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The Direct-to-Patient Channel in Pharma: A Practical Guide to Protect GTN, Expand Access, and Improve Patient Experience

The Direct-to-Patient Channel in Pharma: A Practical Guide to Protect GTN, Expand Access, and Improve Patient Experience

On July 31, 2025, the White House escalated U.S. drug pricing pressure by sending letters to 17 pharmaceutical CEOs demanding concrete steps to align U.S. prices with “most favored nation” (MFN) levels. At the same time, affordability pressure is rising from the bottom up. Patient out-of-pocket spending reached $98 billion in 2024, up nearly 25% in five years, as overall net medicine spending grew 11.4% to $487 billion. The broader message is clear: traditional gross-to-net models are under strain, and the industry is expected to find alternatives.

While ambiguity still clouds how or if MFN pricing will be achieved, the tone has shifted and the urgency to act is unmistakable. Alongside the MFN directive, President Trump’s letter explicitly called for companies to pursue direct-to-patient (DTP) business models. DTP will not resolve every challenge in today’s pharma model, but it is becoming an essential part of the toolkit. When implemented thoughtfully, it can provide patients with more predictable costs and give manufacturers greater control over their channels.

The market has already begun to move. Eli Lilly’s LillyDirect (launched January 2024) offers end-to-end digital access and home delivery for select medicines. Novo Nordisk’s NovoCare Pharmacy provides DTP shipping of Wegovy at $499/month for cashpay patients (with Ozempic to follow shortly at the same price). And the BMS/Pfizer alliance will begin DTP sales of Eliquis on September 8, 2025, at >40% below list for eligible cashpay patients. These programs reflect a broader shift toward manufacturer-enabled DTP experiences that reclaim value from intermediaries while meeting patients where they are.

This white paper outlines key considerations for DTP models. It highlights how the channel has evolved, the opportunities and risks it presents, and practical steps to begin evaluating, piloting, and scaling without compromising gross-to-net performance.

The Direct-to-Patien

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