gross to net Archives

The $356 Billion Margin Trap Is Reshaping Patient Persistence

Post author By Hoot
Post date May 15, 2026

Gross-to-net pressure has become one of the defining commercial realities in specialty pharma. According to Hoot’s latest executive briefing, manufacturers gave back an estimated $356 billion in rebates, government discounts, 340B obligations, and chargebacks before net revenue was ever recognized. That number alone changes how commercial leaders think about growth. The challenge is no longer […]

The Hidden Driver of Gross to Net Erosion Is Patient Abandonment

For more than a decade, pharmaceutical leaders have treated gross to net as a pricing problem. The focus has been on rebates, PBMs, formulary positioning, and increasingly complex contracting strategies. Entire teams are dedicated to modeling discount structures and negotiating access. Yet despite all of this effort, the gap between list price and net revenue […]