What employees may miss when they buy drugs directly online

Direct-to-consumer (DTC) online access to prescription drugs can make treatment feel faster, potentially cheaper and often more transparent. But when a patient fills a prescription outside the normal benefit and pharmacy channel, convenience can come with hidden tradeoffs.

Prescription fills may not count toward insurance cost-sharing. Patients may be confused by introductory pricing and fine print from online providers. If the prescription is filled through a separate platform or pharmacy, the patient’s primary care physician may not see everything that patient is taking and how the DTC drugs might interact with others that they are taking

This matters as glucagon-like peptide 1 (GLP-1) use continues to grow. A recent Navitus Health Solutions Pulse survey found that 68% of users said cost influenced their decision to start or continue treatment, while 24% said they pay more than $250 per prescription fill.

DTC options are clearly growing in number and scale. Hims & Hers reported about $2.35 billion in 2025 revenue, up 59% year over year, with more than 2.5 million subscribers. IQVIA reported in February that over the past two years, direct-to-patient GLP-1 programs have helped push monthly cash-pay to between $299 and $499 through manufacturer-run platforms. Novartis launched a direct-to-patient platform for Cosentyx at a 55% discount from the list price.

This growth reflects consumer demand. Our survey found that nearly 40% of GLP-1 users have used discount programs or manufacturer coupons to offset out-of-pocket costs, and more than 83% believe that Americans are turning to DTC GLP-1 programs because traditional access is too difficult or expensive.

For employers and benefits leaders, the challenge here is how to help employees access the medications they may want without employers having to carry the full cost. In some situations, telehealth plus pharmacy options may be a practical approach, especially when an employer excludes a drug category from coverage or a patient faces an unusually high cash burden at the pharmacy counter. But a lower advertised price is not always the same thing as lower total cost.

This is especially true for workers who have already hit their out-of-pocket maximums for the year, meaning additional costs shouldn’t come out of the employee’s pocket. The deductible is the amount a patient pays before insurance begins covering most of the bill. Most high-deductible plans also have an annual out-of-pocket maximum, capping what the patient spends for the year. If someone buys a drug outside their pharmacy benefit, that purchase may solve a short-term affordability problem, but the money spent often will not count toward either deductible or maximum out-of-pocket threshold, meaning the patient may pay more out of pocket than their plan requires. NovoCare states this clearly in its self-pay terms: If a patient uses that program outside insurance, those payments will not count toward deductibles or maximum out-of-pocket costs.

This nuance matters because a patient who is likely to meet the deductible anyway because of other medical needs may actually spend more over the course of the year by paying cash for a DTC prescription outside their plan. A direct-to-consumer purchase means the claim doesn’t get recognized in the broader benefit system. The cost for a DTC prescription no longer helps a patient gain as much benefit from deductible or out-of-pocket protections.

What DTC purchases mean for care coordination also deserves attention. When prescriptions move across separate telehealth platforms, pharmacies and payment channels, the full medication picture is harder to see. Physicians, pharmacies and electronic medical records do not always connect across systems, making drug interaction checks and medication reconciliation more difficult.

This matters even more with GLP-1s and similar drugs, where side effects and treatment history can influence other care decisions. A surgeon, anesthesiologist or specialist may need to know a patient is taking one of these medications before a procedure or while evaluating new symptoms due to a decrease in gastric mobility or the risk of pancreatitis.

These concerns don’t erase the convenience and potential cost advantages, but they do mean that employers and employees should consider the full picture.

Potential advantages

• Lower upfront cash prices for some patients, particularly when coverage is excluded or limited. Lilly currently offers self-pay Zepbound (tirzepatide) starting at $299 a month, while NovoCare advertises certain GLP-1 introductory offers as low as $149 a month.
• Simpler digital access, including home delivery and clearer consumer-facing pricing than many patients often get from their plan or employers from nontransparent PBMs.
• More direct access to FDA-approved branded products. Navitus found that more than 86% of respondents said they would be willing to pay more for FDA-approved GLP-1 options.

Potential drawbacks

• Purchases made outside insurance may not count toward the deductible or annual out-of-pocket maximum.
• Introductory pricing can obscure the long-term cost. Consumers are increasingly being drawn in by limited-time offers, then asked to navigate more complicated refill pricing later. If they try to “stretch” their doses to save money, regular fill requirements may reduce any cost savings.
• Filling outside the standard benefit can make it harder for clinicians and plan sponsors to maintain a complete view of medication use and appropriate management.

The best approach I would recommend is not to frame this as a fight between legacy benefit design and innovation. Patients are responding rationally to real affordability pressure.

Employers should do the same by helping employees understand what is covered, what counts toward their deductible or out-of-pocket maximum and what coordination supports already exist through the health plan. Before an employee goes outside the system, they should know whether the lower advertised price is temporary, whether the purchase will appear in the rest of their care record, and whether using the benefit may be the better financial choice over time.

DTC drug channels are likely to keep growing. The question for employers is not whether to ignore them or endorse them wholesale. It is whether they can help employees make informed choices before convenience turns into fragmentation and before a possibly cheaper prescription becomes the more expensive decision.

Sharon Faust, Pharm.D., is the chief pharmacy officer at Navitus Health Solutions, a pharmacy benefit manager.