Pharma goes direct-to-patient
Big Pharma’s direct-to-consumer sales channels won’t up-end the US health system.
So pharma has less room to wiggle, but a greater need to do so. One consequence of this dilemma is direct-to-patient sales, which allow manufacturers to skirt insurer- and PBM-negotiated price constraints on their best-sellers (even if they can’t stop IRA or MFN). Eli Lilly in early 2024 set up its own online pharmacy service, LillyDirect, to broaden patient access to its high-demand weight loss drug tirzepatide (sold as Mounjaro and Zepbound), restricted by most payers to only the most severe patients. Novo Nordisk and AstraZeneca followed; Pfizer set up a consumer discount program for clot-buster Eliquis with partner Bristol Myers Squibb and offers a wider product range via PfizerforAll. Roche and Sanofi are said to be considering the model for some products.
These set ups give pharma a way to offer transparent pricing and to demonstrably expand patient access to certain large products ahead of patent expiry (Eliquis may face competition from 2028). As US drug prices have come under scrutiny, manufacturers have been locked in battle with PBMs, each blaming the other for those high prices (though PBMs’ clients, large employers and state governments, also have a lot to answer for, as Roger Longman, founder and Chairman of market access consultancy RealEndpoints points out in a recent article). President Trump told drugmakers over the summer to lower their prices or else, and in return offered ways to help cut out middlemen.
Big Pharma’s direct-to-consumer sales channels won’t up-end the US health system. Insurer-backed health plans will continue to administer and provide most prescription medications to insured patients; direct-to-consumer channels are restricted – for now – to high-use, easy-to-take drugs that enough patients are willing to fund out-of-pocket.
But the appearance of these channels, in relatively quick succession, signals the growing role of patients, the end-users. This is also reflected in FDA’s new pathway for over-the-counter (OTC) drugs, The Additional Condition for Nonprescription Use (ACNU) pathway. This allows some prescription medicines to be marketed as OTC, provided manufacturers provide additional guidance beyond the label – such as app-based questionnaires or videos – to ensure proper treatment selection and use. “The consumer is being invited back into the driver’s seat,” summed up Avalere Health Principal Jessica Cortez on an August 2025 webinar.
The implications of this shift, for consumers and Big Pharma, could be significant. Consumers – already engaging with health technology apps and wearables to track health metrics – will now also have more ways to access (and pay for) medicines. Big Pharma will start to look more like consumer goods companies, bringing on different kinds of experts and, potentially, re-thinking R&D programs with these end-channels in mind.
Big Pharma will start to look more like consumer goods companies.
