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Pharma’s Quiet Channel Shift: What Direct-to-Patient Models Mean for Commercial Teams

Direct-to-patient (DTP) channels have quietly moved from the margins of pharma to a central lever in high-demand categories. One-third of new Zepbound prescriptions in the U.S. are now being filled through LillyDirect, bypassing insurers, PBMs, and traditional pharmacy channels entirely. A channel that once focused on aesthetics, dermatologic treatments, and low-cost generics has become a strategic lever for manufacturers in high-demand categories like GLP-1s. It now allows patients to purchase prescription treatments entirely out of pocket, often through virtual care platforms and online pharmacies.

Lilly and Novo were among the first to develop robust DTP platforms, responding to limited insurance coverage, self-pay demand, and competition from GLP-1 compounders. Their early moves into DTP platforms offer a potential template for other manufacturers, particularly as telehealth demand, Trump pricing policies (e.g., MFN, TrumpRx), and patient expectations continue to evolve.

DTP In the Context Of MFN

Seventeen pharmaceutical companies targeted by the Most Favored Nation (MFN) initiative have now signed voluntary MFN agreements. These agreements secure discounted pricing for self-administered drugs and biologics purchased through DTP channels such as TrumpRx or manufacturer-run sites like LillyDirect. Under these arrangements, manufacturers can sell at MFN prices directly to patients across conditions including:

  • Type 2 diabetes (T2D)
  • Rheumatoid arthritis (RA)
  • Multiple sclerosis (MS)
  • Asthma and COPD
  • Hepatitis B and C
  • HIV
  • Certain cancers

Manufacturers are largely using DTP channels to present patients with prices similar to what payers already pay net of rebates, rather than introducing deeper discounts. The shift is less about undercutting payer-negotiated net pricing and more about making those net-equivalent economics visible and accessible to patients facing payer friction or coverage delays.

What LillyDirect and NovoCare Tell Us About DTP Execution

Both Lilly and Novo rolled out their DTP platforms rapidly. They relied heavily on external telehealth partners (e.g., WeightWatchers, 9am Health), pharmacy vendors (e.g., TruePill, GoodRx), and fulfillment networks (e.g., CVS, Amazon) to stand up patient-facing channels. This partner-first approach allowed them to get to market quickly and capture learnings that could be built into their own DTP platforms.

By operating through multiple partners simultaneously, Lilly and Novo accumulated real-world data on what drove conversion, where patients dropped off, which fulfillment models delivered the best adherence, and how telehealth touchpoints influenced behavior. These learnings became the foundation for more vertically integrated, end-to-end DTP models (LillyDirect, NovoCare), where patient experience is tightly coordinated.

Lilly and Novo have set the precedent for and defined patient expectations of what a best-in-class manufacturer-DTP platform looks like. Table stakes for manufacturer DTP platforms will include:

  • An integrated experience from intake through prescription and refill
  • Integrated virtual care aligned to the clinical needs of the indication
  • Transparent pricing signals that patients can understand
  • Reliable fulfillment and ongoing support

Strategies to Develop Differentiated DTP Platforms

Novel brands will not ‘win’ market share on a well-executed DTP platform alone, but a poorly executed platform can certainly lose it. In highly competitive spaces, patients who encounter a fragmented, confusing, or unreliable DTP experience will be quick to revert to traditional channels, turn to competitor platforms, or disengage entirely.

As such, manufacturers must launch DTP offerings with the required operating capabilities in place. Without the upfront trial and error and operational learnings that come from running a live platform, launching a successful DTP model carries significant execution risk. Manufacturers must look towards creative ways to test the user experience, integration of care services, and fulfilment capabilities before positioning DTP as a core pillar of a brand strategy.

A late-stage asset provides a real-world environment in which to stress-test telehealth integration, resolve fulfillment logistics, evaluate the commercial implications of public pricing visibility, and develop internal competency in patient engagement and data infrastructure. By the time a manufacturer is prepared to deploy DTP as a central pillar of brand strategy for a high-value, high-competition product, the foundational operational and commercial questions should already be resolved.

The Future of DTP

The DTP model has proven itself in high-prevalence, consumer-oriented conditions where patients are willing to pay out of pocket for faster, less burdensome access. DTP becomes of high interest to manufacturers only in areas where payer friction is enough to significantly exclude a larger proportion of potential patients. GLP-1s for obesity represent the clearest example of this convergence, and DTP will likely remain a defining channel in that space for the foreseeable future.

Beyond weight management, DTP may be most relevant for cosmetic or lifestyle indications with limited likelihood of reimbursement, such as fertility, acne and rosacea, and alopecia. Patients may be willing to pay out of pocket for faster or less stigmatizing access. For high-prevalence, chronic conditions that are typically well-covered by insurance (e.g., migraine, diabetes, HIV, asthma, cholesterol/blood pressure management), DTP may offer an additional value and convenience by:

  • Handling benefits verification and prior authorizations on the patient’s behalf
  • Offering cash-pay options as a bridge during delays or lapses in coverage

More complex areas (e.g., autoimmune, GI) will likely require at least a hybrid-care approach given the need for more routine safety monitoring and lab testing, though they may also be viable options for DTP integration due to their status as chronic, highly prevalent diseases.

Drivers for Industry

Gather user data

DTP platforms generate a stream of real-world patient and prescriber behavior data that is difficult to obtain through traditional channels (e.g., on adherence patterns, dropout points, and physician referral behavior).

  • For manufacturers, this data represents a durable strategic asset that extends well beyond the immediate commercial benefit of the DTP channel.

Enhance customer experience

DTP platforms allow manufacturers to design the end-to-end patient journey without intermediaries. A streamlined, consumer-grade experience is a meaningful differentiator, particularly for patients who struggle with access via traditional channels.

  • Manufacturers that invest in this experience early can build stronger brand loyalty and long-term patient relationships that are independent of payers.

Improve cost effectiveness

By selling directly to patients at net-equivalent prices, manufacturers can reduce channel costs while maintaining or improving net revenue per unit.

  • While the DTP channel requires upfront investment in platform infrastructure, telehealth partnerships, and fulfillment logistics, at scale it offers a leaner commercial model, particularly for drugs with large addressable populations and relatively standardized clinical pathways.

Leverage DTP as a learning tool

Manufacturers can use products at the end-of-life cycle in appropriate spaces to “test drive” elements of a DTP program before it becomes a key lever in a major launch.

  • DTP helps manufacturers better understand the frictions faced by HCPs and patients as they navigate an uncertain launch environment

Gain users typically excluded from access

DTP channels offer a viable path to reach uninsured or underinsured patients at price points that, while still out-of-pocket, are far more accessible than WAC-level list prices.

  • As evidenced by GLP-1s, where insurer restrictions have historically been a primary barrier to uptake, DTP has proven to meaningfully expand the treated patient population.

Next Steps for Industry

  • Evaluate the portfolio: Systematically review the portfolio of marketed and pipeline assets potentially appropriate for DTP based on untapped patient populations, level of payer friction, ability for clinical pathways to be standardized and virtual, and consumer WTP. Of note, manufacturers should consider whether there are any risks for insurer coverage and pricing, as the DTP price will be visible and public.
  • Leverage proven models: Learn from markets where DTP / private payments have been well-established (e.g., aesthetic and wellness categories where self-pay is already the norm) to support the roll-up of patient outreach, support, and distribution models.
  • Pick a strategy: Determine the costs and benefits between building an in-house DTP platform (e.g., LillyDirect) with vertical integration of services or partnering with established vendors and distributors that have channels in place to sell directly.

Conclusion

As DTP models expand beyond GLP-1s, manufacturers should evaluate their portfolios with clear patient, payer, and operational criteria. The most successful programs will match the channel to the asset, rather than build infrastructure ahead of a defined need.

Assess Where DTP Fits

Connect with Trinity to evaluate patient, payer, and operational considerations before investing in a direct-to-patient model.

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