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As President Donald Trump intensifies his rhetoric demanding that pharma companies lower their drug costs, industry leaders are increasingly throwing their support behind an emerging trend — direct-to-consumer (DTC) platforms — as one way to appease the White House.

Since Eli Lilly launched its DTC platform LillyDirect in early 2024, various pharma companies — including Pfizer, Novo Nordisk, Roche and Bristol Myers Squibb — have either launched their own or announced plans to do so. And in the last few months, pharma leaders have become more vocal about tying these platforms to the Trump administration’s goals of lowering drug prices.

DTC platforms claim to cut out the middlemen, such as pharmacy benefit managers (PBMs), and offer cheaper prices for branded drugs like Novo’s Ozempic and Lilly’s Zepbound directly to the patient. In theory, the platforms offer a simpler, quicker way for a patient to access medication at often half the list price, especially if the drug isn’t covered by their insurance.

Several pharma CEOs, industry insiders and telehealth executives have expressed support for the idea. But other experts including physicians, academics and — unsurprisingly, PBMs — raised questions about the validity of DTC platforms as a drug pricing reform measure that would help those who need it the most.

“The prices on these platforms [remain] unaffordable for most Americans and most of my patients,” noted Reshma Ramachandran, a primary care physician and assistant professor of medicine at Yale School of Medicine. “This seems like a horse-trade for companies to avoid a more stringent policy around lowering drug prices, and for the administration to claim credit at least in rhetoric without actually lowering drug prices.”

The promise of pharma DTC platforms

At the beginning of August, Trump sent letters to 17 major drugmakers, requesting that they implement Most Favored Nation (MFN) pricing or else face efforts from the administration to “protect American families from continued abusive drug pricing practices.”

In the letters, Trump suggested that pharma companies consider DTC models that would remove middlemen as part of their efforts to align U.S. drug costs more closely with those in other countries.

Pfizer CEO Albert Bourla, as well as Eli Lilly CEO David Ricks, expressed support for the DTC pathway as a drug pricing solution in their Q2 earnings calls. Ricks said that Lilly planned to expand upon the success of LillyDirect when it comes to its GLP-1 drugs, and Bourla noted that pharma executives have been having discussions about the model as a potential solution to drug pricing policy.

“I’m connected very often individually with all the major companies and they are all ready to roll up their sleeves and executive something like that,” he said. “We think it is a fantastic way to go ahead, so we will work collaboratively to do it.”

Roche CEO Thomas Schinecker also recently hinted at plans to launch a DTC model for its medicines as part of its talks with the U.S. government.

BMS, meanwhile, launched its own DTC program called Eliquis 360 Support in July. That program cuts the list price of Eliquis, a blood thinner used to treat and prevent blood clots, by 40% for people who are uninsured or under-insured and who would be paying out-of-pocket for it.

A BMS spokesperson told MM+M that the company shared the Trump administration’s goal of improving affordability, increasing transparency and cutting out the middleman. BMS’ new DTC program, they said, offers a more “direct, transparent” pathway that “bypasses traditional barriers.”

“This program is part of our commitment to increasing patient access and affordability, and being proactive with solutions,” the spokesperson said. “It’s an important step to help patients who are without insurance and who go to the pharmacy counter to self-pay, to provide a significant cost reduction based on the list price and improve the affordability for this life-saving medicine.”

Could DTC lower drug prices?

Beyond the promise of such platforms is the question of whether they would actually result in more money in patients’ pockets. Selling a drug for half the list price on a DTC platform, in theory, sounds significant — but the reality is a little more complicated.

Even with removing middlemen and cutting the price of a drug like Eliquis or Zepbound in half, a patient will still be paying a higher price than they would if their insurance covered the drug. Eliquis 360 cuts the price of Eliquis from $606 to $346 for self-paying patients, but that’s still significantly higher than the average out-of-pocket cost of $38 for patients with commercial insurance — about nine times higher.

According to Eliquis 360 Support’s website, 90% of Eliquis prescriptions are already covered by commercial and Medicare Part D plans. That leaves the remaining 10% of people needing the drug to turn to a DTC platform for a lower price.

As a result, the claim of savings doesn’t translate to the vast majority of patients in the healthcare system, according to Ramachandran. In her day-to-day experience, the only patients she sees using a platform like LillyDirect are those who already have commercial insurance but it doesn’t cover a specific drug — typically GLP-1s for weight loss — and who can afford the hefty out-of-pocket price, however discounted it is.

“They tend to be wealthier, to be frank,” Ramachandran said. For the rest of her patients, it’s “impossible in terms of the pricing.” She pointed to LillyDirect’s monthly offer of Zepbound for $499 as opposed to its monthly list price of $1,049, which is still too expensive for many patients to afford.

“Even to get the [cheaper] vials that LillyDirect was offering, my patients couldn’t afford it,” she said. “So they’re just no longer on these medications. Even at these prices that are slightly lower than the list price, I haven’t seen significant savings for patients.”

In addition, people paying out-of-pocket for drugs through DTC models wouldn’t be spending money that contributes to their insurance deductibles or out-of-pocket maximums. In short, the benefits of such programs as they are currently designed are limited.

A fine-tuned path forward

As more pharma players enter the DTC arena, such platforms will likely continue to proliferate in the coming months. And there’s still an argument being made among industry leaders, and even some PBMs, that a fine-tuned DTC model could work in tandem with other drug pricing measures.

“I do think that the DTC approach, if you think about it purely as a channel for how people get access to drugs — much like Mark Cuban’s company, Amazon Pharmacy and others — has value,” said George Van Antwerp, senior vice president of product innovation and strategic planning at PBM Prime Therapeutics.

Zach Reitano, CEO of telehealth company Ro — which partners with LillyDirect to sell GLP-1s — believes the DTC model has its place in the future of healthcare.

“It’s not an ‘or’ — it’s an ‘and,’” Retaino said. “It’s a mechanism to complement our existing system, where the traditional insurance system falls short. That’s not everywhere, and I think the more we can start to tease out where it’s best and where it’s not, patients will be better off.”

But there are many factors to consider in order for the model to be effective for patients, Van Antwerp said. That includes making sure claims are integrated and that DTC platforms don’t make the healthcare system more fragmented than it already is. He also pointed to concerns — currently being investigated in Congress — that some physicians linked to telehealth companies partnering with such platforms could inappropriately prescribe certain drugs, or are influenced to prescribe the pharma company’s products.

“We want to make sure those things aren’t happening and that the patient is getting the full benefit of clinical oversight, the best drug price, and that we’re working with them to navigate the complex healthcare system,” Van Antwerp said.

“We have to be careful,” he added, “given consumers are already burdened from an out-of-pocket perspective on their healthcare spend, that this isn’t just a new way to shift cost to consumers.”

Both Ramachandran and Alan Sager, professor of health law, policy and management at Boston University warned that pharma’s emphasis on DTC models should not distract policymakers from focusing on more robust drug pricing measures, like the federal government’s march-in rights or Medicare negotiations.

“DTC platforms are yet another political smokescreen for drugmakers to insulate themselves from efforts that would actually save patients money,” Sager said.