Semaglutide (Novo Nordisk)

iStock, peshkov TrumpRX and DTC sales may expand prescription drug access, but they will not solve the affordability crisis by themselves. There’s no doubt that we have a drug affordability crisis in America. A recent Model N consumer study found that 40% of respondents have skipped or delayed filling prescriptions due to cost concerns in the past year. According to KFF , more than half of Americans are worried about affording their family’s medicine. It follows, then, that direct-to-consumer (DTC) approaches have piqued consumer interest. In February the U.S. government launched TrumpRx , a clearinghouse designed to connect patients with DTC medications at a discounted price. Fifteen of 17 pharma manufacturers have agreed to participate in the website, with a selection of their drugs advertised at 50% to 80% off of list prices. This initiative follows a DTC trend already brewing in pharma, with Eli Lilly , Pfizer and others now selling medicines through their own platforms. In the Model N survey, 72% of respondents said they would be very or somewhat likely to purchase medicine this way. Reduced cost is the primary motivator for consumers, with nearly three-quarters saying a lower price would increase their likelihood of buying directly from the manufacturer. According to the 2026 State of Revenue Report, pharma companies plan to continue establishing new DTC sales channels. Unfortunately, DTC will not solve America’s drug affordability problem. 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. The GLP-1 Use Case GLP-1 receptor agonists like Wegovy and Ozempic are a prime example of DTC in practice. Many insurance plans cover these drugs only for diabetes treatment, not for weight loss, which is a very popular use case. Weight loss patients must pay the list price entirely out of pocket when purchasing the drugs at a pharmacy. Originally, most cost around $1,000 per month . Manufacturers may use DTC channels to reduce the consumer price, and recent developments with the launch of TrumpRx saw manufacturers make further price cuts. Novo Nordisk just dropped its GLP-1 list prices to $675 . Still, most GLP-1 brands cost hundreds of dollars a month after discounts, which is cost-prohibitive for many. The savings available on DTC and alternative platforms don’t meaningfully change affordability. Obesity disproportionately affects lower-income people, meaning most of the population that needs this medication can’t obtain it. While DTC can bolster access in some cases, the U.S. healthcare system is too complex for simplistic solutions like a single new distribution channel. How Manufacturers Price DTC Drugs DTC channels offer a discount off the list price. However, list prices are set high due to the rebate and discount system that defines the conventional distribution model. The expectation is that intermediaries responsible for the vast majority of drug purchases, including pharmacy benefit managers, group purchasing organizations, insurers and government payers, will not pay the full list price. Manufacturers are required to give discounts to government programs like Medicaid and 340B, and adhere to prices established under the Medicare negotiation program. For commercial insurance, purchasing entities negotiate substantial discounts and rebates off the list price on behalf of health plans and hospitals. These adjustments create the so-called gross-to-net bubble, as coined by the Drug Channels Institute . The figure reflects the scale of manufacturers’ financial concessions to payers and the diminished net price they collect. Manufacturers set list prices to account for these reductions. In announcing DTC plans, manufacturers touted discounts ranging from 50% to 80% off list price. It’s unknown whether this truly represents a price reduction because the discounts manufacturers offer to commercial and government payers are a closely guarded industry secret. Drug Pricing Opinion: Pricing Transparency Is Coming to the Pharma Industry Opening up about drug pricing decisions is not optional for biopharma anymore. For the sake of credibility, companies should embrace it. February 2, 2026 · 5 min read · Joshua R. Mansbach Read more 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. 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. As a result, DTC will likely benefit only those who are under- or uninsured and those buying medications not covered by insurance, such as GLP-1s for weight loss—assuming these patients are able to afford the drugs. That is a very small percentage of the population. In short, DTC’s emergence will help broaden access but not deliver meaningful savings at scale. 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.