A recent consumer study by Model N found that 40% of Americans have either skipped or delayed filling prescriptions due to concerns about cost. Additionally, more than half of Americans are worried about being able to afford their family's medicine, according to data from KFF.
In response to these concerns, direct-to-consumer (DTC) approaches for purchasing medications have gained attention. In February, the U.S. government introduced TrumpRx, a platform designed to connect patients with DTC medications at discounted prices. Fifteen out of seventeen pharmaceutical manufacturers have agreed to participate in the initiative, offering select drugs at discounts ranging from 50% to 80% off list prices.
This move builds on an existing trend where companies like Eli Lilly and Pfizer have begun selling medicines directly through their own platforms. The Model N survey indicated that 72% of respondents would be likely to purchase medicine this way, with lower costs being the main motivator.
The 2026 State of Revenue Report shows that pharmaceutical companies plan to continue expanding DTC sales channels. However, experts caution that DTC will not fully resolve issues related to drug affordability in the United States. "As vice president of product management at Model N, I’ve worked extensively with pharmaceutical companies on pricing strategies, compliance and distribution. In my view, the new channel is a positive development, as is any step that broadens patient access while supporting manufacturers’ ability to deliver their products. However, DTC’s reach is limited to narrow patient populations and specific therapy areas," said a representative from Model N.
GLP-1 receptor agonists such as Wegovy and Ozempic highlight how DTC models function in practice. These drugs are often only covered by insurance for diabetes treatment but are widely used for weight loss—a use not typically reimbursed by insurance plans. As a result, patients seeking GLP-1s for weight loss must pay out-of-pocket at pharmacy list prices that originally averaged around $1,000 per month. While recent price reductions—such as Novo Nordisk dropping its GLP-1 list price to $675—have occurred following the launch of TrumpRx, most brands still cost several hundred dollars monthly even after discounts.
These savings do not substantially improve affordability for many people who need these medications; obesity disproportionately affects those with lower incomes who may not be able to pay these amounts out-of-pocket. Experts note that while DTC can increase access in certain cases, it does not address the broader complexities of the U.S. healthcare system.
DTC channels provide discounts off list prices set high due to established rebate and discount systems involving intermediaries like pharmacy benefit managers and insurers. Manufacturers must also offer mandated discounts for government programs such as Medicaid and Medicare negotiations. Commercial insurers negotiate additional rebates on behalf of health plans and hospitals—factors which contribute to what industry analysts call the "gross-to-net bubble." This term describes how much manufacturers reduce their net revenues through various concessions.
Manufacturers have promoted DTC plans by highlighting discounts between 50% and 80%, but it remains unclear whether these represent real reductions compared with confidential deals struck with commercial and government payers.
"What we do know is that discounted DTC rates are typically still hundreds of dollars, and the entire cost comes out of the patient’s pocket," noted a Model N executive. "With insurance, they would typically pay a $25 to $50 copay, making DTC drugs significantly more expensive for insured patients, even with the purported discounts."
Consequently, DTC options mainly benefit underinsured or uninsured individuals—or those seeking medications not covered by insurance—if they can afford them at all.
"In short, DTC’s emergence will help broaden access but not deliver meaningful savings at scale," concluded a Model N representative. "Fixing affordability will require reshaping the rebate system, containing list prices, improving transparency and funneling more savings to patients. Until some reforms are put into place, DTC will remain a valuable but limited option."
