Don Anderson, Pharm.D., on the risks of pharmacy fragmentation | PBMI 2026

People can buy drugs from an increasing number of direct-to-consumer (DTC) websites, include some set up by pharmaceutical companies themselves. But the burgeoning DTC market leaves pharmacy benefit managers and health plans blind to the full picture of which drugs their members are taking, and that creates a risk of real clinical harm, according to Don Anderson, Pharm.D., vice president of OrionRx, a pharmacy benefit manager headquartered in Irvine, California.

When a member fills a prescription outside their pharmacy benefit — through a direct-to-consumer business such as Him or Ro,or elsewhere — that claim never reaches the plan's system, Anderson said in an interview with Managed Healthcare Executive (MHE) at the 2026 Pharmacy Benefit Management Institute (PBMI) Annual National Conference in Orlando, Florida. Without visibility into those transactions, pharmacists and care teams lose the ability to catch problems before they become emergencies.

Anderson mentioned wwo patterns OrionRx has already seen among members obtaining medications outside the plan’s normal channels: members taking a much higher dose of a glucagon-like peptide 1 drug than intended, which could lead to liver damage, and members unintentionally taking two or more therapies for the same condition, which in the case of diabetes could lower blood sugar levels to dangerously low levels.

“If I don’t see half of what they’re taking, I have no idea,” Anderson said. The question a plan has to be able to answer, he said, is whether a member is taking the right drugs at the right time — something that's only possible if all of a member's pharmacy activity flows back through a single, visible system.

Anderson's comments came in an interview with MHE conducted after he spoke at a PBMI panel titled , “Direct-to-Consumer Models and the Safety Question No One Owns,” alongside Martty Martínez Fraticelli, Pharm.D., chief executive officer of PharmPix.