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Pharma has always been good at getting our attention. Doctors get invited to steak dinners or offered speaker fees. Flip open NEJM and there’s an Eli Lilly ad staring back at you on page one. Patients get hit with a clever commercial right in the middle of their favorite show.

But the playbook is shifting. Instead of just ads and perks, pharma is now partnering with telehealth companies—or even building their own platforms—to make it easier for patients to get their (expensive) medications.

In this article, I’ll break down what’s happening in the pharma-to-consumer space, where the major partnerships stand today, and what it all means for patients, physicians, and the health system.

Drugmakers are experimenting with two main approaches to get medications directly into patients’ hands:

Eli Lilly and Pfizer have both launched branded platforms, but neither actually runs its own telehealth service. Instead, they partner with independent telehealth companies whose clinicians can prescribe their medications.

The model cuts out pharmacy middlemen, gives patients cash-pay options, and streamlines prescribing.

Novo Nordisk takes a different approach. Its platform, NovoCare, doesn’t require a telehealth visit. Instead, patients who already have a prescription for Wegovy can purchase (cash) it directly from Novo — often at a lower out-of-pocket price and with home delivery. Roche may add this model, too!

With the models in mind, here’s where the major partnerships stand — and where they’ve fallen apart. These deals focus on expanding access to anti-obesity drugs like semaglutide and tirzepatide.

So, as you can see, Novo is rewarding partners who abandoned compounded meds, while cutting ties with those who haven’t. Lilly is enforcing the same rule — keeping WeightWatchers, Ro, and Knownwell in the fold, while dropping Noom.

At its core, pharma’s new direct-to-consumer push is about revenue. More patients on branded meds means more sales. At the same time, these models can improve access to effective therapies like GLP-1s. In theory, it’s a win-win — patients benefit, and capitalism does its thing.

But when you follow the money, things get murkier. A group of senators — Durbin, Sanders, Warren, and Welch — recently released a report raising concerns about these pharma-telehealth partnerships. Their findings weren’t surprising, but they’re worth calling out:

Again, none of this is shocking. Of course pharma designed these partnerships to drive prescriptions of their own drugs. That was the point from day one. And if they’re also increasing access to medications that work, why the outrage?

Some (or just me?) have compared this to the PBM model, where pharma pays rebates to secure formulary access. But there’s an important distinction. In the PBM world, those rebates don’t directly dictate an individual physician’s prescribing. There are multiple layers between pharma and the exam room — insurers, formularies, patient cost-sharing. With these new partnerships, those layers disappear. The telehealth provider is just one step away from pharma, and in some cases, the patient can even pre-select the drug before the visit. That’s a much thinner firewall protecting independent medical judgment.

So, the real risk of these partnerships presents when they cross the line into prescribing that’s unnecessary or clinically inappropriate. That’s where “profit over patients” becomes dangerous.

I’m in favor of innovative models that expand access. But I agree with the senators’ conclusion: if these arrangements are edging into anti-kickback territory — steering patients toward specific drugs through financial relationships and selective networks — then regulators have a role to play. Innovation should not come at the expense of independent clinical judgment or patient safety.

Long wait times and no-shows are the twin headaches of outpatient scheduling—and here’s the irony: the two are connected.

The longer a patient waits for an appointment, the more likely they are to cancel or never show up at all. Add in that no-show rates spike at certain times of day and in certain patient groups, and you start to see the real operational drain this creates.

We’ve thrown the usual fixes at the problem—patient portals, reminder texts, overbooking—but the data tells a different story about where the biggest opportunity might be. It’s not just about reminding patients to come… it’s about rethinking how we build the schedule in the first place.

👉 Full breakdown here.

Medicare Advantage was supposed to deliver better care at a lower cost.

Instead? It’s become a money-making machine for insurers—one that thrives on upcoding, prior auth denials, and favorable selection. Over half of all Medicare beneficiaries are now enrolled in MA plans, and yet the government is projected to overspend by tens of billions of dollars every year.

Even lawmakers—Republican ones—are calling it what it is: a “bastardized” version of the original vision.

So how did we get here? And what would it actually take to fix the system?

👉 See all my prediction updates here.

We were trained to take care of patients. But no one ever taught us how the system actually works:

That’s why I built this course: How Healthcare Really Works.

It’s short, visual, and built for people like us — physicians trying to make sense of the business and policy forces shaping our day-to-day work.

👉 Enroll in the course here.

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