Pharma’s commercial revolution: How integrated DTC models elevate and empower patients

First proven in obesity, integrated direct-to-consumer models cut through market barriers to create efficiencies and expand patient access, choice: A Guest Commentary

The obesity market has catalyzed the emergence of a direct-to-consumer commercialization model that is fundamentally transforming how patients access, clinicians prescribe, and manufacturers deliver therapeutic interventions. What began as a response to an incretin shortage now stands as a foundational shift, poised to disrupt channels and accelerate care pathways far beyond obesity.

That shift also comes at a time when broader forces—vertical integration, out-of-pocket cost pressures and digital-health adoption—have begun eroding entrenched market structures, setting the stage for disruptions that simplify value, while elevating the patient.

For decades, people with obesity, and others seeking pharmaceutical treatment, faced a daunting gauntlet of clinician visits and insurer hurdles that left them discouraged and disempowered. These access barriers were not accidental; they grew over decades as a distribution system originally designed for efficiency evolved to elevate payer control over patient value.

Value chain modernization saw drug makers move away from direct distribution to wholesalers, bringing efficiency but distancing manufacturers from the pharmacy relationship. Pharmacy benefit managers (PBMs) translated these volumes into engineered formularies, margins and access, helping payers control costs—but at the price of patient autonomy. Over time, pharma ceded the pharmacy relationship for scale, stability and payer alignment, focusing mainly on prescribers and intermediaries.

What’s different this time isn’t simply direct patient messaging—DTC promotion has been around for decades—but rather a fully integrated model that unites engagement, prescribing and fulfillment within one digital ecosystem. As precision patient targeting converges with online care delivery, the DTC commercial model is challenging the dominance of brick-and-mortar healthcare institutions and PBMs, and in doing so redefining patient empowerment, prescription enablement, and therapeutic access.

This trend is already extending far beyond obesity, into many areas where motivated patients and digital care infrastructure intersect, and in the next decade, this will create a new high-volume pathway for how medicines are promoted, prescribed and delivered.

Obesity: Catalyst for change

Obesity is a uniquely consumer-driven condition, making it ripe for a reinvention of the direct-to-consumer model. When incretin-based therapies became scarce, compounding pharmacies backed by aggressive investors moved quickly into the gap, extending their reach into branded drug categories and piloting tech-enabled, commercially permissive models that outpaced traditional compliance norms.

High out-of-pocket demand amplified the effect: patients were willing to pay, insurance or not, for effective therapy. This intersection of consumer motivation, non-traditional entrants, and the need for end-to-end integration created a rare alignment that allowed obesity to become the proving ground for a new commercialization paradigm—one that now offers a blueprint for other therapeutic areas.

At the heart of this emerging DTC model is full pathway integration. What was once fragmented across prescribers, payers, and pharmacies is now managed through a single digital infrastructure connecting:

•Patient activation: Digital marketing and telehealth campaigns, spanning social media to TV, directly engage potential patients and route them into streamlined care platforms such as LillyDirect.

•Provider engagement: Eligibility screening occurs before virtual or in-person visits, allowing clinicians to focus on clinical decision-making rather than administrative triage.

•Benefits and payment navigation: Automated systems verify coverage and present transparent out-of-pocket options for both insured and cash-pay patients.

•Direct-to-patient fulfillment: Medications are shipped directly or coordinated through partner pharmacies, shrinking time to therapy from weeks to days.

Together, these elements create a tightly connected patient experience that replaces layers of intermediaries with a digital-first ecosystem built around speed, transparency, and consumer choice.

Navigating the risks

Despite its promise, the DTC approach in obesity isn’t without complexities and risks. The most debated issue centers on inducement: whether or not these pathways might influence clinical decision-making in a way that artificially increases prescribing. Manufacturers must show that visits through these channels do not drive disproportionate product-specific prescriptions more frequently than traditional care, and that eligibility and appropriateness criteria remain rigorous.

There’s also a challenge in bridging the gap between cash-pay and reimbursed markets. Regulatory realities prevent manufacturers from simply offering the same therapy at lower direct prices to individuals than to insurers, making it necessary to deploy sophisticated portfolio strategies and channel-specific product differentiation. Today, that’s often handled through variations in formulation or delivery (such as pre-filled pens versus vials and carve-outs of low-dose pricing within a product intended for up-titration), or through compounding pharmacies that exploit regulatory permissiveness on dosing or product format. In the long term, manufacturers will move past this micro-dosing ingenuity and solve this with sophisticated portfolios that deliver against both clinical need and economic reality across patients.

All parties—manufacturers, prescribers, payers, regulators—are charting new territory. Payers in particular worry about the erosion of their ability to manage care costs and utilization, while some manufacturers see an opportunity to orient future innovation directly toward unmet patient needs, unconstrained by payer or network priorities.

These challenges are real, but in many ways reflect entrenched, historic norms that have very much limited true patient-oriented innovation. They represent the growing pains of an emerging model that, if managed responsibly, will expand access while improving alignment between innovation and patient need.

The future: empowering patients beyond obesity

Major pharmaceutical companies are rapidly scaling DTC platforms across multiple therapeutic categories, proving this approach is not limited to consumer-driven medicine. In just the past three months, DTC launches have accelerated, with five major biopharma companies moving well-established brands into cash pay channels.

This level of activity signals both an appetite for industry-wide innovation and a recognition that DTC models are a foundational shift, not a one-off experiment. While many products selected for early DTC launches are mature brands, they will act as the proving grounds for these market leaders, providing the essential learnings that will inform how DTC commercialization can enable therapeutic innovation, patient access, and value demonstration.

The next phase of DTC innovation will also be paired with data-driven precision, the ability to engage individual patients with tailored outreach informed by digital signals and real-world behaviors.  Historical “precision” approaches were limited to stale claims data and low-resolution models, but new approaches allow for more targeted efforts to focus on connecting patients and prescribers to best fit products. And while these data-driven approaches will raise important questions about privacy and consent, future models can—and must—be designed around transparency and patient choice.

Imagine a future where patient engagement begins with subtle digital breadcrumbs—search history, mobile ID, behavioral cues—prompting targeted outreach for a relevant therapy. This outreach is orchestrated across devices and directly integrated with provider visits, benefits investigation, and prescription fulfillment. Pharmaceutical innovators will be able to directly engage target patients with tailored, segment-specific content, all tied to an integrated care pathway that streamlines clinician engagement, simplifies care economics, and ultimately empowers patients to own their health.

Realizing this vision will depend on building trust: pharma must go above and beyond in demonstrating appropriate, consent-driven data use directly enables patient benefits.

As DTC approaches continue to expand into new areas of concentrated innovation, future pharma leaders will be positioned to reach and empower patients previously overlooked by legacy models—driving better outcomes and truly patient-centric access.

The ascent of direct-to-consumer commercialization represents much more than a tactical response to a single therapeutic market or a moment of policy-driven urgency. It’s a structural reset for how pharmaceutical innovators engage with patients, caregivers and clinicians—shifting the axis of power toward patient needs and elevating the voice of the individual in the care journey. As DTC becomes further integrated with advanced digital targeting and seamless care pathways, those who embrace this transformation will define the next era of healthcare value: empowering people to own their health and freeing the industry to focus innovation on a fuller set of patient needs.

Mike Mortimer is managing partner and founder of private equity firm GHO Capital Partners LLP, and chairperson at life-sciences strategy consulting firm ClearView Healthcare Partners. Sam Ulin is partner and head of marketing at ClearView.

Signed commentaries do not necessarily reflect the views of BioCentury.