Medicine is expensive and only seems to get more so every year. But this doesn’t have to be inevitable. The reason patients pay so much is an insurance industry that no longer functions like insurance. Instead of handling catastrophic and unexpected problems, health insurance is the go-to solution for routine healthcare, including predictable pharmaceutical needs. This has disconnected patients from the prices of their medicines and allowed Pharmacy Benefit Managers (PBMs) to profit from drug discounts intended for patients. The result has been higher drug prices as cheaper medicines routinely lose out to expensive name brands.
Direct-to-consumer (DTC) pharmaceutical sales get around PBMs so patients can get their medicine without a mark-up. When patients buy medications directly from manufacturers prices are transparent, generating competition that allows patients to save money when they buy their medicines. DTC drug sales are not a futuristic concept; they’re already here. Major manufacturers like Eli Lilly and Pfizer run their own online platforms. And because prescriptions are still legally required, DTC does this without risking patient safety.
When manufacturers sell directly to patients, they no longer need to inflate list prices to satisfy PBM rebate demands—the same rebates the PBMs profit from instead of passing to patients. And patients don’t have to navigate the labyrinth of “preferred networks” designed to steer patients to pharmacies owned by the PBMs themselves. DTC pricing is straightforward. Patients see the real cost of their medicine and can purchase the least expensive version instead of the one the profits their PBM the most—which is often less expensive than using insurance.
DTC also expands access. The lower and clearly stated prices helps people who are uninsured find and afford medicine by giving them direct access to the pharmaceutical market. Additionally, many Americans live in pharmacy deserts. Manufacturer-run platforms can get around this problem. They provide direct delivery at predictable prices.
PBMs profit when list prices rise and rebates grow. Manufacturers, by contrast, profit only when patients buy their products. A direct relationship with consumers forces pharmaceutical companies to behave like every other consumer-facing business: lower costs, better service, transparent pricing, and continuous innovation.
Critics claim DTC drug sales are unnecessary or risky. They argue that circumventing the traditional infrastructure might lead to over-prescribing. But that misunderstands the model entirely. Prescriptions are still determined by doctors, not by manufacturers. Drug safety is still enforced. DTC modernizes the drug distribution system while making medicine more affordable.
The old model of drug distribution—built around PBMs whose incentives are often opposite of patients’ interests—cannot last. Prices are too high and still rising. DTC drug sales offer an alternative that lowers prices while increasing access to medicine in rural areas. It’s simpler, cheaper, and prioritizes patient welfare instead of PBM profits. Policymakers serious about addressing the high and rising costs of drugs should consider how to incentivize more drug manufacturers to embrace the new DTC model, and help patients save money on their medicine by skipping the middleman.
The future of U.S. medicine is direct. Patients will be better off for it.
