The U.S. pharmaceutical market's single-center commercial insurance model is fracturing into three distinct payer economies: commercial, government, and self-pay. And each of which have their own distinct pricing logic and compliance risks.

In the first installment of this six-part series, Bill Roth examines the forces driving this shift, from IRA provisions and 340B expansion to the rise of cash-pay platforms offering steep discounts on specialty generics.

As manufacturers face a wave of patent expirations and mounting pricing pressure, the old "one list price, one access strategy" approach is giving way to a more deliberate, bifurcated strategy across all three markets.