Pharma Direct-To-Patient 2.0: From Experiment To Imperative

By Deepak Thomas and Sari Kaganoff

Policy pressure, affordability gaps, and consumer expectations are reshaping how pharma companies think about direct to patient access. The question is no longer if, but how.

New Pathways For Patient Access

Pharmaceutical companies are under pressure to rethink how patients get medicines. Costs have piled up across the channel, including rebates, and distribution fees. For patients, the impact is obvious: prior authorization and benefit design often block therapy even when coverage exists.

At the same time, patients are behaving more like consumers. Gen Z and millennials will soon make up more than half of the U.S. population, and brands must meet patients where they are: online. They expect digital access, transparent pricing, and streamlined service. According to a report by McKinsey, “Consumers are more motivated than ever to choose healthcare options that offer a better experience, higher quality of care, and greater value.” The mismatch between expectations and the reality of the drug channel has created pressure from both sides.

While early examples of pharma companies offering direct-to-patient (DTP) access channels have existed for several years, recently, several leading pharma companies, including Eli Lilly, Pfizer, and Novo Nordisk, have made headlines for launching direct-to-patient programs to reduce some of this friction. Early impact is visible with reports that over one third of U.S. Zepbound prescriptions now run through LillyDirect. Roche’s CEO has recently said the company is exploring selling drugs directly to U.S. consumers “which would cut out pharmacy benefit managers”

Recent actions by the administration are accelerating the shift. In late July, President Trump sent letters to 17 drugmakers demanding they participate in Direct‑to‑Consumer (DTC) channels, offering patients most favored nation pricing on high volume, high rebate drugs, and set a September 29 deadline to commit.

The pressure is no longer theoretical. Policy deadlines, competitive moves, and consumer expectations are converging. Direct-to-patient access has moved from an interesting experiment to an executive-level priority. The question has shifted from whether to try it to how to execute successfully.

Key Considerations In Designing DTP Programs

Building direct-to-patient access is not just about standing up a new channel. Success depends on designing around a few core considerations that determine whether patients actually get on therapy and whether the model is sustainable for the company. GLP-1 medications (where Lilly and Novo both started) offer a good case study for considering DTP program design and also where there is room for improvement.

While innovative, the first generation of DTP models falls short on two core tenets of the consumer buying experience: price and convenience. For example, with GLP-1s, patients today face a binary choice: pay an unaffordable cash price for the branded product or take their chances with unregulated online compounders.

Pharma's attempts to sell directly via existing DTC players, such as Lilly’s partnership with Noom, or Novo’s short-lived partnership with Hims, have also met with challenges. These consumer platforms have been designed around low-cost generic or compounded medications and while providing a good customer experience, leave the patient paying a high price for a branded medication. Misaligned expectations have also plagued several of these relationships, leading to dissolution.

These early limitations underscore the need for a next-generation approach, one that meets the bar set by modern consumer platforms while addressing the structural realities of the drug channel. Here are the key considerations:

Affordability. Most DTP programs sell the medications to patients for cash at net prices, meaning the amount of money that they net off the list price after paying rebates and channel costs. However, net prices are out of reach for most patients paying cash. GLP-1s sold directly to patients cost $499 a month, which is unaffordable for most patients, compared to the $25 out-of-pocket a patient covered by insurance can pay. At current cash price points, many patients simply walk away. Even among those highly motivated to start therapy, most cannot sustain hundreds of dollars a month out-of-pocket. A study by Rock Health found that 47% of consumers considering GLP-1s cited cost as the top deterrent, and 36% of past users stopped treatment due to cost. Pharma companies need to develop models that expand access while providing options both for insurance and cash.

Service model design. Direct-to-patient channels can include many different service offerings, including telemedicine, prescription fulfillment, care navigation, and adherence support. Some of these services are offered directly by the pharmaceutical company, but more often than not, they are offered via partners. Determining which components to include in your DTP channel is a key design question, and often depends on the therapeutic area of the medications you are offering. For example, for some treatment areas, like migraine, sexual health, and obesity, offering access to prescribers is important because it can be hard for patients to find providers who are experienced with the nuances of that treatment area, or they may be uncomfortable discussing the condition with their primary care clinician. For other medications, the cost is the highest barrier, in which case, lower cost drug prices and available pharmacy services are the most critical.

Navigation burden. As we mentioned, today, patients often stitch together prescribing, fulfillment, and support across multiple vendors. Convoluted navigation flows and excessive handoffs increase friction. The burden should not fall on patients to figure out which customer service they need to reach out to, navigate to the correct vendor, or repeatedly enter information into intake forms. Even small points of friction can erode trust; Redpoint Global found that digital friction drops recommendation scores by 13 points.

Awareness and discovery. As any consumer product team would know, launching a channel isn’t sufficient to drive awareness. Patients must know that these programs exist. A Press Ganey survey found that patients now rely on digital sources 3.1 times more than provider referrals when choosing a provider. Pfizer publicized the launch of PfizerforAll with a Super Bowl ad, and while not every pharma company will go that route, ensuring that they are building awareness and driving consumers to the channel they are offering is critical.

Data usage. DTP programs offer the opportunity to connect data across different channels in a way that is difficult to do in the physical world. The Pharma commercial engine has long been built on the likes of claims data, but with the connected experience from marketing collateral all the way through to prescription, there’s an opportunity to generate much richer insight. Connecting these pieces compliantly is a critical part of program design.

Compliance. As with anything in the pharma realm, there are critical regulatory and compliance guidelines to keep in mind when designing a DTP channel. Three of the key issues to keep in mind are patient steerage, physician choice, and patient data privacy. Patient steerage refers to nudging patients toward a channel or payment path for financial reasons. Physician choice concerns improperly influencing prescriber decision-making. Programs must be designed to protect against both while keeping data privacy intact.

Getting DTP Program Design Right

The next generation of DTP must aim to close these gaps. It should integrate telemedicine, hub services, and fulfillment into a single, seamless experience, one that mirrors the convenience and clarity of modern e-commerce. Insurance should be the default payment pathway, with cash positioned as a bridge or fallback. This approach broadens access while improving affordability, giving patients a streamlined journey and giving brands the ability to scale reach without sacrificing product integrity or economic viability.

For each of the areas we highlighted, there are approaches that will help direct patients to what is needed:

Affordability. Start with an insurance-first workflow. While some patients may not have coverage, often it’s a matter of making sure the provider is correctly completing prior authorization forms. Offer patients the ability to first use their insurance coverage, and if that fails, cash as an alternative, rather than assuming they default to cash in a direct to patient model. Another option can be to use a bridge model that allows patients to pay cash for the first prescription while insurance is being processed, so treatment is not delayed. Another area of affordability is the doctor visits offered via partnerships. Be transparent about visit costs upfront and enable one-time visits, rather than directing patients to ongoing subscriptions if not necessary.

Service model design. Tailor the service stack to the therapeutic area. For more complex or sensitive conditions, integrate telehealth with specialist networks. For other conditions, cost of medication or complex prior authorization requirements may be the primary barrier, which means focusing on fulfillment and prior auth support may be the primary focus.

Reduce navigation burden. Create one front door with a seamless transition for patients from one service to another, to prevent patients from inputting information more than once. Ideally enable patients to go through one streamlined process whether they have insurance or not, to make it easier for them to get the lowest cost option, and not require them to know in advance what their benefits status is. Use an orchestration layer that eliminates jarring handoffs and maintains the individual patient context across vendors. Provide real-time visibility into the status of a prescription, whether it’s going through prior authorization, fulfillment, shipment, etc.

Drive awareness and discovery. Treat your DTP channel like you would a drug product, by marketing and advertising the channel directly, via a variety of mediums and channels. Track the success of different channels for driving awareness and adapt accordingly. Take advantage of the opportunity to direct patients from media assets directly to the DTP program. Most traditional pharma advertising does not enable the patient to take an immediate action, but rather recommends they bring it up with their physician at a later date. DTP is uniquely positioned to enable the patient to take immediate action by clicking on something that directs them to the care experience.

Optimize the experience with end-to-end data. Track (in a compliant way) as patients navigate the experience, identifying where there are drop off points and which services are best serving their needs. DTP channels are unique in their ability to track a patient across their whole journey, from awareness through medication adherence over time. Use these insights to optimize the experience and adapt the services you offer to create an even more seamless and optimal experience for patients, enabling them to receive the best care possible.

Design for compliance. Build telemedicine with an external physician group to avoid steerage. Preserve physician decision-making authority by not letting them know which channel the patient came from. Ensure patients authorize their data sharing and protect sensitive data behind firewalls, using unique identifiers to track patient flow through the system. Conduct pre-launch legal review and ongoing monitoring to keep programs aligned with evolving standards.

Acting On The Opportunity

Direct-to-patient access is no longer optional. Policy pressure now comes with explicit timelines. The administration’s demands are clear, making affordability and access a near-term compliance and legal risk, not a future ideal. Consumers are clear that cost and access remain the biggest barriers.

What to do now: start with a priority brand and design the experience based on its specific access challenges. Build for compliance from day one. Make it consumer-grade with one front door, real pricing transparency, automated coverage checks, default to coverage with cash as a fallback, and create a seamless journey without handoffs.

The companies that act to set up these channels well, and in a way that achieves the best outcome for patients, will set the standard. Those that delay will be reacting to regulators, competitors, and patients who have already moved ahead.

About The Authors:

Deepak Thomas is founder and CEO of PHIL, a Patient Access Technology platform that helps brands support their patients across prescriber practices and online. His prior background includes product and general management leadership roles at eBay and Shutterfly where he helped shape the current generation of online consumer experiences.

Sari Kaganoff advises health tech companies on strategy and GTM. She was previously Chief Commercial Officer at Rock Health Advisory, where she built and led the consulting group supporting healthcare companies on digital health strategy. Her work included advising pharma companies on digital and direct-to-patient programs. She also served as an advisor to Rock Health Capital, helping evaluate and guide early-stage health tech investments. Prior to that she spent seven years at McKinsey & Company, co-leading the Health Tech Network and Patient Experience domains and advising healthcare and pharma clients on strategy, GTM, and digital programs.