How Virtual Care Is Rewriting the Direct-to-Patient Playbook

There is a moment the pharmaceutical industry has spent decades and billions of dollars optimizing for—and it is increasingly the wrong one, argued Chris Moose, vice president of life sciences at Wheel, in a session at Asembia’s AXS26 Summit.¹ That moment is the prescribing encounter: the point at which a patient sits across from a clinician, receives a diagnosis, and is handed a script. Wheel is a virtual care infrastructure platform powering organizations including Pfizer, Walmart, GoodRx, and Amazon, and Moose has the data to back up the argument that this moment has moved. And for pharmaceutical companies still building commercial strategies around it, that movement represents an existential challenge.

The Prescribing Moment Has Moved Upstream

The shift, Moose explained, is being driven by a new kind of patient—one who arrives at the clinical encounter already informed, already self-diagnosed, and already with an opinion about what treatment they want.

“Patients are working with someone that has a longitudinal understanding, arguably better than the providers do about that patient, and that's what's going on with these AI [artificial intelligence] chatbots and LLMs [large language models],” explained Moose. “As people hook them into their health records, as they upload their health records, as they ask a question last week and come back today, the LLMs, because they're persistent, are building a longitudinal understanding, and that means the patient is getting better perspective and a more defined opinion about what's going on with their health care.”

This matters commercially because it means the traditional direct-to-consumer (DTC) arc of ad exposure, symptom recognition, and physician visit is no longer sufficient. The patient has already formed intent before the encounter happens. If a pharmaceutical company is not present at the moment that intent crystallizes, it has missed its window.

“Brands aren't ready at that moment, at 11 o'clock when a patient's doing the research online, has a question, thinks they know what they want to do, [and] wants a clinician to help them with that journey,” said Moose. “That moment is what brands are currently missing if they're still going back to the beginning of this thinking about commercialization at the point of care for some kind of a physical setting.”

3 Broken Assumptions—and a New Model

Moose structured much of his argument around 3 assumptions he believes the industry must discard. The first is the equation of affordability with access. The traditional logic—reduce the financial barrier and patients will adhere—is insufficient.

“Access means the ability to start and also to then sustain a treatment,” said Moose. “That means it's the price, and it means it's the encounter. All of those things have got to come together at a moment in time.”

The second broken assumption is that intent translates into care. Moose introduced what he called the "happy path"—a patient who researches, gets same-day virtual access to a clinician, begins therapy within days, and achieves clinical improvement within a month. The contrast with the traditional path—where waits of 2 to 4 weeks for a clinician appointment are common—is stark.

“Intent has a high half-life, so we might spend money creating brand awareness, getting someone understanding that there's a therapy out there that can help them have a happier life, but they don't have any way to then get on to that therapy,” said Moose.

The third assumption is that adherence is best managed at the prescriber level. Moose argued that as the patient becomes more central to the care relationship, the relevant unit of measurement shifts from prescriber script volume to individual patient persistence.

“Now you've got a much harder problem that you have to solve around adherence, but it's critical to solve that, because if your patients are churning, then it's like having a leaky bucket, and we can throw more and more money into our marketing spend and put a bigger hose putting water into this pail that's leaking, but you're never going to catch up,” said Moose.

In place of these assumptions, Moose proposed what Wheel calls the "company wheel"—a circular model in which access, treatment initiation, retention, and data-driven insights continuously feed one another, with each pass around the loop improving the ability to re-engage the patient.

GLP-1s as the Entry Point for Everything Else

Moose grounded the argument in Wheel’s own platform data: 7.5 million encounters, over 20 million voice-of-patient moments, and 4000 patients seen daily. He noted that the growth is not linear—nearly 1.5 million patients were seen in 2025 alone, representing 20% of the platform’s total lifetime volume.

The most significant insight from that data, he argued, concerns what brings patients in and what keeps them. Women’s health accounted for half of all encounters on the platform last year—but nearly 70% of encounters are repeat visits, with patients who began in one therapeutic area migrating laterally into others as they build trust with the platform.

This dynamic is why the glucagon-like peptide-1 (GLP-1) market continues to attract investment despite already being crowded with highly effective therapies. Real-world direct-to-patient (DTP) data supports his case: according to IQVIA’s analysis of 180-day adherence data, patients using DTP vial channels for GLP-1 therapies maintain persistence levels comparable to those with commercial insurance, and manufacturers including Novo Nordisk and Eli Lilly are already using their platforms to offer therapies beyond obesity—a signal that these programs are evolving into enduring multicondition channels rather than product-specific workarounds.²

“Weight management becomes the activation point,” said Moose.¹ “Someone then continues around. They're working with Wheel or their provider to understand more about their medication management, to help more with their diagnosing. Now they're getting chronic care management again.”

The retention data is equally instructive. Moose presented a comparison between 2 program models: a pure access program that puts patients on a single therapy and achieves 50% retention vs a longitudinal, multicondition program achieving 70%. The math is compounding: to reach 50,000 patients at year-end under the 50% model requires starting with a far larger funnel. At 70% retention, the same end point is reachable with 75,000 patients at the top of funnel.

“Retention drives the value, not initiation,” said Moose. “It’s a fundamentally different way of thinking about the market.”

From Transactions to Connected Care—and What to Look For in a Partner

The strategic implications Moose drew were pointed. The first: retire the old key performance indicators. High-volume prescribers, new-to-therapy starts, and script volume are artifacts of the prior model. The first script, he argued, is no longer where value is created.

The second is a harder shift—from transactional interactions to what he called "connected care." The evolution runs from brand-level content to condition-level content, to category management, to comprehensive and connected care across the patient journey. The pivot point, he suggested, is one that the pharmaceutical industry briefly glimpsed during the COVID-19 vaccine rollout: when patients talked about getting "the Pfizer" or "the Moderna," they were relating to the enterprise, not the brand. That enterprise-level relationship is the destination.

“When you talk about the enterprise and the patient understands who those different pharmaceutical companies are and the way this pharmaceutical company has a series of brands that help the patient, you just made that jump from talking in terms of conditions into categories, but more importantly, into comprehensive,” said Moose.

On the question of virtual care vendor selection, Moose described Wheel walking away from a relationship with a manufacturer because the therapy had a viable over-the-counter first-line option that clinicians could not in good conscience bypass.

“Make sure you have someone that's willing to say no,” emphasized Moose. “Make sure you have someone that's treating your patient's data with the utmost respect that you would expect.”

He was equally emphatic on data governance: virtual care partners should operate with the same data security standards as large health systems—personally identifiable information hashing, Health Insurance Portability and Accountability Act–compliant tokenization, and clear separation between brand teams and clinical decision-making.

Moose closed with a formulation that distilled the session’s thesis: simply placing a "talk to a clinician now" button on a brand website is not a patient engagement strategy. What is, he argued, is building systems that convert intent into continuous care—that meet the informed, AI-assisted patient at the moment of need, funnel them into a clinical relationship, and use the resulting data to keep improving the loop. For pharmaceutical companies willing to make that structural shift, the patient relationship that emerges looks less like a transaction and more like the beginning of a long conversation.

References

1. Moose C. Designing DTP care for persistence, not transactions: what 7.5 million virtual visits reveal about durable commercialization. Presented at: AXS26; April 27-30, 2026; Las Vegas, NV.

2. Greenwalt L, Landsman T, Goodswen C, et al. Non-traditional channels: the growth of direct-to-patient programs. IQVIA. February 10, 2026. Accessed April 28, 2026. https://www.iqvia.com/locations/united-states/blogs/2026/02/non-traditional-channels-the-growth-of-direct-to-patient-programs