The 'Direct-to-Patient' (DTP) market is fundamentally changing. Here's what's happened in just the last few weeks: -Lilly expanded its LillyDirect platform to include Walmart for pharmacy pickup, a major retail move. -Amgen launched 'AmgenNow,' offering Repatha at a discount of 60% or more to bypass insurer hurdles. -Novartis is rolling out its own DTP platform for Cosentyx. -A DHC Group survey confirms 94% of pharma leaders are now actively exploring DTP. The goal is clear: take control of the patient experience and improve access. — However, there is a tradeoff. — The current model is built on a cash-pay foundation. As Drug Topics rightly pointed out recently, this can hurt patients by not applying to their deductibles, which may lead to higher total costs. This creates a new kind of access barrier. This highlights the real scaling challenge for DTP 2.0. The platforms that win won't just bypass insurance; they will automate it. The critical backend will be a seamless 'insurance engine' that can handle Benefit Verification, Prior Auth, and appeals. As pharma builds these new channels, will they invest in a robust insurance engine, or will DTP remain a 'cash-pay' niche? #Directtopatient #DTPLogistics #DTPAutomation #PatientAccess
The next wave of DTP won’t be retail partnerships but invisible infrastructure that clears access barriers before the patient ever hits checkout.
Don't most insurance allow for Pay and claim where they can file for "out-of-network reimbursement" by turning in a superbill? Also, without the individual mandate penalty, more people are treating insurance as pure catastrophic coverage and paying cash for routine medications and care especially when cash prices are competitive and as we see driving the costs down aggressively. The big opportunity right now, in my mind, is filling the gap with a risk prevention product that covers you for catastrophic events but allows you to pay direct for routine care without it being an expensive add-on.