The Direct-To-Consumer Drug Gambit and Debate

Some pharmaceutical firms have started selling medications to consumers through their own telehealth operations, raising both concerns and cautious optimism. The practice could increase under a recent executive order from President Donald Trump.

Eli Lilly, Pfizer and Novo Nordisk are now selling their drugs directly to consumers through websites built for that purpose. LillyDirect focuses on conditions such as obesity, diabetes and sleep apnea and offers medications such as Zepbound (tirzepatide) and various insulins. PfizerForAll offers discounts on a range of drugs, such as Paxlovid (nirmatrelvir and ritonavir), a COVID-19 treatment drug, and Xeljanz (tofacitinib), an anti-inflammatory drug used to treat rheumatoid arthritis and several other conditions. Novo Nordisk is the latest to jump on the bandwagon: NovoCare Pharmacy sells drugs such as Wegovy (semaglutide), the company’s obesity drug and a runaway bestseller, at a discounted price.

Mina Allo, Pharm.D., M.P.H.

Offering direct-to-consumer drugs creates “another access point to get medications,” which can be important due to the shortage of clinicians, says Adam Brown, M.D., MBA, founder and principal at the strategy and marketing firm ABIG Health. Others see a major drawback. Drugmakers selling their products directly to consumers “removes payer oversight on utilization,” says Mina Allo, Pharm.D., M.P.H., managing director at Avalere. That oversight, she says, provides some checks that help make sure the drug is being used appropriately.

LillyDirect, launched in January 2024, was the first of these drugmaker direct-to-consumer businesses. The company started the site to “simplify the often-complicated healthcare system, so patients can more easily access independent in-person or telehealth care options, medications and support resources they may need,” Jennifer Mazur, general manager of U.S. LillyDirect, said in an email. LillyDirect helps patients find an independent doctor, access tools on conditions and well-being and potentially reduce their medication costs, she said.

Jennifer Mazur

LillyDirect Pharmacy Solutions offers certain Lilly medicines through licensed, third-party online pharmacies. That allows patients to have their medications delivered to their homes, she said. LillyDirect has a self-pay pharmacy option, where insurance is not required or accepted. The company is selling the 2.5-milligram starter dose of Zepbound (tirzepatide) for $349 for a single month and then $499 for larger doses; the prescription has to be filled within 45 days. The autoinjector version is priced at $650 per month.

CenterWell, part of Humana, recently announced that it would begin filling and shipping orders for Wegovy from the Novo Nordisk website NovoCare. Patients paying with cash pay $499 per month compared with the wholesale acquisition cost price of approximately $1,350. “We’re helping consumers benefit from reduced costs to safe and effective medication,” Guillermo Sollberger, J.D., senior vice president at Humana, said when Humana announced the deal at Asembia’s AXS25 Summit in April 2025.

Lack of coverage

Allo says offering glucagon-like peptide 1s (GLP-1s) directly to consumers was a way for manufacturers to compete against compounding pharmacies, which were allowed to sell their lower-priced versions of the GLP-1s because of a shortage. Access to the less expensive, compounded versions ended this spring when the FDA declared the shortage over. Many employer-sponsored health plans do not cover GLP-1s, so the drugmakers’ direct-to-consumer businesses provide a way to buy the medications at a reduced price, explains Allo. A survey by the consultancy Mercer found that in 2024, nearly all health plans covered GLP-1s for diabetes, but just 44% of large employers with 500 or more employees covered such medications for weight loss.

Still expensive

Direct-to-consumer models can potentially reduce costs for patients by removing intermediaries, such as pharmacy benefit managers (PBMs) and insurers, Brown observes.

Benjamin Rome, M.D.

Benjamin Rome, M.D., an assistant professor of medicine at Harvard Medical School, has a different take. Rome said in an email that the direct-to-
consumer model for GLP-1s can still be too expensive for many people. Even at a discount, the prices of the medications “are still quite high and probably out of reach for most Americans to afford,” according to Rome.

“The notion of the customer being tied to the manufacturer may have some convenience for them [manufacturers],” as it can cut out PBMs and insurers, says Mark Miller, Ph.D., executive vice president of health care at Arnold Ventures. “It ties people to the product more directly.”

But Miller questions whether drug prices will decline if they are sold directly to consumers or whether the manufacturers will keep the money they save by cutting out PBMs. Rome also has concerns because some direct-to-consumer websites include an option to help patients find a prescriber. “There are lots of potential problems if these prescribers are basically offering prescriptions on behalf of the manufacturer, particularly if those prescriptions are paid in part by an insurance company.” Brown also notes the ethical issues of manufacturers directly advertising and selling their drugs. If a physician is employed directly by a drug company, he questioned whether they would do what is best for the patient or what is best for the manufacturer.

Eduardo Grunvald, M.D., director of obesity medicine at the University of California San Diego Medical Center, challenges the description that manufacturers are selling drugs directly to consumers. Instead, they “act as a liaison between the patient and the provider,” and the provider does not work for the pharmaceutical firm, he says. “There is no obligation to prescribe that drug,” adds Grunvald, who consults for Pfizer and Novo Nordisk.

LillyDirect’s Mazur stresses that the provider-patient relationship is completely independent of LillyDirect. She said the website can connect patients to independent, certified specialists in their local areas through telehealth and has a tool to help them find providers who offer in-person care. She said Lilly does not receive compensation from healthcare providers, and healthcare providers do not receive any incentive to prescribe Lilly’s products.

“The care providers listed as patient options on the LillyDirect site are independent and they exercise autonomous clinical judgment in evaluating any medical conditions and resulting care decisions, which may or may not include medication,” Mazur said.

Executive order

An executive order from Trump may give the direct-to-consumer way of selling and distributing drugs a boost. In his May 12, 2025, executive order, Trump called for HHS to “facilitate direct-to-consumer purchasing programs for pharmaceutical manufacturers that sell their products to American patients at the most-favored-nation price.” A fact sheet accompanying the order calls for HHS to “establish a mechanism” for Americans to buy their drugs directly from the manufacturers, “bypassing middlemen.”

Allo says she will be interested in seeing how direct-to-consumer drug sales will apply to other categories of drugs besides GLP-1s. The public is familiar with GLP-1s, she notes, but when it comes to other medications, they generally do not have “as much information to make informed decisions.”

Brown comments, “It remains to be seen if the executive order will have teeth or if it is more political showmanship.”

Rome says the executive order was unclear about what it meant by direct-to-consumer purchasing programs, and he points out that patients typically pay less for brand-name drugs covered by their insurers. Rome says he expects more manufacturers to test out the direct-to-consumer model but notes that perhaps one reason Novo Nordisk and Eli Lilly have gone that route for their GLP-1s is the lack of coverage for weight loss drugs, both from Medicare and many with private insurance. “But I do not think direct-to-consumer purchasing will dramatically replace insurance coverage in terms of paying for prescription drugs. The costs of brand-name drugs are just too high for that to happen,” Rome adds.

At the Asembia meeting, Sollberger said he expects the direct-to-consumer model to expand to other types of drugs, such as those to treat mental health conditions. “I think patient demand for choice will continue to drive innovation in our system. We’re going to have to stay nimble in order to meet that,” Sollberger said, predicting that direct-to-consumer is “going to become the norm.”

Rome says he sees the direct-to-consumer model as more of a Band-Aid: “The existence of these programs is indicative of some of the broader problems with high drug costs in the U.S., but I don’t see it as a solution.”