TrumpRx promises to lower the price of hundreds of medicines for roughly 140 million Americans covered by Medicare or Medicaid. Add in the estimated one third of Americans under the age of 65 enrolled in high-deductible plans who routinely skip care because they can’t afford it, and you’re looking at one of the largest price resets in the history of American pharmaceuticals.

There is a hole at the center of this political celebration, though. It’s this: a drug discount only matters if a patient can get a diagnosis, and today, millions can’t. Patients are not only priced out by cost. They’re locked out by complexity.

That’s the blind spot no one is talking about.

Price transparency is not the threat. The real disruption is what happens when a patient can suddenly see the lowest price but still can’t get a prescription because no one has given them a bridge to diagnosis.

The future belongs to pharma companies that invest in that bridge.

Affordability without access is half of a solution

The pharma industry spends about $18 billion a year on consumer marketing that encourages patients to “ask your doctor about…” Then, somewhere between 55% and 80% of those patients never get past that first conversation because the current system requires them to self-navigate a maze of delays, deductibles, prior authorizations, unavailable appointments, diagnostic bottlenecks, and fragmented digital tools.

They stall in the same place: awareness without action.

ixlayer conducted a survey back in September, with the Digital Health Coalition, and discovered that 82% of pharma executives believe fragmented patient experiences diminish the impact of their direct-to-consumer (DTC) investments, with 76% pointing to prior authorization as limiting DTC effectiveness.

Patients, of course, feel the inertia of these roadblocks even more sharply, and they are not only open to pharma providing a pathway, they expect it. In a research survey we ran earlier this year with Ipsos, 81% of patients agreed that pharmaceutical companies should provide resources to patients to help them get the care and medicines they need, yet only 16% believed the pharma industry prioritizes their needs

Now add TrumpRx to that landscape. It can make insulin 50% cheaper, but if the patient has no A1c test, no primary care visit and no recent labs, essentially no pathway to a prescription, then savings are irrelevant. This gap will define the next decade of patient access and it will separate the companies that treat TrumpRx as a threat from those who use it as an opportunity to bring millions of Americans back into the system.

TrumpRx is neither a front door nor a pathway

Yes, TrumpRx will accelerate price discovery. Patients will know that a brand medicine may cost $40 instead of $140. For the first time, they will have visibility into the cash-pay floor. But TrumpRx does not, and cannot, diagnose anyone. It can’t order a T1D test or evaluate shortness of breath. It doesn’t solve prior authorization and can’t write an independent prescription.

This is where the blind spot, the hole, becomes increasingly consequential.

Pharma has an opportunity, and arguably a responsibility, to adopt and scale the rails that carry patients from awareness to clinical action. That means direct-to-patient (DTP) programs that integrate condition education, testing, telehealth, and prescription pathways, if needed, that lead to an appropriate pharmacy, including TrumpRx.

It’s the clinical layer that will transform a political promise into real access and improved health outcomes for patients.

DTP is no longer a pilot program, it’s the missing infrastructure

In the same ixlayer and DHC survey mentioned earlier, the one surveying pharmaceutical executives, nearly three out of four pharma leaders said they are running or preparing to launch a DTP program in the next year. Ninety-four percent have either launched, are planning a launch, or are actively exploring DTP.

Why? Because DTP solves the blind spot TrumpRx exposes, patients need help moving from awareness to care and diagnosis.

The companies that treat TrumpRx as a magnet will win the next decade

While providing affordable medicine is the most obvious raison d'etre of TrumpRx, the off-label use is the light it shines on this addressable problem in our healthcare system: barriers to access. Millions of patients who have been uninsured, underinsured, or stuck in high-deductible plans will suddenly be motivated to seek care if the path is clear and the price is predictable.

DTP pathways do something the legacy system does not: they align healthcare access to the reality of people’s modern and busy lives. Telehealth at home, online prescription fulfillment during a work break, all of it accessible within a real person’s schedule and they do it in a compliant way that preserves independent medical judgment and protects patient choice.

The opportunity is not to drive transactions. The opportunity is to drive access to care, potential diagnosis, appropriate treatment, adherence, and most importantly, improved outcomes.

The market is shifting toward digital initiation, not digital promotion

The next battleground for pharma is not advertising, it is activation. Patients are no longer served by websites with downloadable PDFs, instead they need real services that help them move forward.

In our patient research survey, ixInsights 2025, with Ipsos, patients said the number one reason they are dissatisfied with digital health experiences is that they are forced to use multiple tools to get what they need. Otherwise known as digital fragmentation. Patients want a single pathway that gets them from information to action. Patients reported that they strongly prefer features like virtual consultations, 82%, pharmacy delivery service ,67%, and using at-home diagnostic testing kits, 62%.

On the industry side, pharma executives overwhelmingly rated accelerated time to clinically appropriate treatment and improved patient experience as the top success indicators for a DTP program, ahead of return on investment.

A notable shift that signals that the industry sees the same blind spot: if you do not close the loop between awareness and care, patients won’t benefit and your brand won’t either.

What pharma needs to do now

TrumpRx resets the pricing floor. Great. Pharma must reset the access layer.

Here’s what that requires:

• A diagnostic bridge. Patients can’t benefit from lower prices without a diagnosis. DTP programs that bake in at-home or local lab testing, referrals, and provider choice will improve access for patients.
  
• Preserve clinical independence. Any pathway must be designed so that physicians set clinical protocols, make prescribing decisions, and maintain full autonomy.
  
• Offer routing optionality. Patients need to be able to take their prescription anywhere: TrumpRx, retail pharmacies, local providers, or mail order.
  
• Make the journey seamless. Patients want access in three clicks, not three portals. They want authorizations, telehealth, test results, and prescription workflows in one continuous experience.
  
• Design for transparency, not influence. DTP is not about steering. It is about giving patients options, clarity, and the ability to act on their timeline.
  
• Invest in outcomes, not channels. The value of DTP is measured in faster time to care, improved adherence, reduced drop off, and higher completion rates, not clicks or impressions.

If pharma waits for this to evolve organically the gap between access and affordability will widen and pharma will lose the opportunity to serve patients in the way they’re requesting while shaping a solution that collects the fragmented pieces available today into a single cohesive pathway.

TrumpRx makes solving patient access an imperative

The political narrative around TrumpRx is compelling, as lower prices for essential medicines make headlines. Ultimately, though, the healthcare system is more than a shopping cart. It is a series of clinical steps that must be completed before a discount matters.

A drug price cut without a diagnostic pathway is not access. It’s the illusion of access.

The pharma industry can fill that gap now, not because it’s politically fashionable, but because the system has reached its breaking point. Patients are telling us they want help. Pharma executives are telling us that fragmented experiences waste billions. Our own programs show us that when you give patients a seamless way to move from awareness to clinical action, they take it.

TrumpRx is creating a better end-destination. Pharma needs to invest in the bridge to get there.

Pouria Sanae, is CEO and Co-founder, ixlayer.