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Various kinds of medical pills with Rx sign on smartphone screen , online pharmacy concept Atstock Productions/iStock Big Pharma has finally gotten its arms around something advocates have wanted for a long time: direct-to-consumer sales. Eli Lilly and Pfizer are leading the way. Big Pharma is finally beginning to offer what patient advocates have been asking for: a direct-to-consumer option to buy medicines straight from the manufacturer. This past week, Eli Lilly announced the addition of starter Zepbound vials to its DTC platform, called LillyDirect, expanding options for patients to self-pay for the popular weight loss drug. A day later, Pfizer announced the digital portal PfizerForAll , which provides access to the New York pharma giant’s vaccines, plus migraine and respiratory drugs. The two programs connect patients to telehealth care and a third-party service for the delivery of medicine. “It does just make the full digital telehealth pharmacy experience online really seamless,” Dedham Group Principal Manny Jurado told BioSpace . “It’s like you’re able to integrate everything into almost more or less a one-stop shop.” Jurado says these DTC approaches are a long time coming. Advocates have been calling for a new way for patients to access medicines that could help bring down costs by cutting out the so-called middle-men that pharma industry groups say push up prices. But DTC adoption has been slow. These latest announcements are a welcome advancement, Jurado said. “I’m sure pharma already had a lot of plans about this multiple years ago, but it’s now finally that we’re able to see it come to fruition,” he said, acknowledging the complexity of developing these programs in terms of compliance and regulatory hurdles. While the process cuts out the trip to the pharmacy, patients are not exactly receiving the medicine from Lilly or Pfizer’s personal storage rooms. Jurado said the pharmas have contracted third-party providers for the actual distribution. He noted that the DTC idea is not new. Amgen and AbbVie have existing platforms and the pharma industry has played around with the idea previously with minimal success. Now that Lilly and Pfizer are diving in, he suspects more—including Lilly’s chief rival Novo Nordisk —will follow suit. Zepbound Pushes Lilly Toward DTC Option Lilly was a natural entrant given the craze around Zepbound and the supply hurdles the company has faced. LillyDirect launched in January , just two months after Zepbound’s approval. Then last week, Lilly announced the availability of single-dose vials of Zepbound at a 50% discount compared to the list price of other treatments in the incretin class. CEO David Ricks said during a fourth quarter earnings call in February that the idea came from the challenges patients have experienced accessing obesity treatment. “Finding medicines in their pharmacies, that’s a been a challenge,” Ricks said on the call. “And I think particularly as supplies are tight, many patients report driving to five, six, seven pharmacies to find the medicine they need. This simplifies that process.” The direct pharmacy also gives patients confidence that they are getting a genuine Lilly-manufactured drug, as compounded or illicit versions of Zepbound have trickled into the market, the CEO added. “We haven’t thought about it as a way to create some new retail distribution business. It’s a way to serve the patients that want our medicines better,” Ricks said. But Lilly will benefit from getting new patients started on treatment, Jurado said. While the online pharmacy serves as an option for patients whose insurance has denied coverage of the weight loss drug, the single-dose vial offered through LillyDirect is just a starter dose—patients will eventually have to step up to a higher dose which will need to be accessed another way, according to Jurado. In addition, as the coverage landscape for weight loss medication evolves, cash-pay patients will likely switch over to insurance and long-term care. Lilly did not frame the new vial offering as a way to cut costs for patients. The drug launched last year in its injectable form with a list price of $1,059.87 a month for the various doses. But removing the injectable from the equation does lead to a savings in terms of the overall price and some of the manufacturing complexity. A number of third-party providers have been pulled together to deliver LillyDirect. EVERSANA and others are conducting pre-authorizations; Form Health and 9amHealth are doing the telehealth services; and TruePill and Amazon Pharmacy are offering the pharmacy services, among other providers. Pfizer tackles an ‘overwhelming’ system While Lilly is doubling down in DTC, Pfizer is just getting started. With PfizerForAll, patients can purchase prescription drugs, over-the-counter medications and diagnostic tests, available for pick-up at a local pharmacy or through home delivery. The service will also connect patients with in-person or online appointments with healthcare professionals and offer a scheduling tool for adult COVID-19, flu, pneumococcal pneumonia and respiratory syncytial virus (RSV) vaccinations. In addition, PfizerForAll provides access to the company’s savings programs, which include solutions for co-pay and insurance. “People often experience information overload and encounter roadblocks when making decisions for themselves or their family in our complex and often overwhelming U.S. healthcare system. This can be extremely time-consuming and lead to indecision or inaction – and as a result, poor health outcomes,” Aamir Malik, Pfizer’s executive vice president and chief U.S. commercial officer, said in an August 27 statement. “We are pleased to offer PfizerForAll to help relieve this burden on people, especially as we enter the fall season in the U.S., and streamline the path for those seeking better health.” While Lilly is trying to address a nearly insatiable demand for its weight loss drug, Jurado said that migraine medicines have also been in demand. Pfizer markets Nurtec and Zavzpret. “We’re seeing more and more of these pseudo-retail type products and retail therapies starting to make more sense from a direct-to-consumer standpoint and ease of online access,” Jurado said, adding that migraine treatment requires a neurologist, which can be hard to access. Pfizer has stated plans to expand the program, potentially to a broader range of conditions. In announcing PfizerForAll, Pfizer also did not mention slashing prices as a reason behind the move. While the program connects patients to existing affordability programs, no new options were released to coincide with the DTC launch. Ready, Set, Launch When contacted by BioSpace , AbbVie pointed to the Synthroid Delivers program, which offers the brand name thyroid hormone medicine directly to patients for $25 per month for a 90-day prescription. AbbVie uses Eagle Pharmacy to fulfill the orders. Amgen did not return multiple requests for comment, but STAT identified the company as one that has used virtual care in the past for its migraine drugs. Jurado suspects there may soon be more companies joining the DTC marketplace. “I would assume that there’s going to be a lot of other players who are either potentially launching, or are even thinking about launching,” Jurado said.