ ๐ฉ๐๐ฉ๐๐ซ ๐๐จ๐ฎ'๐ฅ๐ฅ ๐๐ฏ๐๐ซ ๐๐๐๐
If you care about #340B policy, use the long weekend to read this outstanding new paper:
"Stretching Scarce Authorizing Legislation as Far as Possible: A Legislative History of the 340B Drug Pricing Program."
Sayeh Nikpay @saynikpay and her colleagues went back to the early 1990's to reconstruct the program's origins. Their research draws on interviews with 18 key participants and 175 primary source documents spanning 1990โ1992.
Their conclusion is difficult to ignore:
340B was originally designed as a narrow policy solution to address an unintended consequence of Medicaidโs best-price provision and to support core safety-net providers.
But the paper makes a compelling case that todayโs program extends far beyond Congressโs original intent.
Whether you support or oppose the current structure of 340B, this paper is essential reading for anyone who wants to understand how we got here.
Read it here: https://t.co/MrD8O31wNI
One especially fascinating detail: The disproportionate share hospital (DSH) eligibility threshold of 11.75% was chosen to qualify two specific hospitals and secure bipartisan support from Senator Hatch and Representative Bliley.
In other words, the threshold was not grounded in any broader scientific or policy rationale.
Amazing.
๐๐๐ ๐๐ก๐๐ค๐๐จ๐ฎ๐ญ: ๐๐จ๐ฐ ๐๐๐ซ๐ญ๐ข๐๐๐ฅ ๐๐ง๐ญ๐๐ ๐ซ๐๐ญ๐ข๐จ๐ง ๐๐ฌ ๐๐๐ฌ๐ก๐๐ฉ๐ข๐ง๐ ๐๐ก๐๐ญโ๐ฌ ๐๐๐ฑ๐ญ (๐๐๐๐๐)
The PBM market is entering a shakeout phase.
In this short video excerpt from DCIโs recent PBM Industry Update webinar, I review:
โข The changing market shares of the largest PBMs
โข Why many smaller PBMs still depend on the Big Three
โข How vertical integration continues to reshape the industry
โข Why regulation and scale pressures could accelerate consolidation
We expect the PBM market five years from now to look very different from today.
Watch here
๐
https://t.co/kh6kalPPlx
#PBM #Healthcare #Pharmacy #DrugChannels #HealthPolicy
๐๐ข๐ง๐ค ๐๐ก๐๐๐ญ: ๐๐๐ ๐๐๐ ๐ฎ๐ฅ๐๐ญ๐ข๐จ๐ง ๐๐๐ฒ ๐๐จ๐ฅ๐ฌ๐ญ๐๐ซ ๐๐ข๐ ๐๐ก๐ซ๐๐ ๐๐๐ซ๐ค๐๐ญ ๐๐จ๐ฌ๐ข๐ญ๐ข๐จ๐ง ๐๐๐ซ๐ฌ๐ฎ๐ฌ ๐๐ฆ๐๐ฅ๐ฅ๐๐ซ ๐๐จ๐ฆ๐ฉ๐๐ญ๐ข๐ญ๐จ๐ซ๐ฌ
PBM reform may not have the impact many expect.
In a recent Drug Channels Institute webinar, we discussed:
โข How new federal transparency rules could disadvantage smaller PBMs
โข Why the Big Three are better positioned to adapt
As transparency becomes standard, differentiation shrinks.
As compensation shifts away from list prices, PBMs move toward fee-based models. (Hello, Net Pricing Drug Channel! #NPDC)
The twist: these changes could reduce pressure for further legislation and ultimately strengthen the largest players.
More in The Pink Sheet
๐
https://t.co/4yuwzlU2Sh
#PBM #DrugPricing #HealthcarePolicy
From PHIL: ๐๐ซ๐จ๐ญ๐๐๐ญ๐ข๐ง๐ ๐๐ซ๐จ๐ฌ๐ฌ-๐ญ๐จ-๐๐๐ญ ๐๐๐ซ๐๐จ๐ซ๐ฆ๐๐ง๐๐ ๐๐ก๐ซ๐จ๐ฎ๐ ๐ก ๐๐ข๐ง๐ ๐ฅ๐-๐๐ก๐๐ง๐ง๐๐ฅ ๐๐๐จ๐ฌ๐ฒ๐ฌ๐ญ๐๐ฆ๐ฌ
Learn more about PHILโs technology solution for brands: https://t.co/FGHxk0Xefw
Read the article: https://t.co/aAMLtvrUUP
#sponsored
๐จ ๐๐ซ๐ฎ๐ ๐๐ก๐๐ง๐ง๐๐ฅ๐ฌ ๐๐๐ฐ๐ฌ ๐๐จ๐ฎ๐ง๐๐ฎ๐ฉ, ๐๐ข๐-๐๐๐ฒ 2026 ๐จ
Bryce Platt breaks down a timely mix of policy, pricing, and market dynamics:
โข Are drug launch price analyses built on flawed assumptions?
โข Pharmacy closures are acceleratingโnew data reveal where and why
โข The complex reality of how hospitals are paid for uncompensated care
โข Key differences between 340B hospitals and federal grantees
โข A fresh (and unexpected) take: specialty pharmacy as a luxury hotel
Dive in:
๐
https://t.co/ipzCxgCpuK
๐จ340๐ ๐ข๐ง 2026: ๐๐๐ซ๐ค๐๐ญ ๐๐ก๐ข๐๐ญ๐ฌ, ๐๐จ๐ฅ๐ข๐๐ฒ ๐๐๐ญ๐ญ๐ฅ๐๐ฌ, ๐๐ง๐ ๐๐ก๐๐ญ ๐๐ก๐๐ฒ ๐๐๐๐ง ๐๐จ๐ซ ๐๐ญ๐๐ค๐๐ก๐จ๐ฅ๐๐๐ซ๐ฌ (Live Video Webinar) ๐จ
The 340B Drug Pricing Program remains one of the most complexโand contentiousโparts of the U.S. drug channel.
On June 12 (12:00โ1:30 p.m. ET), Iโll be hosting a live webinar where Iโll break down whatโs really happening behind the headlines:
โข The economics and continued growth of 340B
โข DCIโs latest data on contract pharmacy trends and market dynamics
โข How PBMs, manufacturers, and distribution strategies are evolving
โข Key legal, regulatory, and state policy developments
โข IRA implications, rebate model proposals, and oversight challenges
โข the growing role of employers and plan sponsors
โข Emerging risks and โand what to watch next
โข And more
Clear facts. Sharp analysis. Live Q&A.
If 340B affects your business, you wonโt want to miss this.
Register ๐ https://t.co/OTVVdcutCQ
#340B #DrugPricing #PBM #Pharmacy #DrugChannels
In 2024, Blue Shield of California promised "$500 million in medication savingsโ with its widely-praised attempt to unbundle the traditional PBM model across nine different vendors. At the time, I was a bit skeptical. (Link in comments.)
So, howโs it going?
Not so well.
According to this @modrnhealthcr interview with Paul Markovich: "Progress toward major savings is proving more gradual than the company anticipated."
Blue Shield reports $100 million in savings through "lower administrative costs." But last year, Mr. Markovich revealed that the company had already โspent nearly $100 million getting our pharmacy model set up and working.โ
So, despite the glowing press coverage in 2024, there's little evidence of net savings (so far).
I remain skeptical that Blue Shield has stumbled upon a viable and scalable alternative to the traditional PBM model.
In anything, the company's misadventures reinforce a lesson often emphasized by Mark Cuban @mcuban :
๐๐จ๐ฆ๐ฉ๐ฅ๐๐ฑ๐ข๐ญ๐ฒ ๐ข๐ฌ ๐ญ๐ก๐ ๐๐ง๐๐ฆ๐ฒ ๐จ๐ ๐ฅ๐จ๐ฐ ๐๐จ๐ฌ๐ญ๐ฌ ๐๐ง๐ ๐๐๐๐ข๐๐ข๐๐ง๐๐ฒ.
Full interview: https://t.co/n055yftgtX
๐๐ฉ๐๐๐ข๐๐ฅ๐ญ๐ฒ ๐๐ก๐๐ซ๐ฆ๐๐๐ฒ ๐๐๐๐ซ๐๐๐ข๐ญ๐๐ญ๐ข๐จ๐ง: ๐๐๐โ๐ฌ ๐๐ฑ๐๐ฅ๐ฎ๐ฌ๐ข๐ฏ๐ ๐๐ง๐๐ฅ๐ฒ๐ฌ๐ข๐ฌ ๐๐๐ฏ๐๐๐ฅ๐ฌ ๐ ๐๐๐ซ๐ค๐๐ญ ๐๐ญ ๐๐ง ๐๐ง๐๐ฅ๐๐๐ญ๐ข๐จ๐ง ๐๐จ๐ข๐ง๐ญ
The specialty pharmacy market keeps growingโฆ but not the way you might think.
DCI identified 1,910 accredited locations.
But:
โข Growth has slowed
โข 40% of pharmacy locations now operated by healthcare providers
โข Independents down to 29% share (from 59% in 2015)
โข Two-thirds of specialty revenues flow through a few PBM-affiliated giants
Fragmented on the surface. Concentrated underneath.
Read our full analysis:
๐
https://t.co/LqpRzCvGO5
๐๐ซ๐ข๐จ๐ซ ๐๐ฎ๐ญ๐ก๐จ๐ซ๐ข๐ณ๐๐ญ๐ข๐จ๐ง: ๐๐๐ฆ๐ข๐ง๐ข๐ฌ๐ญ๐ซ๐๐ญ๐ข๐ฏ๐ ๐๐จ๐ฆ๐ฉ๐ฅ๐๐ฑ๐ข๐ญ๐ฒ = ๐๐๐ฅ๐๐ฒ๐๐ ๐๐๐ซ๐
New data on ~206,000 brand-name drug #prescriptions with initial prior authorization (PA) rejections:
โข Only 35% cleared same day
โข 65% delayed (median = 6 days)
โข Nearly half (46%) were never approved
Multiple PA reviews and added rejection reasons significantly reduced same-day processing:
โข Refills and complex cases were less likely to move quickly
โข Medicaid patients and those with multiple conditions had lower approval rates
โข Wide variation across drugs highlights uneven access ๐
For many patients, an initial PA rejection means delayed (or no) treatment.
Source: JAMA Health Forum https://t.co/LY2ryRhtmG
From @ConnectiveRx: ๐๐ก๐๐ซ๐ ๐๐ซ๐จ๐ฌ๐ฌ-๐ญ๐จ-๐ง๐๐ญ ๐๐ซ๐๐ฌ๐ฌ๐ฎ๐ซ๐ ๐๐๐ญ๐ฎ๐๐ฅ๐ฅ๐ฒ ๐๐ข๐ฏ๐๐ฌ ๐๐๐ญ๐๐ซ ๐๐๐ฎ๐ง๐๐ก
Register for "Gross-To-Net FOMO: What GTN Dangers Are You Missing Post-Launch?" (free webinar): https://t.co/SXA6zp2AgE
Read the article: https://t.co/tlKFZCmutD
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๐จ ๐๐ซ๐ฎ๐ ๐๐ก๐๐ง๐ง๐๐ฅ๐ฌ ๐๐๐ฐ๐ฌ ๐๐จ๐ฎ๐ง๐๐ฎ๐ฉ, ๐๐ฉ๐ซ๐ข๐ฅ 2026๐จ
Are PBMs steering patients? Are insurers shifting profits? And whatโs really behind hospitalsโ โfake pricesโ?
This monthโs roundup tackles some of the most contentious issues in todayโs drug channel:
โข PBM-affiliated specialty pharmacies: New data shows major differences in patient accessโand raises tough questions about steering
โข MLR profit shifting: Fresh evidence that vertically integrated insurers may be moving margins within Part D
โข Nonprofit hospitals: A provocative look at the widening gap between mission and financial reality
Plus: A behind-the-scenes look at how we build a DCI webinar
Read the full roundup here
๐
https://t.co/2NJHmf9VOg
๐๐จ๐ฌ๐ฉ๐ข๐ญ๐๐ฅ๐ฌ & ๐๐ก๐๐ข๐ซ ๐ ๐๐ค๐ ๐๐ซ๐ข๐๐๐ฌ
A must-read, hard-hitting piece from Anthony DiGiorgio @DrDiGiorgio on the economics of nonprofit hospitals and the growing gap between their public mission and financial reality.
He lays out the extensive subsidy ecosystem supporting hospitals:
โข Property and sales tax exemptions
โข Public funding (DSH payments, GME, research support)
โข 340B Drug Discount Program revenues
โข Market powerโdriven pricing from consolidated health systems
โฆamong others
Then comes the key question:
"After all of those subsidy streams, what exactly is still unfunded"?
As he puts it, hospitals should provide a true accounting:
โข What is the net Medicaid shortfall after supplemental payments?
โข What is the real value of tax exemptions?
โข Where does 340B revenue actually go?
โข How are funds allocated across executive pay, administration, expansion, reserves, M&A, and lobbying?
Until we see that level of transparency, claims about underfunding deserve more scrutiny.
Strong, provocative piece.
๐ https://t.co/EJZ8DAHOQL