Major pharmaceutical companies are accelerating their shift to direct-to-consumer (DTC) sales and recurring delivery models, offering patients a simpler, cash-pay alternative to traditional pharmacy channels. According to a new report by Axios, the trend has gained new urgency after President Trump gave 17 pharma CEOs a 60-day deadline to cut U.S. drug prices and expand access through DTC or direct-to-business sales.

The move is partly fueled by consumer demand for easier, insurance-free access to high-demand medications like GLP-1 drugs, used for diabetes and weight management. These medications are often excluded from insurance formularies, making cash-pay DTC models more attractive to patients—and financially advantageous for manufacturers.

Eli Lilly was first to launch a DTC healthcare platform with LillyDirect, providing virtual visits and recurring medication delivery for diabetes, obesity, and migraine treatments. Pfizer and Novo Nordisk followed with their own versions of cash-pay platforms. According to a Lilly spokesperson, roughly 25% of new prescriptions for its weight-loss drug Zepbound were filled through LillyDirect in Q1 2025.

The DTC experience often starts with an online consultation via a telehealth provider, leading to direct shipment of medications from the manufacturer. Some platforms, such as Novo Nordisk’s, skip the consult step but allow patients with existing prescriptions to order and receive their medications through direct fulfillment.

While these offerings can lower consumer costs and bypass traditional pharmacy benefit managers (PBMs), they also raise regulatory and ethical questions. Critics warn of risks including overprescribing, lack of third-party oversight, and steering patients toward more expensive name-brand drugs.

President Trump’s directive was framed as a call to action, stating that “companies must provide U.S. patients with access to medications at prices no higher than what is charged in other developed nations.” His letters also called for the repatriation of overseas profits and warned that enforcement mechanisms would follow if companies failed to comply.

INSIDER TAKE

This isn’t just a pharma or politics story—it’s a case study in how recurring revenue, direct access, and platform control are reshaping even the most regulated industries.

The Subscription Model Comes to Healthcare
Pharma companies are turning products into platforms. They’re building end-to-end services that mirror subscription businesses: virtual onboarding, personalized plans, recurring delivery, and digital retention tools.

Cash-Pay = Recurring Revenue with Fewer Intermediaries
Like direct-to-consumer subscriptions, these models bypass legacy gatekeepers (in this case, insurers and PBMs). The result: better margins, faster onboarding, and more control over pricing and user experience.

Consumer Behavior Is Shifting
Patients—especially in high-demand categories like weight management—are demonstrating a willingness to pay out-of-pocket for convenience and transparency. This aligns with broader trends in wellness, fintech, and education, where recurring access and flexibility often trump legacy channels.

Platform-as-a-Service Is the Competitive Moat
These platforms aren’t just selling pills—they’re owning the full user journey. That’s a powerful retention lever. Subscription executives should take note of how this strategy applies to any product category facing commoditization.

Regulatory Tailwinds and Red Flags
As in subscriptions, increased scrutiny on pricing, transparency, and user protections is inevitable. DTC health platforms may soon face compliance requirements similar to those shaping negative option billing, cancellation flows, and recurring disclosures in the broader subscription economy.

 
Pharma’s pivot to subscription-like DTC platforms is a leading indicator for how high-value, regulated products can be transformed into service-based, recurring revenue businesses. Subscription executives across industries should study this playbook carefully, and be prepared for similar pressures on price, transparency, and platform accountability in their own markets.