Will Pharma’s Direct-to-Patient Push Disintermediate Wholesalers?

The pharmaceutical industry is entering one of its most fascinating channel-strategy transitions in decades.

Major manufacturers are increasingly stepping into direct-to-patient (DTP) territory by building their own digital storefronts, offering steep cash-pay discounts, and in some cases, bundling telehealth, affordability services, and home delivery.

Names like Eli Lilly, AstraZeneca, Amgen, Bristol Myers Squibb, Novartis, and Boehringer Ingelheim have moved from quiet pilots to highly visible consumer platforms. And in parallel, Genentech is preparing a flu-season DTC program for Xofluza, showing that even acute categories are now testing patient-direct channels.

The question many in the industry are asking is simple: Do these moves bypass the traditional wholesale infrastructure and potentially weaken the position of wholesalers like Cencora, McKesson, and Cardinal Health?

On the surface, the story looks disruptive:

• Amgen unveiled a DTP platform offering 60% discounts on Repatha, promoting the lowest U.S. net price among G7 countries.
• BMS launched its own cash-pay portal with 80% discounts on Sotyktu.
• AstraZeneca joined with ~70% off Farxiga and Airsupra.
• Novartis and Boehringer followed with price-slashing offers on Cosentyx and Spiriva Respimat.

And recently, consumer research shows three-quarters of U.S. patients say they’d consider purchasing medications directly from pharma if offered a simpler, more transparent experience.

For some observers, these signals point to a future where manufacturers run patient channels directly and wholesalers fade into the background. Reality paints a more nuanced—and strategically interesting—picture.

DTP Changes the Front End, Not the Core Plumbing

What’s happening today is not disintermediation in the literal sense. Yes, manufacturers are owning more of the initiation and engagement layer—price transparency, affordability, telehealth, patient onboarding, and fulfillment options.

But the middle and back-end infrastructure remain enormously complex, tightly regulated, and operationally unforgiving. Even when a patient fills through a manufacturer-linked portal, the process still relies on:

• Temperature-controlled storage and shipping
• DSCSA serialization and track-and-trace
• Cold-chain handling for biologics and GLP-1s
• 340B administration and chargeback management
• Returns processing and inventory reconciliation
• Interoperability with hospitals, IDNs, infusion centers, and clinics

This is precisely the infrastructure that wholesalers have built over decades. Digital front doors can change, regulatory logistics do not. DTP may take the consumer “click,” but wholesalers still move the molecule.

In other words: Manufacturers may control the front stage, but distributors still run the backstage—and the backstage is where risk, regulation, and reliability live.

Why Pharma is Leaning in

Manufacturers are not pushing DTP because they want to rebuild the supply chain. They’re doing it because the traditional pharmacy and PBM ecosystem has become too friction-heavy and rebate-bound in certain categories.

Cash-pay offerings let them:

• Cut payer friction and abandonment
• Test pricing elasticity without the rebate wall
• Build real-world data earlier in the journey
• Increase adherence and continuity
• Engage patients directly in chronic and wellness-adjacent categories

They are searching for control, transparency, and consumer experience, not warehouse operations or thermal packaging fleets. That is why even as DTP programs expand, none of these companies are attempting to replicate the core wholesale network.

How the Big Three Distributors are Positioning

Cencora: Building the rails for advanced therapies

Cencora’s most recent results and investment commitments make its strategy clear. The company is deploying $1B through 2030 to expand its U.S. distribution footprint, including new facilities and increased cold-chain capacity.

They are emphasizing specialty care, GLP-1 logistics, and patient-access technology, while exploring strategic alternatives for non-core assets to sharpen focus.

This is not defensive—it’s proactive. Cencora sees a future where logistics sophistication, specialty handling, and access workflows define competitive advantage. They’re building the infrastructure layer DTP providers will still rely on, even as pharma owns more of the patient interface.

McKesson: Doubling down on oncology and specialty networks

McKesson’s long-standing focus on community oncology and specialty clinics gives it a uniquely durable position. These care settings are where infusion, REMS-restricted therapies, and complex care coordination happen.

No consumer portal can replicate the infrastructure McKesson has built across these practices, payer systems, and provider workflows. McKesson is becoming an outcomes enabler, not just a channel mover.

Cardinal Health: Owning reliability across sites of care

Cardinal has leaned into the breadth and reliability of its provider network: hospitals, IDNs, physician offices, ambulatory infusion, and home settings.

As more specialty drugs move into outpatient and home-based care, Cardinal’s operating discipline and footprint provide a critical backbone. Its value proposition: low friction, broad coverage, high reliability are the exact opposite of what most DTP programs want to rebuild.

Where DTP Really Does Move the Needle

DTP isn’t symbolic. It matters significantly in certain segments:

• Lifestyle/cardiometabolic (GLP-1 weight management, cardiology, diabetes)
• Dermatology, respiratory, women’s health
• Mental health and other telehealth-friendly categories
• Seasonal and acute programs (flu antivirals)
• Self-pay and under-insured populations

In these pockets, DTP can peel volume away from traditional channels. But even there, once programs scale or complexity rises, wholesale infrastructure comes back into play.

Think of it as DTP opening the front door to access innovation, while wholesalers continue managing the foundation, plumbing, and utilities.

Policy Winds Strengthen, Not Weaken, Wholesale Relevance

The news cycle around “Most Favored Nation” drug pricing and reports of price-concession discussions by Pfizer and AstraZeneca illustrates how fluid pricing and channel structures could become under regulatory pressure. In volatile policy environments, distribution certainty becomes even more valuable.

That means a reliable, neutral wholesale backbone continues to be strategically essential even as pharma experiments with direct pricing windows.

Conclusion

The direction of travel is clear: Pharma is moving closer to the patient. Distributors are moving deeper into specialty infrastructure and outcomes enablement.

These paths do not collide, they interlock. DTP is not disintermediating distributors; it is re-intermediating the pharmaceutical economy:

• Manufacturers will own more of the consumer journey.
• Wholesalers will own more of the regulated, specialty, and clinical logistics stack.
• The patient will experience greater transparency and convenience.
• Providers will still rely on distribution continuity and access support.
• Data and digital services will become shared responsibilities, not competing ones.

The future is not “pharma replaces the channel.” It is a hybrid ecosystem, where Cencora, McKesson, and Cardinal Health become even more critical as the invisible infrastructure behind next-generation access models.

And that makes this moment not one of disintermediation but of channel evolution and strategic rediscovery.

About the Author

Thani Jambulingam, PhD, is a professor of food, pharma, and healthcare business at Saint Joseph’s University’s Erivan K. Haub School of Business.