Enabling patients to order prescription medications directly from the drug maker is an emerging trend exemplified by the launch this year of two online platforms, LillyDirect and PfizerForAll, by Eli Lilly and Pfizer, respectively. Other pharmaceutical companies may follow suit. While these initiatives facilitate patient access to certain products, they also raise (ethical) questions concerning the possible disruption of established patient-physician relationships and the potential for conflicts of interest.
The drug maker Eli Lilly launched a site called LillyDirect in January that allows patients with diabetes, obesity and migraine to connect to telehealth providers and in-person referrals who can prescribe medications, which are then filled by third-party pharmacy dispensing services, such as Truepill or Amazon Pharmacy, and in the case of Lilly products delivered to the patients’ homes. Pfizer unveiled a similarly designed digital portal at the end of August, intended to connect patients to a range of healthcare services and products.
The salience of these platforms became apparent when Lilly launched discounted versions of its weight loss drug Zepbound (tirzepatide) last week. The discounts will only apply to low-dose vials of the drug sold solely through its direct-to-consumer online portal, LillyDirect. Moreover, the discounts will only be made available to cash-pay patients.
Low-dose vials of Zepbound—previously available as injectable pens with a list price of $1,060 per month—will be priced at $399 and $549 for a monthly supply of a 2.5 mg and 5 mg dose version, respectively.
Eli Lilly says that the decision is “expanding access and supply” of Zepbound. Nevertheless, only the starter doses will be offered in the vials and not the higher dose injectable pens that many patients may require to achieve significant weight loss. In fact, Lilly just raised the cost of getting high-dose pens with the use of a coupon from $550 to $650 per month.
Lilly is providing the low-dose vials solely through LillyDirect, in effect steering patients towards its products. Additionally, while patients can access medicines through LillyDirect prescribed by their own doctor, the website directs patients to “talk to a doctor to find out if Lilly medicines are right for you.”
Direct-to-consumer programs offer access advantages to patients as they sidestep several of the intermediaries in the drug supply chain. But they may also bypass meaningful engagement between the patient and their regular doctor who has first-hand knowledge about a person’s medical history and co-morbidities. This seems especially relevant with respect to weight loss medications where monitoring, follow-up and diet and exercise advice, may be crucial. The high percentage of patients who discontinue their obesity medicines, with possible weight rebound as a result, reinforces the importance of closely managing the condition and its treatment modalities.
The American College of Physicians has expressed concern about the use of telehealth services to prescribe products as part of direct-to-consumer sales efforts by pharmaceutical firms. For telemedicine to take place “responsibly” in its view, the group suggests that care should happen in consultation with physicians who have established relationships with their patients.
And while the doctors in the telehealth network aren’t compensated by Lilly for prescribing the manufacturer’s drugs, only those patients prescribed the Lilly product Zepbound will be eligible for the at-home delivery service. In this respect, the LillyDirect model and others like it give the appearance of potential conflicts of interest.
This week Pfizer launched its direct-to-consumer platform, PfizerForAll, an online portal designed in the company’s words to help “simplify and coordinate healthcare for consumers.” PfizerForAll targets patients seeking care for migraines, Covid-19 or influenza, in addition to vaccines for Covid-19, flu, respiratory syncytial virus and pneumococcal pneumonia. The program partners with UpScriptHealth, Alto Pharmacy and Instacart to carry out its mission.
Analogous to LillyDirect, patients can connect with a healthcare provider via a telehealth company to obtain an array of services, including diagnostic tests, prescriptions, medications delivered to their home, scheduling of vaccine appointments at major retailers like CVS Health and co-payment savings if prescribed a Pfizer product. PfizerForAll prominently features information on Pfizer products, though it is not limited to just those.
The end-to-end offerings included in the new direct-to-consumer platforms facilitate patient access to certain healthcare products and services. But they also entail potential conflicts of interest if and when drug manufacturer sponsors of these platforms exert indirect control over the diagnosis and prescribing function as well as the pharmacy fill.
