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In 2001, Peter Ax left his role as an investment banker to purchase a Utah-based online pharmacy, which ultimately grew into major telehealth platform UpScriptHealth.

In the early days of using the internet to write prescriptions, “we had to define the doctor-patient relationship on the web, and we’ve been in business ever since,” Ax says.

UpScriptHealth — a partner of Pfizer’s recently launched direct-to-consumer (DTC) platform PfizerForAll — is now playing a major role in redefining the pharma-patient relationship, one in which pharma is increasingly seeking to remove middlemen and sell their products to patients directly.

Pharma companies are no longer satisfied just being manufacturers of drugs; they aspire to be patients’ main point of contact throughout their healthcare journeys — a role traditionally held by doctors — in a shift that could upend the healthcare system.

“Pharma is recognizing they have to play a role in the delivery of care because of the broken healthcare model — and they’re going to become more and more prominent in the delivery of care,” Ax explains.

Benefits for pharma going DTC

Eli Lilly launched pharma’s first DTC platform, LillyDirect, in early 2024 with the goal of “simplifying the patient experience to help improve outcomes,” CEO David Ricks said at the time.

LillyDirect is designed to offer patients living with obesity, diabetes or migraines a seamless experience on one platform. It connects them to healthcare providers via telehealth or in-person appointments, issues prescriptions and provides drugs from an online pharmacy.

The platform attempts to offer an alternative approach to the traditional healthcare route, which often requires patients to cobble together an arduous, disjointed path of booking doctors, navigating insurance, copays and pharmacies.

Lilly and Pfizer have positioned their platforms as solutions for patient woes, but some industry experts view the platforms as a novel convergence of DTC advertising and telehealth designed to drive prescriptions.

Ax pinpoints the numerous benefits the DTC model provides for pharma companies — one being that drugmakers can increase the total addressable population that can access their products.

Pharma companies may also glean deeper consumer insights and spur increased adherence to medication, according to Ro CEO and cofounder Zach Reitano, whose telehealth company is partnering with LillyDirect to offer cheaper versions of Zepbound.

“We’re going to see that the seamless nature of the experience results in better adherence and, ultimately, better outcomes,” Reitano says. “If pharma can reach more people who persist on the medication, that’s going to be something that is quite compelling for a lot of companies.”

UpScriptHealth drives value for the pharma company by directing traffic from the branded drug website to telehealth platforms, and ultimately to a doctor who’s specifically trained in that medication and the entire disease state.

For example, on the Ubrelvy webpage, a tab dubbed “talk to a doctor” immediately redirects users to UpScriptHealth’s platform for a $35 physician visit.

Ax says UpScriptHealth tracks how many prescriptions are being written for respective drugmakers’ products, but how often prescriptions are filled varies.

“For example, what we can tell the pharma company is that we’ve seen 5,000 patients go through this platform this month, and out of those, 4,000 received a prescription,” Ax explains. “And out of that 4,000, 700 received a prescription of this drug, and the rest received other types of treatment.”

Pharma is noticing the benefits: UpScriptHealth inked six partnerships with major drugmakers in 2022, with the number rising to 30 by 2024. Ax expects that to double this year. Meanwhile, other major telehealth players, such as Populus and Prescribery, have also moved into the pharma DTC space.

Concerns/Senate investigation

But not everyone is convinced that pharma’s new DTC foray is revolutionary for patients — or as transparent as it should be.

One common concern among critics is the lack of clarity around how physicians on telehealth platforms are compensated and whether they’re influenced — either overtly or subtly — to prescribe more of the pharma company’s medications.

The platforms specifically work to “collapse the space and time between a patient seeing an ad and getting a branded medication in their hand,” according to Matt McCoy, assistant professor of medical ethics and health policy at the University of Pennsylvania.

“The concern is that from the moment you get to these sites, you’re on a path that’s intended to channel you toward getting the drug,” McCoy says, pointing to how consumers are a couple clicks away from a consultation and prescription. “Someone who’s persuaded by an ad can take immediate steps, rather than the [longer] traditional steps.”

Adriane Fugh-Berman, a professor of pharmacology and physiology at Georgetown University Medical Center, thinks there’s a lack of transparency around the contractual relationships of the telehealth companies and the pharma companies, as well as around the expectations of the healthcare providers working for the platforms.

“From a business standpoint, it’s advantageous for [pharma companies] to cut out the middleman and market directly to patients,” Fugh-Berman says. “But this is pharma usurping the role of healthcare providers. It has the veneer of objectivity and of not being a direct marketing effort, even though it is.”

Certain lawmakers have recently echoed similar concerns. Last fall, Sens. Dick Durbin (D-IL), Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) sent letters to Lilly and Pfizer requesting more information about whether the new DTC platforms engage in “inappropriate prescribing.”

Both Reitano and Ax emphasize that pharma companies don’t incentivize physicians in ways that impact providers’ independent decision-making.

“They’re not compensated any differently whether or not they write a prescription at all, let alone for a specific product,” Reitano says.

Eli Lilly declined an interview for the story, but said in an emailed statement that “these providers are fully independent from Lilly, exercise their own clinical judgement in evaluating and making care decisions, are not incentivized to prescribe Lilly medicines and do not provide any compensation to Lilly for referrals.”

Still, McCoy says a gray area remains when pharma is the first point of contact for patients in the healthcare system, noting that their incentives weren’t neutral.

He hopes there will be some movement on the regulatory front to provide more transparency into the platforms in order to minimize any potential risks for patients. But he says he’s “skeptical” that any tangible regulation would pass anytime soon.

Ax expects more major drugmakers to follow in Lilly and Pfizer’s footsteps and launch their own DTC platforms in what he refers to as a shift toward above-brand strategies.

“The entire sense of what pharma means to patients is going to evolve,” Ax explains. “It’s not just, ‘We’re here to sell you a drug, we’re going to charge you too much for it.’ That whole mentality is going away over time. These pharma companies are going to be a part of the solution in your world as a patient.”

From the February 01, 2025 Issue of MM+M - Medical Marketing and Media