Reasons Behind the Rising Popularity of DTC Online Prescription Services

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: As also noted by the iPrescribe survey, what are the primary reasons why 52% of respondents choose DTC online prescription platforms?

Banas: At first, I was like, ‘wow, that's crazy.’ And then I was like, ‘oh no, that actually makes sense.’ There are a couple things that come to mind. I'm still an actively practicing physician, although not nearly as comfortable in the outpatient space as I am on the inpatient space. I was a hospitalist, but a lot of patients may not want to bring these things up with their doctors. For whatever reason, a lot of patients may feel—like I spoke about earlier—that they're not going to qualify for that particular therapy, or that they've been down this path with their doctor before, and the doctor is just simply not going to prescribe it. ‘I've tried this before. My doctor is a stickler for this sort of thing.’

There’s a little bit of, I don't want to say gaming the system, but finding your sweet spot for your providers, and sometimes, whether it's comfort, whether it's the ability to access your primary care doctor, which I mentioned before can take months sometimes. The third thing—until recently, and the survey actually bears this out, but if you had asked me these questions two years ago, I would have almost guaranteed you that primary care doctors, internists, family doctors, were not writing for GLP-1s. I can almost guarantee it because it was this new diabetic medication that was on the scene, and I'm telling you that as an internist myself, there's a certain ‘we're comfortable with insulin, we're comfortable with metformin and glipizide,’ and maybe some of the other SGL2 inhibitors. I'm sorry I'm using all this jargon, but some of these other medications.

Once you hit a certain threshold, you're like, ‘I need an endocrinologist. I need a specialist. This is out of my comfort zone.’ And as the data started coming in, folks had to get more and more comfortable with it. You actually see internists prescribing this at a higher rate, year-over-year. You even see OBGYNs writing for these particular drugs, because a lot of times, women are using their OBGYNs as their primary care doctors, but two years ago, that wasn't the case.

You can imagine there's this sort of—as the industry catches up, or as folks get more and more comfortable with this—maybe patients don't realize that their doctor is indeed comfortable with this medication, and so they go looking for alternative. Again, not overly surprised. They certainly make it easy. It is easy to do these things on these DTC platforms, intentionally so.