PHARMACY MARKET STRUCTURE

Pricing DCI: U.S. pharmacy dispensing revenues hit $751 billion in 2025 as GLP-1s reshape the market

Drug Channels Institute published its annual pharmacy rankings this week, ahead of the full 2026 Economic Report (releasing March 24). Total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached an estimated $751 billion in 2025—a 10% increase over 2024's $683 billion. GLP-1 agonist drugs are now the dominant structural driver: over the past five years, GLP-1 dispensing revenue growth has accounted for approximately 60% of retail pharmacies' total revenue growth. The top 15 companies captured nearly three-quarters of all dispensing revenues. The four largest organizations—CVS Health, Walgreens, Cigna (Evernorth), and UnitedHealth Group (Optum)—together accounted for more than half of the total U.S. market, underscoring the degree to which vertical integration has consolidated pharmacy economics under PBM-insurer parent companies.

340B PROGRAM

340B House members push to ban 340B rebate model in must-pass appropriations bill

340B Report reported that a bipartisan group of House lawmakers is circulating a letter to include language in must-pass federal appropriations legislation that would explicitly ban the 340B rebate model. The effort builds on the 163-member bipartisan letter sent to HHS Secretary Kennedy in September 2025 urging the agency to abandon the rebate pilot. HHS formally withdrew the current pilot in February 2026 following court losses, but agreed to potentially restart the administrative process with new guardrails. Using an appropriations rider would go further than the administrative withdrawal—it would prohibit the executive branch from spending federal funds to implement any rebate model, effectively requiring congressional authorization for any future shift from upfront discounts to post-purchase rebates.

The 340B litigation landscape continues expanding. 340B Report's latest roundup tracks active litigation in Maryland, Rhode Island, South Dakota, and Oregon, adding to existing cases in Colorado, Hawaii, Vermont, and New Mexico. Endpoints News reported that Sanofi, AbbVie, Novartis, and AstraZeneca face a revived 340B pricing case—a court action that could reopen manufacturer liability for historical 340B pricing practices. The combination of legislative bans (appropriations rider), state-level protections (contract pharmacy laws), and revived litigation creates a multi-front environment where manufacturers must defend their 340B positions simultaneously in Congress, state legislatures, and federal courts.

PBM REFORM IMPLEMENTATION

Policy PCMA urges DOL to rescind commercial PBM transparency rule; pharma industry celebrates CAA 2026

PCMA filed a formal request (March 19) urging the Department of Labor to rescind its proposed PBM remuneration transparency rule for self-insured employer plans, arguing it is duplicative of the CAA 2026 provisions already enacted. The DOL proposed rule—comment period closing March 31—would require per-drug disclosure of manufacturer rebates, administrative fees, spread pricing, and pharmacy clawbacks. Ropes & Gray's analysis noted that the DOL rule targets the self-insured employer market segment, which is the largest in U.S. health insurance and the segment where CBO projects the greatest fiscal impact from PBM reform ($1.865 billion of the $2.12 billion total deficit reduction score).

BIOSIMILAR PIPELINE

Biosimilar Sandoz and Samsung Bioepis expand partnership with up to five biosimilars, targeting Entyvio

FiercePharma reported (March 18) that Sandoz has entered a global licensing and commercialization agreement with Samsung Bioepis for up to five biosimilar candidates. The lead asset is SB36, a vedolizumab biosimilar referencing Takeda's Entyvio, currently in preclinical development. Samsung Bioepis will handle development, manufacturing, and regulatory filings; Sandoz will commercialize globally (excluding China, Hong Kong, Taiwan, Macau, and South Korea). The deal builds on the companies' existing partnership for PYZCHIVA (ustekinumab biosimilar, launched in the U.S. in February 2025) and EPYSQLI (eculizumab/Soliris biosimilar). The agreement could expand Sandoz's total biosimilar portfolio to 32 assets, which the company described as an industry-leading position targeting the estimated $320 billion biosimilar loss-of-exclusivity opportunity over the next decade.

QUICK TAKES

• Pricing Health Affairs study found that brand-name ICS-LABA inhaler list price reductions in 2024 were associated with increased generic uptake—evidence that proactive manufacturer price cuts ahead of IRA negotiation can accelerate rather than slow competitive entry. This finding has direct implications for the 15 drugs in IRA Cycle 2 (2027 price applicability): manufacturers weighing preemptive list-price reductions should model whether the strategy protects market share or inadvertently opens the door to generic competition.
• 340B National 340B advocacy group launches litigation fund to help states defend contract pharmacy access laws against manufacturer lawsuits. Active litigation now spans Maryland, Rhode Island, South Dakota, Oregon, Colorado, Hawaii, Vermont, and New Mexico. The 5th Circuit's 2025 unanimous decision upholding Louisiana's law remains the strongest precedent for state protections, while DOJ's Colorado brief backing AbbVie represents the strongest federal intervention on the manufacturer side.
• Policy PCMA: PhRMA celebrates PBM reform — In a pointed March 16 blog post, PCMA highlighted PhRMA CEO's public celebration of the CAA 2026 provisions as evidence that PBM reform serves manufacturer interests. PCMA argues that with PBMs "handcuffed," manufacturers face no counterbalance to list-price inflation. The political framing battle over who benefits from PBM reform will shape the next round of drug pricing legislation.
• Biosimilar FDA publishes revised biosimilar development guidance (March 10) — The fourth revision of the BPCI Act Q&A guidance updates analytical assessment, clinical study requirements, and interchangeability standards. The revision signals FDA's evolving approach as the biosimilar pipeline accelerates beyond first-generation products into complex oncology and autoimmune biologics.
• 340B Sanofi, AbbVie, Novartis, AstraZeneca face revived 340B pricing case — Endpoints News reported that four major manufacturers face a revived court action over historical 340B pricing practices. A ruling reopening manufacturer liability could create retroactive financial exposure and strengthen covered entities' leverage in the ongoing 340B reform negotiations.

WHAT TO WATCH NEXT

DCI 2026 Economic Report on U.S. Pharmacies and PBMs—March 24

Drug Channels Institute releases its 17th edition next week: 12 chapters, 500+ pages, 270 exhibits, nearly 1,300 endnotes. The report will contain the definitive vertical integration analysis (Exhibit 267), updated PBM market share data, specialty pharmacy revenue breakdowns, and the most current assessment of how the Net Pricing Drug Channel (NPDC) transition is reshaping economics across all participants. DCI's April 10 webinar will provide a forward-looking PBM industry update analyzing the transition challenges ahead of the August 2028 delink deadline. This report sets the analytical baseline for every market access strategy discussion through 2027.

DOL PBM transparency rule comment deadline—March 31, 2026

PCMA's March 19 rescission request will be one of many comments the DOL receives before the deadline. The rule would require per-drug disclosure of manufacturer rebates, administrative fees, spread pricing, and pharmacy clawbacks for self-insured employer plans—the largest market segment in U.S. health insurance. If finalized as proposed, disclosures would apply to plan years beginning on or after July 1, 2026. Market access teams at manufacturers and PBMs should be preparing for a scenario where both CAA 2026 (Part D) and DOL (commercial) transparency mandates are simultaneously in effect, creating full-book-of-business visibility into remuneration flows for the first time.

CVS Caremark Prolia/Forteo biosimilar formulary switch—April 1, 2026

CVS Caremark's formulary switch from branded Prolia and Forteo to biosimilar alternatives takes effect April 1 on major national commercial template formularies. Ospomyv (Cordavis/CVS private-label) and Stoboclo (Celltrion) replace Prolia; generic teriparatide, Bonsity, and Tymlos replace Forteo. This is the first major test of the private-label biosimilar model outside the Humira and Stelara categories. Watch for Amgen's response—the company faces franchise displacement in osteoporosis following the same pattern that hit AbbVie's Humira.