In May, President Trump signed an executive order imposing Most-Favored-Nation (MFN) price caps on pharmaceuticals. While the problems of price caps like MFN pricing have been explored at length, the order had an upside in that it also included a provision to facilitate the direct sale of prescriptions to patients for manufacturers that meet the price cap. Direct-to-consumer (DTC) sales can help lower prices for patients.
Since the executive order, President Trump has announced TrumpRX.gov, which—beginning in 2026—is intended to facilitate DTC sale of pharmaceuticals. DTC pharmaceutical sales is not just a good idea, its so good companies had already started implementing this service, without federal involvement. In fact, the proposed TrumpRX website functions by redirecting patients to the existing DTC websites for participating companies.
The big problem in DTC care right now isn’t that it doesn’t exist, it is that patients don’t know about the option or how much money they can save with it.
In July, Bristol Myers and Pfizer both announced they would sell the blood thinner Eliquis directly to patients with a prescription at lower prices. Eli Lily and Pfizer now sell medicines for diabetes, obesity, respiratory conditions, and more directly to patients instead of only through insurance. Eli Lily’s DTC system has reduced the prices of some weight loss drugs by up to 40 percent. The company Novo Nordisk offers more than half off Ozempic and discount Wegovy in its DTC model.
The advantage of a DTC model is avoiding the added costs of insurance and the predatory behavior of pharmacy benefit managers (PBMs), while also reintroducing competitive market forces. When patients can see and compare real prices, companies must compete on cost and service.
The shift is happening in the generic market also. Many generics have cash prices lower than insurance copays. Companies like GoodRX sell many generics for less than patients would pay using insurance, sometimes less than half the average copay. GoodRX isn’t the only one either, Blink Health and Inside Rx work on similar DTC models.
The problem of overpriced generics prompted the Texas’ state legislature to require pharmacists inform patients if the cash price is lower than their insurance copay. Unfortunately, most states don’t require this, leaving many patients unaware they could pay less at the counter.
For branded and generic drugs alike, DTC sales require fewer middlemen. Fewer intermediaries between manufacturers and patients mean fewer points where PBMs and insurance add costs. Patients often pay less when PBMs and insurance are out of the transaction.
More competition lowers prices in theory and in reality. Lower prices not only cut costs for most patients; they help those who previously could not afford their medicine. One-fifth of Americans have skipped filling a prescription due to cost. Making medicines more affordable doesn’t just save money, it can be the difference between receiving or forgoing treatment.
DTC delivery also expands pharmaceutical access. Nearly 16 million Americans—almost 5 percent of the population—live in pharmacy deserts in both urban and rural communities. For these patients, access to medicine is obviously limited, but delivery of DTC prescriptions eliminates that problem for drugs that can be bought directly and delivered to their home.
Empowering consumers to purchase directly from manufacturers is a simple and effective way to reduce the price of routinely used medicines. It lets patients see the real prices, choose the best deal, and receive safe, fast delivery—benefits insurance and PBMs often fail to provide. DTC prescriptions can’t replace insurance for every drug, but they are already cutting out-of-pocket costs for many brand name and generic medicines people routinely take. Unlike MFN pricing, DTC sales can lower prices and expand access to affordable medicine for Americans struggling with the high costs of their prescriptions.
