By Peter Loftus
Drugmakers are moving to sell their medicines directly to patients, abandoning the middlemen they have long relied on.
The shift is a huge departure from how pharmaceutical companies including Eli Lilly, Novo Nordisk and Pfizer have sold drugs for decades and threatens the multibillion-dollar business of firms that have traditionally filled prescriptions.
It is saving some patients hundreds of dollars off the cost of prescriptions because companies have been lowering the prices for drugs sold directly.
Meantime, drugmakers who have been rolling out the services in recent months see a big opportunity to boost sales, though they risk losing revenue if they don't offset lower prices by selling to more patients.
"For the first time, pharma is actually looking end-to-end at the full patient journey," said Pratap Khedkar, chief executive of pharmaceutical consulting firm ZS. "That is a very different mindset than has been the case for the last 50 years."
The trend is most pronounced in the booming weight-loss drug market. Eli Lilly and Novo Nordisk are seeing big growth in sales of their popular drugs through direct-order services the companies have started since last year.
Bristol-Myers Squibb and AstraZeneca, in addition to Pfizer, have launched the services for treatments for diabetes, psoriasis and cardiovascular disease, including the widely used blood thinner Eliquis sold by Pfizer and Bristol-Myers.
The growth of the services, which are offered through websites, reflects just how comfortable consumers have become with getting healthcare digitally. Now, many patients talk with doctors and order drugs online.
"This is how people are experiencing healthcare," said David Moore, executive vice president of Novo Nordisk's U.S. operations.
Drugmakers generally offer direct-to-patient services through company-operated websites. Since patients will need a prescription, some sites help patients find a doctor for either an in-person or telehealth visit.
Patients buy their medicines through the sites at discounted prices -- often half the list price -- and often without using insurance. The services usually arrange for home delivery, or for patients to pick up prescriptions at a pharmacy.
Craig Voorman started ordering discounted vials of Lilly's weight-loss drug Zepbound through LillyDirect last year so he could save hundreds of dollars a month.
Voorman, a 71-year-old retired pharmaceutical sales manager living in Fort Myers, Fla., gets his health insurance through a Medicare plan that doesn't cover the drug, which meant he used to pay the full cost.
"It was $1,050 at Costco when I started, and the vials were not available," he said. "As soon as it was offered at $550 in the vial, I switched." He used the savings, he said, to help his daughter-in-law pay for her prescription for the drug.
About 30% of the roughly 500,000 weekly prescriptions for Zepbound in the U.S. are now sold through Lilly's online service at discounted cash prices -- as low as $299 a month, versus a list price of $1,086.
The direct-to-patient service is helping fuel what is expected to be nearly $13 billion in total Zepbound sales for 2025.
Direct-to-patient is "creating an experience for consumers that you would expect outside of healthcare," Jennifer Mazur, senior vice president of Lilly USA's consumer-services division and general manager of LillyDirect.
For decades, the pharmaceutical industry has sold drugs to wholesalers and pharmacies, which then provide the drugs to patients and get reimbursed for the bulk of the cost by patients' health-insurance plans.
Drugmakers also have been exploring working more directly with self-insured employers to provide coverage and access to certain drugs.
The services could get a boost in traffic in early 2026 if the Trump administration goes ahead with plans to launch TrumpRx, a drug-buying website that will connect patients with discounted prices.
The efforts cut out middlemen called pharmacy-benefit managers, or PBMs, who usually play a key role in getting prescriptions filled and reimbursed.
PBMs often negotiate how much health plans will pay for a prescription and recommend which drugs patients can get and how much their copay or other out-of-pocket charge will be.
The firms make money from client fees and a cut of rebates paid by drug manufacturers .
"For most patients, drugs will cost even less out of pocket and face fewer safety concerns when their medications are delivered through their prescription drug benefits at their pharmacies and with their doctors involved," said a spokesman for Pharmaceutical Care Management Association, a PBM trade group.
Direct-to-patient likely won't be a sales channel for complex and pricey biotech drugs, particularly those dosed in healthcare facilities, according to industry officials and analysts.
Nor might it drive much sales for drugs that have broad insurance coverage with affordable copays for patients.
The dynamics of the weight-loss drug market, however, make it well-suited for a direct-purchase model because insurance coverage of weight-loss drugs is low, leaving more people exposed to the full price of the drugs.
Also, social media is fueling consumer demand for the drugs to a much greater degree than most other drug categories.
About 10% of Novo Nordisk's U.S. prescription volume for Wegovy, Executive Vice President Moore said, comes from direct cash purchases. Analysts expect Wegovy to generate $11.9 billion in global sales this year, up more than 40% from last year, according to FactSet.
Write to Peter Loftus at Peter.Loftus@wsj.com
(END) Dow Jones Newswires
December 08, 2025 12:00 ET (17:00 GMT)
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