Trade & Channel Strategies 2025: Why Pharma Is Entering a Multi-Payer, Multi-Pricing, Multi-Channel Era

In his keynote address, “Navigating Disruption in the Pharmaceutical Channels,” Bill Roth, general manager and managing partner of IntegriChain’s consulting business, described 2025 as a pivotal year for the industry—one defined not just by evolving product archetypes but by the unprecedented acceleration of regulatory change. Although he typically revises his macro framework only once every decade or more, Roth explained that the current environment has forced a significant shift in how he views pharma’s trajectory across generics, brands, specialty, orphan/rare, and cell and gene therapies.

What makes this moment unique, he argued, is the scale and speed of policy transformation. Major regulatory developments—including the Medicare MFP program, the introduction of the 340B rebate, changes to the MDRP, and updates to the physician fee schedule—are reshaping commercial strategies in real time. He noted that manufacturers are now making preemptive changes to pricing and contracting before regulations take effect, a behavior he described as virtually unheard of in past cycles.

Roth emphasized the importance of looking beyond the policies themselves to understand their downstream commercial effects. For example, he predicts significant WAC reductions across the market and a long-term decline in 340B value as new rules strip margin from the program. He also introduced a new concept—the “medical benefit bubble”—warning that once MFP values fold into ASP for medical benefit products in 2028, the resulting gap between WAC and ASP will likely force further WAC compression.

Another emerging area of disruption is the industry’s rapid shift toward direct-to-patient models. Roth highlighted ongoing debates about whether this movement is driven by genuine operational advantage or political and public-perception pressures. His goal for the keynote was to provide a broad, high-level map of these intersecting forces—an approach he believes resonated strongly with attendees.

He also commented on other topics that have piqued his interest; his new six-part series; and much more.

A transcript of his conversation with PC can be found below.

PC: With your “Popping the Gross-to-Net (GTN) Bubble” series concluding, in Pharma Commerce’s December issue, you decided to begin a new six-part series focusing on "The Great Repricing.” Could you elaborate on what that series entails?

Roth: This article series is—I'm a little worried it might go over some people's heads, because it's not necessarily going to apply to all the products that we have out there. So I'll just kind of look at general medicine brands to answer your question. What I see is what I would call a mult-payer, multi-pricing, multi-channel model. And what I mean by that is I'm seeing five different types of payers break in the market. It's not just insurance and cash, because there's those of us that have insurance that use cash, even Medicare patients—when the weight loss drugs aren't covered, they default to cash, even Medicaid. When it's not covered, if it's affordable, defaults to cash.

So you have commercial concierge, commercial Medicare, Medicaid, and self-pay. Then within that, all that requires a myriad of different pricing models, so we're getting more complex in our pricing models. We'll have the high WACs, we'll have the insurance models, we'll have the government models, and then the cash models really are going to exist almost outside of that, because the pricing in our industry—a lot of it comes back to what does and doesn't affect a government price. What affects reimbursement? What affects the price that the VA pays on something with the Federal Supply Schedule?

Commercial teams haven't necessarily been involved in all that. And then when you think through the channels that need to exist in that, an easy way to think about it is the profitability of insurance allows a lot of different intermediaries to take a cut between the manufacturer, the PBM, the pharmacy, the GPO, the distributor, all the way out. If you're running a cash business, you can't have all those levels of intermediary. You got manufactured, to the pharmacy, and to the patient, because there's a consumer-driven price sensitivity.

It's kind of the way that mass merchants like Walmart think about how they need to buy Advil and Tylenol. It doesn't afford lots of intermediaries in the middle of it. That means that you have to set up your supply chains now in different models to meet different pricing models, to meet different payer models, and so I'll do my best over the six-part series to try to make this make as much sense as I possibly can. But it is going to be a complex topic that'll vary pretty greatly by your product archetype and by where you are in your life cycle, so it should be fun. I look forward to writing it.