How Direct-to-Patient is Redefining Drug Pricing

The current prescription journey is not working. It is not working for patients struggling to afford vital medications. It is not working for prescribers battling complex, fragmented systems. And it is not working for manufacturers who are unable to optimize profitability and access the real-time insights needed to demonstrate value for money.

With so many issues, we need to not just change the current prescription journey, but transform it. We need to improve patient access. We need to offer greater pricing transparency. We need to decrease the administrative burden on prescribers. And we need to empower manufacturers to optimize gross-to-net and improve pull-through.

Integrated direct-to-patient (DTP) models offer the opportunity to do all the above and more. By combining technology, real-time data and human support, DTP models help more patients get the right price for them, get on therapy faster, and stay on therapy longer. This delivers better outcomes for patients themselves, prescribers, and brands alike.

What Are the Current Drug Pricing Challenges?

More than half (55%) of Americans are worried about affording their family’s prescription drug costs.¹ When people are forced to make choices between their medications and other bills, it can lead to lower adherence or coming off treatment altogether. Around three in 10 adults report not taking their medicines as prescribed at some point in the past year because of the cost. This includes not filling prescriptions, taking over-the-counter drugs instead, cutting pills in half, or skipping a dose.

At the same time, prior authorization (PA) costs around $93 billion a year, adding complexity to patient access and increases prescriber burden.² According to a survey by the American Medical Association, PA increases the chance of physician burnout, takes up valuable staff time, and leads to higher overall utilization of healthcare resources.³ The survey also highlights the ‘devastating effect’ of PA on patient outcomes. More than one in four physicians report that PA has led to a serious adverse event for a patient in their care and more than eight in 10 say it has led to treatment abandonment. Eight in 10 physicians say PA delay or denial leads to patients paying out-of-pocket for a prescription medication.

Manufacturers are under increasing pressure to make medications more affordable and demonstrate value while also trying to navigate an increasingly complex drug pricing policy environment. In 2025 alone, most-favored-nation pricing was resurrected, implementation of Maximum Fair Price continued, the Centers for Medicare & Medicaid Services tightened rules on physician-administered medicines, and Congress expanded the orphan drug exclusion to the Medicare Drug Price Negotiation Program. Each of these changes on their own would be notable. Together they highlight the need for manufacturers to be increasingly agile and strategic.

Direct-to-Patient Models

DTP models simplify the prescription journey, removing logistical, cost and communication barriers, and ensuring patients receive medications quickly, safely and at the lowest possible cost. By combining agentic AI, digital infrastructure and human support, DTP helps patients achieve their desired health outcomes, while also delivering better outcomes for brands and providers.

Executed properly, DTP models allow patients to see the price of their medication, choose how they will get it, check status in real-time, and receive human support when needed. They also allow manufacturers to deliver consistent onboarding and fulfillment, to automatically route prescriptions down the most profitable route, measure what matters most, and finally align resources with patient outcomes rather than intermediary margins.

How Does DTP Create Transparent Pricing for Patients?

Patients today want a retail-grade experience with transparent pricing, fast access, and proactive support. They should not have to shop around from pharmacy to pharmacy to find the best price or worry about overpaying or hidden membership or subscription costs.

Effective DTP models identify the best price for any medication by utilizing advanced AI-driven verification to analyze patient benefit information, historical medicines pricing, pharmacy data, and real-time claims adjudication. At the same time, coupons and discounts from manufacturers are auto applied to ensure patients do not overpay and there are no hidden costs – only the copay, if applicable.

Removing the initial cost barrier in this way helps patients start treatment faster and stay on treatment longer. It also helps build trust and brand loyalty. If there is a way for patients to save money on their medication, DTP models can help them find it.

How Does DTP Reduce Administrative Burden for Prescribers?

A key benefit of DTP models is their ability to automate, bypass third party tools, speed up PA, and reduce administrative burden for prescribers. For example, automated prescription validation at intake prevents incorrect or incomplete submissions from reaching payers. This results in faster PA cycles and fewer rejections, eliminating common points of friction that delay time to therapy.

In another example, white-labeled electronic health record (EHR) integrated prescriptions can embed the brand name or program directly into the EHR workflow. This increases visibility and makes it easier for prescribers to choose the correct path for their patient without needing to remember or configure anything. Direct-to-PBM electronic prior authorization, which bypasses third-party tools and is automatically pre-filled with EHR-sourced clinical data, also leads to higher approval rates and faster therapy starts.

Once the administrative burden on prescribers has been reduced, they can be empowered with real-time data and patient-level tracking. This gives HCPs live visibility into each patient’s journey, letting them know exactly where patients are in the fulfillment process and where extra support may be needed.

Unlocking Insights and Optimizing Profitability

In a complex drug pricing environment, manufacturers need to challenge the pharmaceutical chain status quo, adopt new ways of working, and clearly demonstrate value. By cutting out intermediaries, DTP models result in more value delivered to the patient and less value taken out of the system. Manufacturers can finally align resources with outcomes instead of intermediaries’ margins.

Currently, gross-to-net is dictated by the supply chain, forcing manufacturers into overlapping rebates, discounts, and 340B obligations. Double discounting on the same prescription often results in brands losing margin and failing to capture ROI. DTP models use real-time pricing logic to automatically route prescriptions down the most profitable path. This optimizes gross-to-net and increases adherence without compromising patient experience. Affordability and adherence can be further boosted with built-in copay support and auto enrollment, removing the hassle of enrollment or card activation.

Unlike current systems which leave brands piecing together fragmented data from multiple vendors and sources, DTP models allow manufacturers to see and control the entire prescription journey. This allows brands to track where and why prescriptions stall, identify missed or unsubmitted PAs and predict patient drop-off, empowering brand teams to proactively address access barriers, optimize outreach and make faster, data-driven decisions. Full, live visibility into each patient’s journey also allows field teams to identify and act on stalled cases in real-time. By aligning HCPs, field teams and pharmacy operations on a single source of truth, brands can increase pull-through and once again reduce time to therapy.

Embracing automation can also help to apply the benefits of DTP to a wider range of products. For example, the cost of traditional distribution historically created an operational cost barrier which meant DTP stopped making sense for high-volume products priced below $50. However, by automating eBI and eBV and removing manual touchpoints, volume can be scaled without the traditional ‘hiring spike’ that usually eats up margins. This makes DTP possible for products with retail prices as low as $35.

Conclusion

Drug pricing is undergoing a period of rapid change. DTP models offer the opportunity for greater affordability and increased transparency, while also improving ROI for manufacturers. In an era when the need to demonstrate value is greater than ever, the question should not be whether to adopt DTP models, but how quickly they can be adopted.

Jeremy Richardson is the chief commercial officer at Gifthealth.

References

1. Kearney A, Montalvo J III, Kirzinger A, Hamel L. Public opinion on prescription drugs and their prices. KFF. Published March 31, 2026. Accessed May 14, 2026. https://www.kff.org/health-costs/public-opinion-on-prescription-drugs-and-their-prices/
2. Howell S, Yin PT, Robinson JC. Quantifying the economic burden of drug utilization management on payers, manufacturers, physicians, and patients. Health Aff (Millwood). 2021;40(8):1206-1214. doi:10.1377/hlthaff.2021.00036
3. American Medical Association. Prior Authorization Physician Survey. Chicago, IL: American Medical Association. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf. Accessed May 15, 2026.