PBM Reform Is Coming, Another 340B Lawsuit, & 2025 Medicare Rx Formulary Trends

Hey all,

Today we’re covering a lot of big news in the world of pharmacy today. I am especially interested in what the language of PBM reform looks like for the end of the year spending bill. My concern is the language in the bill will not match the headlines we’re seeing. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroCard)

Today Is the Biggest Day Ever for PBM News, No? (Cost Curve) 

Brian Reid unpacks a day filled with PBM news, starting with a year-end PBM reform bill expected to include Medicare delinkage, 100% rebate passthrough, Medicaid provisions, and transparency—details that could reshape how PBMs operate. Former President Donald Trump also criticized PBMs as “horrible middlemen,” rattling the market and driving down stocks for United, CVS, and Cigna. It looks like big insurers and their PBMs are in for a world of hurt over the next four years. Full Article.

Sanofi Sues HHS Over 340B Rebate Plan (Stat News)

Sanofi has filed a lawsuit against HHS after the agency threatened sanctions over its new payment model for 340B hospitals, which involves issuing credits after hospitals provide claims data. HRSA argued the model violates federal law by potentially charging hospitals more than the maximum allowable price, while Sanofi contends the plan prevents waste and abuse in a program that accounted for $66.3 billion in drug purchases last year. This marks the fourth recent lawsuit by drugmakers, including J&J and Lilly, challenging HRSA over payment practices in the 340B program. Full Article.

(Brooks Conway) 2025 Formularies and IRA Impact: Brooks Conway highlights significant trends in CMS 2025 formularies driven by the IRA. Nationwide carriers showed more stability, while regional competitors made sharper changes, including removing 10% or more RxCUIs in some markets. Coverage for GLP-1s like Mounjaro and Ozempic will exceed 97% of plans in 2025, while Wegovy lags below 2% despite its expanded indication. Humira coverage will drop slightly to 93% of MAPD plans as biosimilars gain traction. These shifts underscore the evolving formulary landscape as the industry adapts to new IRA provisions. Full Analysis.