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Pharmaceutical Executive
Direct-to-Consumer Prescription Care Comes of Age
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Key Takeaways
- DTC prescription models empower patients with more control over medication access, driven by high-deductible plans and rebate fatigue.
- Fragmented pharmacy access highlights the need for a cohesive, member-centered experience, which DTC aims to provide.
A look back and ahead at the growing trend—sparked recently by the GLP-1 trail—and new ways to harness this Rx access channel for positive outcomes.
It was May 1983 when American consumers first saw a TV commercial for a prescription drug: an ad for the pain reliever Rufen.1 The moment marked the start of a new relationship between pharmaceutical manufacturers and patients, effectively changing conversations in exam rooms across the nation. For the first time, doctors weren’t the only source of information about medication options, and patients brought with them questions, preferences, and brand awareness.
Thirty years later, in 2013, Pfizer took the next leap by offering Viagra via home delivery discreetly, conveniently, and directly to the patient’s doorstep. It was a turning point that established the direct-to-consumer (DTC) channel in prescription care. Patients were willing to pay out of pocket, and they valued privacy. Sound familiar?
Fast forward to today, GLP-1s are blazing their own DTC trail. With heavy advertising and celebrity endorsements, they’re shedding the old stigmas and perhaps signaling a cultural shift. While these two drug classes might seem worlds apart, they both illustrate the accelerating trend: consumers are increasingly in the driver’s seat when it comes to how and where they get their prescriptions filled. Fueled by consumer expectations, high-deductible health plans, and benefit complexity, DTC models are no longer an outlier. When done right, DTC can be a powerful strategy for cost containment, member engagement, and even clinical improvement. Employers who pay attention to this trend, and partner with the right solutions, can reduce waste, expand access, and strengthen the value of their benefit offerings.
For those of us working in pharmacy benefits, this is an invitation. We can lean in and design smarter solutions that help patients get the medications their doctors prescribe at the best possible cost with the support they deserve. DTC is proving to be one of those options.
What’s driving the rise of DTC prescription models?
Several big forces are at play, including:
- High-deductible health plans and denials. With thousands of dollars in up-front costs and increasing denials, patients are shopping smarter for the best price and access.
- Rebate fatigue. As scrutiny over opaque rebate deals grows, some manufacturers are exploring DTC as a way to set a fair price and streamline access for patients.
- Fragmented pharmacy access. Today’s system already fragments care between retail, mail-order, specialty, and hospital pharmacies. Patients juggling multiple meds need consistency and support, not more fragmentation. The emergence of DTC spotlights the need for a cohesive, member-centered experience.
Choosing DTC typically means that patients pay for their medication directly, outside of their health insurance and without applying any out-of-pocket payments toward their insurance deductible—a financial loss they knowingly accept. For many, the benefits of predictable pricing, easier access, and avoiding the headaches of formularies and denials outweigh the disadvantage of not having those costs count toward meeting their deductible for the year. In essence, DTC provides a simpler experience that many find preferable, even if it means forgoing some insurance benefits.
Not just lifestyle meds
DTC isn’t just about lifestyle drugs. In some cases, it’s about access and equity.
Women’s health, for example, continues to face long-standing coverage gaps and stigma. Whether for menopause support, hormone therapy, or treatments for conditions such as endometriosis or migraines, many women face delays or denials when trying to access necessary care. Many employer-sponsored plans either don’t cover hormone therapy or require step therapy or medical necessity documentation, and compounded bioidentical therapies are often excluded outright. In these cases, DTC can be a valuable lifeline, particularly when paired with pharmacist support and integrated into broader care.
DTC doesn’t mean patients fly solo
Direct access shouldn’t mean doing it alone. No matter how the drug is delivered, members need support. Education, monitoring, and guidance are what turn access into positive outcomes.
That’s where modern prescription care comes in. Increasingly smart pharmacy benefit managers (PBMs) are stepping up to provide this support, including building DTC into their approaches without losing sight of clinical care. Our GLP-1 weight management program, for example, created in collaboration with Personify Health, includes DTC access to Wegovy and Zepbound, and full care support for under $600 per month. Employers have the option to subsidize it or simply offer it as a voluntary benefit. Either way, it meets a rising demand in a thoughtful and sustainable way. And importantly, it’s integrated. When a prescription is denied, we intervene and guide the patient into a clinically proven program that offers coaching, tools for sustainable weight loss, and ongoing pharmacist support.
This is one example of a benefit employers can offer to meet members where they are, while improving long-term health outcomes.
DTC doesn’t mean going around the PBM. Instead, it’s a call for PBMs to evolve. To become true partners in care, not just processors of claims.
When thoughtfully integrated, DTC can become part of a broader strategy that lowers costs, improves member satisfaction, and simplifies access. Employers and manufacturers don’t need to navigate this on their own. With the right PBM partner, DTC becomes more than a distribution channel. It becomes a smarter, more connected model of care.
The real opportunity ahead? Turning every prescription into a moment to engage, educate, and empower.
Susan Thomas is Chief Commercial Officer at LucyRx.
Reference
1. Scott, D. The Untold Story of TV’s First Prescription Drug Ad. STAT. December 11, 2015. https://www.statnews.com/2015/12/11/untold-story-tvs-first-prescription-drug-ad/
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