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Pharma is quietly rebuilding the traditional drug supply chain.

It’s getting better at capturing patients’ attention and then routing them through new distribution channels that sell medications directly to them. Pharma’s latest DTC strategies, plus the new TrumpRx play, are all converging on the same pressure point. Even though I covered this topic over the summer, it’s worth a quick update.

In this article, I’ll highlight pharma’s new front door, walk through the middle of the funnel, and then show how this all lands on patients, physicians, and pharma.

I saw a patient in clinic this week who whipped out their phone to show me a TikTok video of an influencer talking about Eli Lilly’s Zepbound. “Can you prescribe this so I can lose weight?” they asked. “I can try,” I said, “but your insurance probably isn’t going to cover it—you’ll likely be paying out of pocket.”

After the visit, I felt uneasy. I’m used to patients telling me about something they “read online.” I’m not used to patients getting medical guidance from TikTok in between comedy clips and beauty content. The video clearly “promoted” Zepbound, but there was no disclosure that it was sponsored by Eli Lilly.

Interestingly enough, a research letter published in JAMA analyzed TikTok content where influencers promoted GLP‑1s, ADHD meds, and autoimmune biologics, and compared those posts against FDA and FTC requirements for fair balance and disclosure. The authors found that most videos emphasized benefits, rarely mentioned risks or alternatives, and often failed to clearly disclose financial relationships or sponsorship (2% of all the posts analyzed!). In other words, a lot of what looks like “personal health advice” on TikTok is functioning as drug promotion with far weaker guardrails than traditional DTC advertising.

Once a patient is primed by TikTok or Instagram, pharma has made it much easier to finish the funnel. The path from “I saw this drug online” to “I’m on it” now runs through branded telehealth and direct cash‑pay programs.

All of these share the same pattern: patients feel like they’re getting help navigating a broken system, while manufacturers quietly gain more control over pricing, volume, and distribution.

TrumpRx is the federal government’s new direct‑to‑consumer website that will allow patients to buy certain drugs straight from the manufacturers at government‑negotiated, “most‑favored‑nation” prices (that is, prices set to the lowest levels paid in other wealthy countries). It was created as the Trump administration’s answer to public frustration over drug costs, especially GLP‑1s, with the promise that Americans won’t pay more than patients in other wealthy countries.

Several drugmakers have already agreed—or volunteered—to offer medications on TrumpRx:

In practice, TrumpRx functions as a government‑run front door into these manufacturers’ existing DTC and cash‑pay programs: patients search TrumpRx.gov, get routed to a Lilly/Pfizer/Novo site, and complete the purchase there at the “discounted” most-favored-nation price, while the underlying list prices and channel economics largely stay intact.

Pharma’s relatively new direct‑to‑consumer (or direct‑to‑patient) model is exciting, but the winners and losers aren’t evenly distributed. Patients lose a bit less, physicians break about even, and pharma still wins.

For patients, these DTC channels are often the only way to access drugs we would prescribe because they’re clinically useful, but can’t, because insurers don’t cover them. Back to the patient I mentioned earlier: obesity, years of failed weight‑loss attempts, and an insurance plan that won’t touch Zepbound. If I send a standard prescription, she’s staring at roughly $900 a month. Through LillyDirect—or eventually TrumpRx—that drops closer to $300. That’s still painful, but for some, that’s the price drop that’s needed to purchase the medication. GLP‑1s are the headline, but the real need extends to SGLT2 inhibitors, migraine therapies, lipid‑lowering agents, and other drugs that remain effectively out of reach when insurance says no.

For physicians, we inherit one new problem and one new tool. The problem is the downstream effect of TikTok/Reels/Shorts as an unregulated, highly targeted ad channel. Patients now show up pre‑sold on a specific brand (”I want Mounjaro, not Ozempic”), convinced the drug they saw is their solution. Sometimes they’re right, but sometimes they’re not. That makes for harder conversations and more pressure to say yes. On the flip side, some patients come in better informed and more engaged, ready to actually talk through options instead of passively nodding. That’s a win. And on the tooling side, these DTC programs give us one more lever when insurance walls us off from high‑value meds. I say “relatively cheaper” because $300–400 a month is still out of reach for many of my patients—but it’s at least a different conversation than $900–1,000 cash at the pharmacy counter.

For pharma, though, this is still a win even after “cutting” prices. If Lilly and Novo both drop prices on their weight‑loss meds, they’re moving together. The relative competitive landscape doesn’t change much. In my report on Why Are U.S. Drug Prices So High? I argued that the root of the problem is upstream: patent law and market exclusivity rules that give manufacturers wide latitude on pricing. Those rules are unlikely to change—and frankly, some level of exclusivity is the only reason drugs like GLP‑1s get developed in the first place (they cost billions of dollars to develop).

So the “next best” path is to play within the existing rules to blunt prices for patients. Cost Plus Drugs is one version of that: cut out PBMs and sell at transparent cash prices. What we’re seeing now with pharma’s own DTC platforms and TrumpRx is a similar move. It’s just executed by the manufacturers themselves.

In other words, the channel is changing more than the underlying incentives. We may get more patients on needed drugs and slightly lower prices at the margin, which is good. But the fundamental power dynamic hasn’t shifted.

In summary, pharma is rebuilding the path from awareness to prescription, and we’re left practicing medicine inside someone else’s growth strategy.

AI is everywhere in healthcare right now—scribes, prior auth tools, “clinical copilots”—but most of what we’re rolling out is designed to make a dysfunctional system run a little faster, not to fix the dysfunction itself. We’re pouring time, money, and attention into tools that optimize around fee‑for‑service, prior auth, and documentation bloat instead of asking whether those constraints should exist in the first place.

That might feel like progress day to day, but it has a cost. The more “efficient” we make bad processes, the harder it becomes to build or justify truly transformative AI that could redesign workflows, payment, and staffing from the ground up. At some point we have to ask: are we reducing friction, or just deepening the grooves of a system we already know is broken?

👉 Full breakdown in my latest Huddle+ article here.

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