Patients Face New Care Complexities as DTC Options Expand

As pharmaceutical companies rapidly expand direct-to-consumer (DTC) models amid shifting US drug pricing reforms and the upcoming launch of TrumpRx, experts warn that these approaches introduce as many complexities as benefits for patients.

Pharma Embraces Direct-to-Consumer Models Amid US Drug Pricing Reforms

DTC pharmaceutical models allow manufacturers to advertise and sell medications directly to patients at discounted cash prices.¹ Patients pay out of pocket, removing the insurance component and eliminating the need to submit claims or seek insurer approval. By bypassing retail pharmacies, wholesalers, and pharmacy benefit managers, these models streamline the supply chain and increase pricing transparency, instead relying on online platforms, telehealth services, and home delivery. In turn, manufacturers gain more control over distribution and can offer patients more reliable access.

Eli Lilly and Company was an early DTC model adopter with the January 2024 launch of LillyDirect, an online platform that connects patients with telehealth services for obesity, diabetes, and migraine care.² Its LillyDirect Pharmacy Solutions platform, powered by third-party digital pharmacy fulfillment, offers consistent access to select Eli Lilly medications with home delivery. Purchasing directly through the company also enables automatic application of eligible affordability programs, including savings cards.

Pfizer entered the market later that year with PfizerForAll, which similarly enables patients to schedule telehealth visits, fill prescriptions, and access savings programs for its migraine, COVID-19, and flu medicines. It also provides home delivery for both prescription and over-the-counter products, as well as COVID-19 and flu tests, while connecting eligible patients to support services and affordability programs.

Earlier this year, Novo Nordisk launched NovoCare Pharmacy, offering home delivery of all semaglutide (Wegovy) dose strengths at a reduced cost of $499 per month.³ Although 90% of current semaglutide users pay only a $0 to $25 monthly co-pay, this option is intended to support uninsured patients who pay out of pocket. The company also emphasized that purchasing through NovoCare Pharmacy ensures access to authentic semaglutide amid widespread concerns about counterfeit or compounded products.

Momentum accelerated after President Donald J. Trump sent letters to major pharmaceutical companies this past summer as part of the most favored nation (MFN) executive order, which seeks to align US drug prices with the lowest prices offered in other developed nations.⁴ The letters urged manufacturers to extend MFN pricing to all Medicaid patients and commit to not offering lower prices abroad, warning of aggressive federal enforcement against “abusive drug pricing practices.”

The plan also allows manufacturers to bypass intermediaries and sell directly to patients if the price does not exceed the lowest available rate in developed countries. Building on the growing DTC landscape, Trump announced TrumpRx in September, a government website launching in 2026 that will enable Americans to purchase medicines directly from manufacturers at steep discounts.⁵

Pfizer became the first company to reach an agreement with the administration on September 30, offering most of its primary care treatments and select specialty products through TrumpRx at an average discount of 50%. In return, Pfizer receives a 3-year exemption from tariffs on branded drugs manufactured outside the US, which took effect on October 1.

Soon after, Amgen launched AmgenNow to expand access to evolocumab (Repatha) and stated it plans to make the program available through TrumpRx.⁶ Days later, AstraZeneca finalized its own agreement and joined the initiative, followed by Eli Lilly and Novo Nordisk, which both agreed to reduce prices on their glucagon-like peptide-1 (GLP-1) receptor agonists for inclusion on TrumpRx.^7,8

The Trade-Offs of DTC Models

DTC models offer both advantages and drawbacks for consumers, according to experts interviewed by The American Journal of Managed Care^® (AJMC): Joey Mattingly, PharmD, MBA, PhD, of the University of Utah College of Pharmacy; Jennifer Graff, PharmD, of Innov8 Health Policy; and Brian Reid, MS, of Reid Strategic.

Graff explained that these models have reshaped the patient journey by reducing the “friction” associated with finding a provider, scheduling appointments, undergoing tests, and receiving a diagnosis and treatment. Mattingly added that consumers may feel more in control of their medication choices because they can select treatments without insurance approval. Specifically, Reid said that DTC platforms provide access to drugs not covered by insurance or those that typically require complex utilization management.

Medications commonly offered through DTC platforms include GLP-1 receptor agonists for weight loss and inexpensive generics for conditions such as high blood pressure or high cholesterol, according to Mattingly. Other available products address needs outside traditional benefits, including treatments for male pattern baldness and erectile dysfunction.

Despite these advantages, Graff emphasized that DTC models can introduce new challenges for consumers.

“…The patients who are most likely to benefit from the DTC models are those who are engaged, where the friction cost to engage in the DTC model is lower than the friction cost of receiving care through their normal health care coverage,” she told AJMC. “This means that patients may be paying more out of pocket. The cost that they’re paying as a consumer doesn’t come out of their total out-of-pocket network or deductible costs, and so it’s almost inflating the costs above and beyond what they might be seeing through employer-sponsored coverage."

Mattingly also warned that DTC models may result in consumers receiving medications from multiple sources, increasing the risk of unrecognized drug interactions. Traditional pharmacies typically check for interactions, counsel patients on refills, and ensure that therapies are not harmful, which are safeguards that can be lost in DTC pathways.

“…It’s just going to put more people in this weird place where we might see adverse events, because our system is kind of crazy, and I think we can make it simpler,” Mattingly said in an interview with AJMC. “Why can’t we have a one-stop shop for patients so that everything is under one pharmacy home?”

Reid added that many consumers remain skeptical of DTC programs because their prices are often higher than what they are used to paying. Although DTC models may benefit some outliers, he noted that they are not “viable” options for most consumers and will not solve broader health care spending challenges.

“We need to be thoughtful and sensitive to the limits of this and be very clear about the problems we’re solving as opposed to putting this forward as some sort of magic tool that’s going to revolutionize the health system, bring low net prices to everyone, and create an alternative universe for these kinds of purchases that’s going to be happening,” Reid told AJMC. “…It’s going to be important to really define our terms about who’s going to benefit, what kind of medicines we’re talking about, what kind of prices we’re talking about, and just let the chips fall where they may.”

Uncertainty Surrounds TrumpRx as Launch Nears

With TrumpRx slated to launch in 2026, the experts stressed that many questions remain. Rather than acting as a commercial player, Reid explained that TrumpRx is envisioned as an aggregator of existing systems to improve user experience.

“TrumpRx itself raises the question of how we corral a rapidly expanding universe and ensure that we don’t, in an effort to simplify the system, actually fragment things in a way that’s going to be pretty hard for patients,” he told AJMC.

Although manufacturers have agreed to participate, Mattingly noted that not all products will be included in the program. Graff echoed Reid's point, explaining that, unlike manufacturer-run DTC programs, TrumpRx does not yet offer a streamlined marketplace where consumers can consult a telehealth provider and obtain medications at a reasonable cash price.

“It’s not quite clear that the TrumpRx plan will be much more than a landing page, which is a good starting spot, but perhaps not what all consumers are going to need to see lower prices when they go to fill their medications,” she said in an interview.

Looking ahead, Reid stressed the importance of educating patients on their benefits and options. Lower-cost options are generally positive, but he cautioned that they may add complexity, increasing the risk that patients choose a higher-cost DTC option without realizing they could access a lower-priced alternative through their insurance. Consequently, Reid underscored the responsibility of stakeholders to prioritize patient education.

“The pharmaceutical industry, the health care system as a whole, has never really prioritized that kind of education, and I think that’s often been to the detriment of patients,” he concluded. “I think we’ve got a new challenge in front of us, to make sure that in this world of expanding options, which is fantastic, we make sure that patients are educated enough to understand what those options are.”

References

1. “Pharm-to-table”: the impact of direct-to-consumer pharmaceutical sales on patient access, market dynamics and investor strategy. Debevoise & Plimpton. September 29, 2025. Accessed November 25, 2025. https://www.debevoise.com/insights/publications/2025/09/pharm-to-table-the-impact-of-direct-to-consumer
2. McCormick B. Pfizer enters direct-to-consumer market with telehealth, prescription services and more. AJMC. August 28, 2024. Accessed November 25, 2025. https://www.ajmc.com/view/pfizer-enters-direct-to-consumer-market-with-telehealth-prescription-services-and-more
3. Novo Nordisk introduces NovoCare Pharmacy, lowering cost of all doses of FDA-approved Wegovy (semaglutide) to $499 per month and offering easy home delivery for cash-paying patients. News release. Novo Nordisk Inc. March 5, 2025. Accessed November 25, 2025. https://www.prnewswire.com/news-releases/novo-nordisk-introduces-novocare-pharmacy-lowering-cost-of-all-doses-of-fda-approved-wegovy-semaglutide-to-499-per-month-and-offering-easy-home-delivery-for-cash-paying-patients-302392874
4. Santoro C. Trump directs pharma companies on cutting drug prices under Most-Favored-Nation order. AJMC. July 31, 2025. Accessed November 25, 2025. https://www.ajmc.com/view/trump-directs-pharma-companies-on-cutting-drug-prices-under-most-favored-nation-order
5. Joszt L. White House, Pfizer reach agreement on drug discounts; Trump announces TrumpRx. AJMC. September 30, 2025. Accessed November 25, 2025. https://www.ajmc.com/view/white-house-pfizer-reach-agreement-on-drug-discounts-trump-announces-trumprx
6. McCormick B. Amgen direct-to-patient program aims to expand access to evolocumab amid US drug pricing reforms. AJMC. October 6, 2025. Accessed November 25, 2025. https://www.ajmc.com/view/amgen-direct-to-patient-program-aims-to-expand-access-to-evolocumab-amid-us-drug-pricing-reforms
7. Mattina C. White house to announce second drug pricing deal as AstraZeneca joins TrumpRx. AJMC. October 10, 2025. Accessed November 25, 2025. https://www.ajmc.com/view/white-house-to-announce-second-drug-pricing-deal-as-astrazeneca-joins-trumprx
8. McNulty R. Trump announces deals with Lilly, Novo to cut weight loss drug prices. AJMC. November 6, 2025. Accessed November 25, 2025. https://www.ajmc.com/view/trump-announces-deals-with-eli-lilly-novo-nordisk-for-lower-weight-loss-drug-prices