Why Pharma Is Exploring Direct-to-Employer Benefit Models

In the final installment of his three-part interview series, Jay Bregman, founder and CEO of Andel, discusses the factors contributing to pharmaceutical manufacturers’ growing interest in engaging employers more directly, as well as the potential implications for the broader drug distribution ecosystem.

Pharmaceutical manufacturers have historically relied on intermediaries—including pharmacy benefit managers (PBMs), wholesalers, and dispensing pharmacies—to manage access, pricing, and fulfillment. However, evolving employer expectations around cost transparency and administrative simplicity are contributing to renewed interest in alternative commercial models. According to Bregman, part of this shift is tied to how services are priced, with some newer approaches emphasizing transaction-based fees rather than traditional administrative charges or per-member-per-month arrangements.

He also points to the role of infrastructure in enabling these models. Platforms designed to centrally receive and route prescriptions—rather than dispense them directly—can introduce additional flexibility in how prescriptions are fulfilled across pharmacy networks. In this framework, automation and integration with existing systems are positioned as key components in managing the end-to-end process, from prescription intake to delivery.

At the same time, broader adoption of direct-to-employer approaches may depend on coordination across multiple stakeholders, including manufacturers, employers, and pharmacies. Operational considerations—such as workflow integration, scalability, and stakeholder alignment—are likely to influence how quickly such models expand beyond early use cases.

Looking ahead, Bregman suggests that interest in these approaches could extend beyond a limited set of high-cost or high-demand therapies, depending on demonstrated outcomes related to cost management and user experience.

Access the first and second parts of Bregman’s video interview series below:

• Direct-to-Employer Drug Purchasing Emerges as Companies Navigate high Prescription Costs
• Rising GLP-1 Demand Pressures Conventional Employer Drug Benefits

A transcript of his conversation with PC can be found below.

PC: Pharma manufacturers have historically sold through intermediaries rather than engaging employers directly. What's driving the interest on the manufacturer side to explore more direct commercial relationships, and what does that mean for the broader distribution ecosystem?

Bregman: Look, I think the first thing is, everything has to be reimagined, particularly the charging model, right? So, you know, at Andel, we charge a fee for each prescription filled, but we don't charge any administrative fees to the employer, no PMPM. We don't charge for telehealth, we don't charge for wraparound services. Why? Because, most clients that we talk to just simply don't want them and don't need them. So why, why not just give that money back to basically contribute to lowering the cost of the drugs for the employer? We don't take a spread on the drugs because we feel like we want to be aligned with the employers and the employees to lower costs as much as possible to create as many members as possible. So I think there are structural things that need to be done in order to do that. The second thing I would say is it needs to be a full-service solution, an end-to-end solution. What I mean by that is, you know, Andel chose to build a non-dispensing pharmacy. All of the scripts come to us. Any doctor in the country can submit scripts to our, Surescripts integration and into our infrastructure, and then from there, we can triage them and send them to any dispensing pharmacy in the country. You know, when you have that level of sophistication and automation, that's how you can control the experience, and that's how you can really change the way in which things are done. If you're actually just using traditional infrastructure, like, hey, it's still got to go to a pharmacy, you’ve got to enter some coupon or whatever that is, that's not really going to change anything.

Building a new drug distribution model requires alignment across employers, manufacturers, and employees simultaneously. What are the biggest operational and adoption hurdles in getting a model like this off the ground, and what does the path to scale actually look like?

I think the future of it looks like many, many, many, many, many more drugs. So I think what you're going to see is that people will remember, GLP-1s as the thin end of the wedge, and that ultimately companies will look at these new platforms like Andel, and they will say, "We're saving tons of money. Our member experience is better. We get more control over our spend. What more can we do, in this way? And why, why didn't we think about this before? Why, why couldn't this have happened?"