Tackling Affordability with Direct-to-Patient Sales

Direct-to-patient (DTP) sales programs allow pharmaceutical companies to sell medications directly to patients, bypassing traditional intermediaries such as wholesalers, retailers, and payers e.g., health insurance plans or integrated delivery networks. While the concept is not entirely new, its adoption gained significant momentum during the COVID-19 pandemic, as companies sought remote healthcare solutions to improve access and reduce barriers.

A notable example involves a leading pharma company developing biologic therapies for patients with rheumatoid arthritis. By creating an online platform, the company allowed patients to order medications directly from the manufacturer after receiving their prescription. The program provided the drugs at a patient-friendly price point, shipped medications to patients’ homes, and included educational resources to support medication adherence.

This reimagined sales model bridges the gap between affordability and convenience, empowering patients in ways traditional systems have struggled to achieve.

The primary goal of direct-to-patient sales programs is to empower patients by improving access and affordability.

For patients requiring high-cost therapies for rare or chronic conditions, affordability often feels out of reach. Traditional patient affordability programs—such as short-term co-pay and bridge programs—only partially address these concerns. The rise of payer co-pay accumulators and maximizer programs are also undermining traditional affordability programs. By contrast, DTP programs are designed to reduce friction throughout the process of obtaining medications.

Additionally, direct-to-patient sales are particularly beneficial for Medicare patients, who are often ineligible for traditional financial assistance due to regulatory constraints. The direct channel ensures patients can access therapies without the usual bottlenecks, enhancing medication adherence and streamlining the experience.

How do direct-to-patient initiatives stack up against other affordability programs? Below is a comparison of key strategies pharmaceutical companies commonly employ:

1. Co-Pay Assistance Programs
These initiatives help reduce out-of-pocket costs at pharmacies by subsidizing the co-pay amount. They are effective at lowering upfront costs for eligible patients but may not address other barriers, such as ongoing affordability or coverage hurdles. Also, such programs are restricted only to patients with commercial insurance plans due to regulatory restrictions (e.g., can’t support patients on Medicare, Medicaid, or other government provided health plans).

2. Bridge Programs
Bridge programs offer patients temporary access to medications while awaiting insurance approval or during transitional periods between coverage plans. While effective in closing short-term treatment gaps, these programs are primarily designed for temporary use and don’t provide a sustainable affordability solution.

3. Free Trials
Free trials allow patients to try medications before committing financially. These programs can increase patient access but might result in potential gaps in treatment once the trial period ends.

The Direct-to-Patient Edge
Compared to these programs, direct-to-patient sales provide a comprehensive, patient-centered solution:

• Enhanced patient access through direct shipping, reducing geographical or logistical barriers
• Wider reach to support access for any patient regardless of their healthcare coverage
• Greater affordabiltiy via streamlined pricing mechanisms
• Improved adherence due to stable access to care despite any changes in their coverage and enhanced convenience of home delivery

Unlike other solutions that focus on partial affordability or access gaps for a limited population of patients, direct-to-patient programs deliver on both fronts for potentially all patients while building long-term trust and loyalty among patients.

Figure 1: While direct-to-patient sales offer significant benefits for improving patient affordability and access, they also come with challenges.

Of course there are some challenges in launching a DTP program but with proper planning and strategic collaboration, pharmaceutical companies can ensure DTP programs remain both compliant with evolving regulations while enhancing patient access.

Direct-to-patient sales programs represent a bold and necessary evolution in the pharmaceutical industry’s approach to patient access. By situating patients at the center of the distribution model, these programs offer a practical response to pressing affordability challenges, particularly for high-cost therapies like biologics and for therapies that manage chronic conditions, which necessitates predictable access to medications.

At their core, DTP programs demonstrate how innovation can align with patient needs to deliver a more accessible, affordable, and personalized healthcare experience.