What’s new? Some PhRMA member companies are rolling out new platforms so patients can buy medicines directly from manufacturers – at a lower cost.
Why it matters: Insurers and pharmacy benefit managers (PBMs) make millions of Americans pay full price for medicines – even when they get big discounts. Direct purchase programs (DPPs), often referred to as direct-to-consumer, allow patients, caregivers and employers to buy prescription drugs at a transparent price, and without markups that can result in patients paying more out of pocket.
The current problem: Millions of Americans are paying higher cost sharing and facing new barriers that slow or prevent access to medicine.
- Insurers and PBMs are shifting more costs to patients through deductibles and coinsurance – steadily increasing the amount commercially insured patients pay out of pocket by 5.8% annually.
- Approximately 40% of Americans have a high-deductible health plan that requires them to typically pay the full list price for medicines until these high deductibles are met – an amount often $2,700 or more.
- Additionally, just three big PBMs control 80% of prescriptions in the U.S. The same PBMs excluded 1,400+ medicines in 2025 – and the problem has gotten worse as they exclude an average of 27% more medicines each year.
- Unfortunately, while payers are shifting costs onto patients, PBMs and insurers are also preventing manufacturer copay assistance from counting towards patient cost sharing - causing patients to pay more.
What’s more: DPPs also give patients the ability to access prescribed medicines by reducing or eliminating insurance barriers.
- Patients are increasingly facing initial denials at the pharmacy counter, which can delay access to medicine – if they can access it at all.
- These barriers include embedded step therapy, prior authorization, formulary exclusions and other hurdles that may slow access. Patients in both Medicare Part D and commercial markets may face multiple rejections and barriers – sometimes up to 11 times – before approval of a medicine.
Biopharmaceutical manufacturers are bringing solutions
- Amgen: AmgenNow makes Repatha® available directly to American patients, making it easier to access at a significantly lower price.
- BMS: BMS is expanding its direct patient purchase program offerings, with BMS Patient Connect, starting with Sotyktu® for eligible patients at lower costs.
- BMS + Pfizer: The BMS-Pfizer Alliance Eliquis 360 Support program offers eligible patients lower out-of-pocket costs and direct shipping.
- Novartis: Launching a direct-to-patient platform for Cosentyx®, offering a new option to help reach patients more directly.
Bottom Line: DPPs can deliver real savings and better access for patients, cutting through red tape and putting control back in their hands. Visit AmericasMedicines.com for more information about these new offerings.
Caroline Dunne
Caroline Dunne serves as a Director of Public Affairs at PhRMA, where she leads communications strategies and initiatives for the organization's cost and value priorities. She brings extensive experience in advocacy strategy, with a background that spans gubernatorial and presidential politics. Caroline is passionate about contributing to an industry whose innovations have had a meaningful impact on her family's life.