Rural Concierge PCPs, Pres. Trump’s EO Explained, Specialty Pharmacy Rankings

Hey all,

Happy Thursday! Reading about MDs converting to concierge medicine reminded me of my own struggle to find an MD in upstate NY. I ultimately chose a direct primary care membership, paying out of pocket because I wanted a doctor focused on my health rather than insurance billing. This model prioritizes the patient-doctor relationship through longer appointments and more personalized care, but unfortunately remains inaccessible to many people in my area due to cost barriers and limited availability. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(KFF Health News) Concierge Medicine’s Impact on Rural Care

As more doctors in western Massachusetts adopt concierge and direct primary care models—charging patients recurring fees to reduce workloads and offer longer visits—residents in rural areas are left with fewer accessible primary care options. While some physicians view this as necessary self-preservation in a strained system, critics warn it exacerbates doctor shortages and creates a two-tiered system favoring those who can pay extra for care. Maybe if primary care physicians were paid better and didn’t have to handle so much unpaid administrative work, more would stay in traditional practice and have the time to actually care for their patients. Full Article

(Cost Curve) Trump’s Drug-Pricing Executive Order

Donald Trump’s new executive order on drug pricing is a sprawling policy mix that revives several Trump 1.0 initiatives—most notably, a move to cut Medicare payments to 340B hospitals, potentially costing them $2 billion annually. The order sidesteps once-central proposals like international reference pricing and rebate reform, while spotlighting newer targets like PBM broker fees, site-neutral payments, and small molecule drug penalties. Though ambitious in scope, much of the order lacks clear implementation paths and leans heavily on future Congressional action. Full Article.

(Drug Channels Institute) Top 15 Specialty Pharmacies of 2024

PBM-owned specialty pharmacies continued their market dominance in 2024, capturing two-thirds of all pharmacy-dispensed specialty drug revenues, according to Drug Channels Institute’s latest analysis. The report underscores how vertical integration allows these entities to exploit non-transparent revenue streams—such as 340B contract pharmacy margins, service fees from manufacturers, and copay maximizer partnerships—while health systems expand in-house dispensing to counter manufacturer restrictions. Independent pharmacies face consolidation and shrinking market share, even as they gain ground in exclusive dispensing networks. Full Article