Do Direct-to-Consumer Pharmacies Present More Challenges for Patients?

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At the beginning of the year, Lilly launched LillyDirect, a direct-to-consumer (DTC) platform, aiming to improve access to drugs, including the antiobesity medication Zepbound (tirzepatide). As part of the process, LillyDirect sidesteps pharmacy benefit managers (PBMs) and insurance formularies, selling drugs directly to the patients at a potentially lower price. However, a recent commentary published by JAMA Network points out that the service also incorporates Lilly's co-payment assistance programs, arguing that it could destabilize efforts by PBMs and health plans to manage cost-control initiatives.¹

“As prices and spending on prescription drugs have risen in the last several decades, PBMs have provided an important counterweight, negotiating rebates—or discounts—from drug makers in exchange for better formulary coverage that drug companies need for patients to access their products,” said Benjamin N. Rome, MD, MPH, author of the JAMA article. “For some drugs, PBMs can extract meaningful discounts. For example, rebates offset more than half of Medicare spending on drugs for diabetes in 2021.”

Among other features, LillyDirect provides a referral list of in-person and telehealth providers, making access considerably easier. Citing a long history of interactions between the two parties, Rome believes that it could lead to biased prescribing practices influenced by drug company promotions. Paired with DTC marketing, he warns this could result in higher use of expensive branded drugs as opposed to cheaper alternatives.¹

“Pharmaceutical companies promote their drugs to clinicians by employing armies of detailers to visit physician offices, funding meals and conferences, and retaining some physicians as paid consultants. Studies consistently show that clinicians who receive manufacturer visits and incentives are more likely to prescribe that manufacturer’s drugs,” Rome explains. “Drug companies also spend billions of dollars each year advertising their drugs directly to patients, who have limited ability to discern the therapeutic risks and benefits of these products. The result of these marketing strategies is greater use of expensive drugs over less costly alternatives.”

Despite these issues, Rome suggests that there are a few alternative solutions to DTC platforms:

• Currently, formulary tools are difficult for patients to understand, with most healthcare providers showing disdain for them. Therefore, insurers should streamline the process to make it more transparent.
• Improving communication between pharmacies and medicine prescribers.
• Expanding drug price negations that have been in the works resulting from the Inflation Reduction Act.¹

When the platform launched last month, Lilly stated that it would continue to update the service, with the potential for further products, partners, and services, including programs to support patients with medicine adherence. The company also stated that the service will result in less burdens for patients struggling with chronic illnesses.^2,3

"A complex US healthcare system adds to the burdens patients face when managing a chronic disease. With LillyDirect, our goal is to relieve some of those burdens by simplifying the patient experience to help improve outcomes," said David A. Ricks, chair, CEO, Lilly, in a press release. "LillyDirect offers more choices in how and where people access healthcare, including a convenient home delivery option to fill Lilly medicines they have been prescribed."

In an interview with Pharm Exec last month, Bill Roth, general manager, managing partner, Blue Fin Group, discussed the impact of LillyDirect on prescription drug sales and patient management, commenting on the ethics involved with providers having close ties with manufacturers.⁴

“From the point of view of the manufacturer, if you've ever spoken behind closed doors with a brand manager, they really have two main focuses. They actually do care about the patients that they want their drug to get to. I haven't met a brand manager in my 30+ year career that isn't forwardly altruistic about the reason that they have their product on the market to begin with,” Roth explained. “I think where the ethics play in is whether or not the payers have placed the product in a realistic position for affordable access. That's a broad topic we're hitting across the spectrum. The reality is that the plan sponsors want to make sure that the patients have access to products. The patients want affordable access to those products."

“The challenge is that when you're facing aggressive rebate scenarios the various discounts and statutory rebates that manufacturers are required to pay to the government, how do you pay for those economics and still have something positive at the end of the day? There's a specific number of drugs on the market right now that have hundreds of millions of dollars of sales, and they can't make money on the product.”

References

1. Direct-to-Consumer Drug Company Pharmacies. JAMA Network. February 27, 2024. Accessed February 29, 2024. https://jamanetwork.com/journals/jama/fullarticle/2815802

2. Eli Lilly Launches Telehealth Platform to Sell Certain Drugs Directly to Consumers. Pharmaceutical Executive. January 5, 2024. Accessed February 29, 2024. https://www.pharmexec.com/view/eli-lilly-launches-telehealth-platform-to-sell-certain-drugs-directly-to-consumers

3. Lilly Launches End-to-End Digital Healthcare Experience through LillyDirect™. Lilly. January 4, 2024. Accessed February 29, 2024. https://investor.lilly.com/news-releases/news-release-details/lilly-launches-end-end-digital-healthcare-experience-through

4. The Impact of Eli Lilly's New DTC Platform on Rx Drug Sales and Patient Access: An Interview with Bill Roth, General Manager, Managing Partner, Blue Fin Group. Pharmaceutical Executive. January 18, 2024. Accessed February 29, 2024.