Q&A: Where Direct-to-Patient Pharma Stands Today

Chip Parkinson, CEO of Gifthealth, spoke with Pharmaceutical Commerce about the state of the direct-to-patient (DTP) channel in 2026.

The conversation comes as the model absorbs a series of fast-moving developments, including the launch of TrumpRx, Office of Inspector General guidance addressing Anti-Kickback Statute concerns around cash-pay drug sales, and a wave of platform launches from top-five pharma companies. Parkinson discusses what's driven that activity, how MFN pricing pressure and consumer expectations are shaping adoption, and where he expects cash-pay and insurance rails to head through 2027.

PC: How has the DTP landscape evolved in 2026? What stands out most?

Parkinson: It's really been an interesting six months. Three probably stand out for me.

First one is government got into the arena. That wasn't in place in January. TrumpRx launched in February, 17 most favored nation deals signed so far, and we saw the addition of generics to the platform. Obviously, TrumpRx is what it is. You access manufacturer websites through TrumpRx, but it definitely raised the idea of price transparency behind his name. I think that'd be the first one. Government got into the arena, finally.

The second one, I think, is probably more consequential than anything else, which is the OIG guidance in February around being able to serve lower-priced drugs to patients through cash pay, even to Medicaid and Medicare patients. Typically, the Anti-Kickback Statute was a big concern for a lot of manufacturers and why they sat on the sidelines for direct-to-patient. Now all of that's been cleared, so that would be the second one that I think is really interesting.

And then the third one is just some of the top five pharma companies announcing DTP platforms. When you have some major pharma brands launching those programs, not just a coupon — coupons have been around for a long time, as we know — but actually a platform, standing up a platform to deal with patients who could benefit from cash pay.

Those three things probably stand out the most for me in the first six months of the year.

Has MFN pricing pressure combined with rising consumer expectations driven DTP adoption?

I think it's accelerated more than I thought, even in January. All of those things I just talked about — TrumpRx coming on board, OIG guidance, more big pharma coming into platforms — all of that happened basically within a 150 day window, which is amazing. You never see that kind of speed in pharmacy and access innovation. Usually it's a slow, tough, year-by-year formulary slog.

So, I think it's actually accelerated and held up. We're also seeing the reality of utilization increase. Quarter over quarter, you've seen a higher percentage of brands that have had platform launches. You see that actually being a material disclosure in a lot of the quarterly earnings releases.

And so the consumer preference for this type of transparency, and the ease that it brings to the doorstep, you actually see it reflected in the volumes that are reported running through the platforms versus everywhere else. So, definitely more than held up — accelerated a little bit.

Then there are consumer expectations. This is an interesting one for me, especially with TrumpRx. Coupons have been around for a long time. Manufacturer assistance programs have been around for a long time. They've historically been kind of tough to activate, hard to combine at the pharmacy counter. You get to the pharmacy counter, you have the right coupon, there are competing coupon programs at the pharmacy counter. Oftentimes the pharmacy has ones that they want to drive because they economically participate in them. And so there's this question of, “is that sort of coupon experience now the default patient experience in direct-to-patient?” I don't believe it is. I often get to the pharmacy counter and it's not exactly what you expected it would be, and you've got to combine coupons to get to the lowest price, and it may not be in stock.

So, I believe the platforms are still going to be the driving part of the technology, and it's that combination with people that actually drives more uptake in DTP. That's what my bet is.

It also drives more outcomes. Coupons and cost share certainly have some impact on long-term adherence, but starting earlier and staying more persistent longer, the platforms are starting to prove out that they're more capable versus a coupon. I think that sort of gets to the consumer pace.

And then you asked, "Hey, is this a temporary thing still?" No, it's definitely structural. MFN is structural. Gross-to-net is compressed, so manufacturers are going to have to continue to prove value for every script. And then we have PBM reform coming on board. It'll all shape this space. These are structural drivers, not really cyclical. The bar has gone up. I think consumer expectations since January are even closer than they were to a consumer-grade e-commerce experience.

What major DTP/commercialization trends do you expect in H2 2026 and early 2027?

I do see four or five pretty significant trends.

First one is specialty – we'll start to see direct-to-patient platforms defined not just as cash, but as insurance or cash, based on what's lowest cost for the patient and easiest for them to get to, driving more into specialty. Specialty is greater than 50% of drug spend, and 2% of patients are responsible for that 50%, but that's where the friction is the highest. It's hard to really get access as quickly as you need to, for all kinds of reasons, so that's where the direct-to-patient approach — the ROI — will be the highest. That's trend one. I think we'll see a move into specialty.

Trend two will be cash and insurance coming together on a single set of rails, instead of what now are concurrent or parallel paths. I think the platforms that are developing, and certainly Gifthealth is developing this, will bring cash-pay and insurance-pay patients together and then route them to the best, lowest-cost option. I think this parallel track we see now between cash and cover will come together and the rails won't be separate anymore.

I do think the OIG announcement in February would be the third thing. They actually asked for formal feedback on a full safe harbor, not just an OIG memo, so I think that will develop in 2027. We'll see a full safe harbor for this go-to-market approach and that'll be an even more distinctive change for manufacturers still on the sidelines a little bit.

And then, I think we'll see this pilot era we're in now, where not all brands are launching through DTP or a hybrid approach, shift from experimentation, and we'll start to see more brands launch with a hybrid DTP-insurance-rails approach.

Those, I think, are going to be the big developments going forward, exciting for patients and exciting for manufacturers, who get a full view of the patient flow in a platformed experience: faster brand adoption, faster to first fill, and more persistency as that platform develops and more brands launch into it.