Exploring the pros and cons of direct-to-patient drug programs
Cardiovascular medications only work if patients can afford to buy and take them. Newer agents like GLP-1 receptor agonists and SGLT2 inhibitors may offer excellent potential, but they also can be priced out of reach for many patients.
One way pharmaceutical manufacturers are working keep drug prices down is direct-to-patient (DTP) prescription drug platforms. These cut out the middlemen such as insurers and pharmacy benefit managers (PBMs) to offer name-brand drugs at a lower cost. A new analysis in JACC reviewed the use of these programs, highlighting potential positives and negatives.[1]
"In the face of high prescription drug costs in the United States, DTP platforms offer an alternative pathway for patients to purchase important treatments at lower prices. As these platforms gain visibility, cardiologists should understand how they operate and which patients may benefit from them, their limitations, and their potential impact on access and adherence to evidence-based cardiovascular therapies," wrote lead author Kavya M. Shah, MD, a researcher with the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center, and colleagues.
President Trump's 2025 Executive Order to implement “Most Favored Nation” drug pricing also accelerated the rise of DTP platforms as manufacturers want to show they are lowering prices proactively. Drug makers have introduced DTP options for treatments such as apixaban, dapagliflozin and semaglutide. More drugs are expected to be added due to the White House’s February 2026 launch of TrumpRx, a government-run website connecting patients to manufacturer-run DTP platforms.
The study's authors said cardiometabolic medications account for almost a quarter of all prescription drug spending in the United States and dominate Medicare Part D expenditures, showing the importance of drug pricing policy for cardiovascular care.
"For the 84% of Americans who have prescription drug insurance, these platforms may not offer meaningful savings, as DTP prices may exceed the negotiated rates available through private or public payer pharmacy benefits. Insured patients should also note that DTP drug purchases do not currently count toward yearly deductibles or out-of-pocket maximums, which could lead to higher overall health care expenditures," the authors wrote.
They said drugs such as apixaban and dapagliflozin already have price reductions under the Medicare Drug Price Negotiation Program, which could diminish any advantages of DTP programs for Medicare patients.
However, for the uninsured, patients enrolled in high deductible plans, or paying out of pocket, DTP platforms could offer more affordable therapies, the researchers wrote.
Cardiologists should be aware of these alternative plans, but also understand the potential downsides. These programs typically offer a small selection of drugs made by a pharma company, for example. Even some brand-name medications on DTP platforms may have cheaper generic alternatives.
"For such drugs, discount initiatives like Walmart’s $4 Prescription Program, third-party coupon platforms like GoodRx, or online pharmacies unaffiliated with manufacturers, like Amazon Pharmacy, may offer better cash-pay pricing," the researchers wrote.
For patients who do have insurance but face regular access delays due to prior authorization, or are required to go through step therapy first before receiving the drug their doctor wants them to take, DTP programs may offer an advantage. The authors said a key case for this is PCSK9 inhibitors such as evolocumab, where restrictive coverage policies have limited uptake, despite strong clinical evidence showing the benefit in high-risk patients.
"DTP platforms may enable more timely access to clinically appropriate therapies by sidestepping these insurer approval processes. But such workarounds also raise broader equity concerns, as not all patients can afford drugs via these platforms," the researchers wrote.
They added that it remains unclear if circumventing formulary controls through DTP platforms will further increase drug costs over time because they may reducing payer bargaining power.
Another consideration with DTPs is how they may impact medication adherence, monitoring and safety. The platforms can complicate cardiologists’ ability to obtain accurate medication fill histories from electronic health records (EHRs), for example, introducing a "blind spot" that did not previously exist.
Read more and see a cost comparison chart for average pricing between DTP, Amazon Pharmacy and GoodRx platforms.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]