Lower prices, no prior auth, price transparency. What’s not to like about the direct-to-employer channel? | Asembia AXS26 Summit

Patients and the payers (usually employers) who cover the cost of drug benefits both gain from direct-to-patient models, according to Sarah Thomas, head of growth and commercialization at HealthDyne.

Direct-to-patient sales and distribution — sometimes referred to as “direct-to-employer” if occurs in the context of employer-based health insurance — give employers more certainty about how much coverage of a certain drug is going to cost and make pricing more transparent, said Thomas. “There are advantages for patients too, she said, with the caveat that typically just one brand of a drug is going to be be available in the direct-to-employer model.

“A patient can have very seamless access to the therapy,” Thomas said. There are no PA [prior authorization] barriers, none of the kind of controls that have existed before — with an understanding that patients are being prescribed to label.”

“It allows that employer to get a better price right up front. It allows the patient to get access to a therapy class they wouldn't have had access to,” Thomas said.

Thomas and Skomo, chief operating officer for HealthDyne, led a session today about affordability and direct-to-patient drug sales at the Asembia AXS26 Summit, a specialty pharmacy meeting in Las Vegas. They were interviewed by Managed Healthcare Executive.

HealthDyne, a pharmacy technology and distribution company that distributes specialty drugs from pharmacies in Lakeland, Florida, and Centennial, Colorado, announced in January that it will be a dispensing pharmacy for certain Eli Lilly medicines. Llily has an active direct-to-consumer business called Lilly Direct that features the company’s immensely popular products, Zepbound (tirzepatide) and Mounjaro (tirzepatide), for weight loss and Type 2 diabetes, respectively. In March, Lilly announced the launch of Lilly Employer Direct, a version of direct-to-patient sales that is configured as a benefit that employers can offer alongside other drug coverage. The Lilly announcement said that HealthDyne and CenterWell will be dispensing pharmacies for the program.

Demand for the glucagon-like peptide 1 (GLP-1) drugs, coupled with the Trump administration’s most-favored-nation policies, has fueled the rapid growth in direct-to-patient drug sales. Thomas said the implications go beyond just a handful of drugs. ”We’re starting to see an evolution of how employers buy benefits,” she said in an interview with Managed Healthcare Executive.

Although GLP-1s have led the way, Thomas said biosimilars may be prime candidates for the direct-to-patient model.

“You've had a lot of biosimilars in the market that have been trying to get market adoption. Now you have PBMs white labeling their own. Is it really the lowest net cost option for the patients?” You know, maybe not,“ Thomas said, “Maybe the employer says, ‘Hey, I'm sick of these games. I'm going to go allow for a marketplace of biosimilars that patients can choose from and offer a $0 copay because maybe at the end of the day they're going to pay less. So I think there are some areas where some really unique things in the market are starting to happen.”