The Growing Role of DTC Healthcare

In a video interview with Pharma Commerce, Colin Banas, MD, DrFirst’s chief medical officer, describes have many Americans face significant challenges in accessing GLP-1 drugs due to their high cost. Despite the growing popularity and usage of these medications, which were originally developed for diabetes treatment, the price remains largely unchanged. Even with insurance coverage, patients often encounter co-pays or out-of-pocket expenses upwards of $500 to $600, making the medications unaffordable for many. Research indicates that once out-of-pocket costs exceed $100, medication adherence drops dramatically, further limiting access.

Additionally, insurance companies frequently require patients to try other medications first, a process known as step therapy, which can delay access to GLP-1 drugs. The drugs' weight loss benefits have garnered attention, but insurance companies still primarily cover them for diabetes treatment, leaving individuals seeking them for weight loss without coverage options. Moreover, as ongoing research uncovers more potential benefits of GLP-1 drugs—such as their positive effects on cardiovascular disease, Alzheimer's, and chronic kidney disease—insurance policies have not yet adapted to these expanded uses. As a result, many Americans who could benefit from these drugs for conditions beyond diabetes find that coverage is not available.

Banas also comments on patients turning to direct-to consumer (DTC) platforms following insurance denials; rumors of DTC advertising being banned; and much more.

A transcript of his conversation with PC can be found below.

PC: An iPrescribe survey found that many patients turn to DTC platforms following insurance denials. How can these platforms address these challenges more effectively in order to better serve patients?

Banas: It's an interesting survey that you brought up, and there really were two big revelations that came out of it. I'm not sure that anybody would be surprised by them. Like you said, about a third of the time, it was related to cost as a reason to go DTC, whether it was insurance doesn't cover it, or out of pocket is simply too much when I go to my local retail pharmacy. The other one was convenience, which we can set aside and talk about in a second, but DTC is filling a need. I would consider it an access need.

It's providing a convenient way for access and options. In the old days, I had one option, I'm going to go to my doctor, and I'm going to wait to get on the waiting list. Maybe in six months, I'll finally get in to see them, and in my 15 minutes, I might be able to rattle off all of my chronic diseases and concerns, and maybe weight loss will bubble up to the top. Hopefully, if my doctor knows about this particular therapy, is comfortable with this therapy, and is educated, maybe I might qualify. You can imagine, as we've become so used to instant access in other areas of our lives—think about retail, think about banking, think about aviation—all these things are available at the touch of our app on a phone or a mobile device.

It becomes accessibility, it becomes option. And then there’s competition. In the United States, competition among all of these various accessibility options potentially leads to alternatives, whether it's alternative therapies, alternative costs, things like that. I am not surprised in the slightest that DTC has become a bigger and bigger portion of the way Americans seek healthcare. In fact, some of the pharmaceutical manufacturers actually are offering their own DTC now. I think of LillyDirect as one of the pioneers in that space.