Despite the recent storm, winter—or at least February—is almost over. Before we thaw out, here’s a brisk tour of the forces reshaping the drug channel. In this issue:

Plus: Meet the expanding Drug Channels Institute team!

P.S. Join my more than 68,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.

My initial response to the FTC PBM settlements, Mark Cuban on LinkedIn

ICYMI, Mark Cuban is highly skeptical of the Federal Trade Commission’s settlement with Express Scripts. As he correctly notes: “If the PBM convinces the employer to choose the current system, then they can do it just the way they always have.”

Mark Cuban is right: the FTC–Express Scripts settlement doesn’t overhaul the entire system. He zeroes in on the crucial “Section XI. Meeting Competition” loophole that I wrote about in The FTC Blows Up Express Scripts’ PBM Model—and Launches the Net Pricing Drug Channel.

Nonetheless, I still believe that the settlement puts us on a path toward something better.

By basing patient out-of-pocket costs on net prices and passing through rebates at the point of sale, the settlement helps shield patients from the excesses of the gross-to-net bubble.

What’s more, the default plan sponsor agreement aligns with a Net Pricing Drug Channel (NPDC). Yes, plans could still undermine the NPDC through the Section XI carve outs. That’s probably why Wall Street didn’t freak out.

But changing the default sets the system in motion.

A top-down attempt to “fix everything” at once is almost guaranteed to fail, creating chaos and disruption for healthcare stakeholders and patients. Setting new rules and letting incentives do the work, however, could (maybe, hopefully) get us there.

Either way, it’s going to be a wild ride. Stay tuned!

Patient Perspectives on Health Insurance Design: A Mixed-Methods Analysis, Journal of Market Access & Health Policy

Here’s some evidence of patient demand for the NPDC.

Surveyed patients (n=146) strongly support changes that reduce unpredictable out-of-pocket costs:

Eliminating coinsurance for stable chronic meds
Covering high-value drugs without deductibles
Capping medication costs as a share of income
Replacing coinsurance with fixed copays
Here are the summary results:

[Click to Enlarge]



As you can see, affordability and predictability matter more than transparency. Patients want to plan and budget—not estimate—out-of-pocket costs. And after paying premiums, they expect coverage for high-value care.

As Peter Kolchinsky of RA Capital often says: No one fakes cancer to joyride chemo.

The QALY Paradox: An Unintended Consequence Of Most Favored Nation Drug Pricing, Health Affairs

I have long argued that international reference pricing is a flawed policy shortcut, not a sustainable solution. Benchmarking U.S. drug prices vs. other countries overlooks fundamental structural differences in healthcare financing, delivery, and value assessment frameworks.

This timely Health Affairs article raises a deeper legal and policy question at the intersection of quality-adjusted life-years (QALYs) and Most Favored Nation (MFN) pricing models:

When Congress explicitly prohibits a particular methodology in statute, can the executive branch effectively circumvent that prohibition by adopting foreign prices derived from the banned methodology?
As the authors explain, the U.S. ban on QALYs reflects a “bipartisan compromise to protect vulnerable groups from being disadvantaged in the pursuit of cost containment.” Referencing foreign prices is not a neutral act when those prices are grounded in frameworks that U.S. law has deliberately declined to adopt.

Kudos to Dominique Seo, Kenneth E. Thorpe, and T. Joseph Mattingly II for a thoughtful and nuanced take on these complex issues.

Site-of-Care Shift for
Physician-Administered Drug Therapies: 2026 Update, BRG

Drug Channels Institute, LinkedIn

We have been expanding the DCI team. I’m delighted to introduce some of my new colleagues.

Connect with them on LinkedIn:

Tyler, Bryce, and Marie will be at the Drug Channels Leadership Forum. If you’ll be in Miami, introduce yourself.