Is a Direct-to-Patient Access Model Viable For My Product?
Eli Lilly recently launched LillyDirect, a website offering access to telehealth consultations and direct home delivery of certain drugs to treat diabetes, weight loss, and migraine. The website can connect people to HCPs for in-person visits like a conventional “doctor finder” tool. The introduction of LillyDirect has sparked questions from our clients, including whether a direct-to-patient program may be a viable model for their product.
Before we discuss that question, it’s important to note that the service is not free. Many major payers cover telehealth consultations, but if a payer doesn’t cover the cost for, say, the obesity consultation, there’s a cash pay option for $199 per month through Lilly’s partner FORM. That price covers a monthly HCP consultation, regular dietician appointments, and access to the platform. Any Lilly product dispensed by the two participating pharmacies (TruePill and Eversana) would also be covered by insurance. If the drugs are not covered by insurance, patients would pay the cash price.
From Archbow’s vantage, LillyDirect is primarily an attempt to create additional channels for patient access to clinicians who may prescribe a Lilly product. That said, the direct model does offer some tantalizing possibilities for the future of drug access – namely, as a way to circumvent the intermediaries whose fees to pharma are often blamed for causing inflated WAC prices.
So here are several questions you should contemplate if considering a similar model:
1. Is the therapeutic area and potential product conducive to a telehealth model?
2. Do I have access to or relationships with appropriate vendors? (i.e., Telehealth, Patient Support Services, Dispensing entities, etc.)
Required vendor services may include electronic benefits verification, affordability support, prescription routing, online ordering, claim adjudication, payment processing, shipping notifications, refill reminders, and prescription renewal
3. What options should be considered to establish a new patient access/dispensing model?
Outsourced or Insourced services?
Build or Acquire?
Many manufacturers want to engage directly with patients and differentiate themselves by meeting the patients ‘where they are.’ Additionally, as PBMs increase their pressure on the market, a significantly lower patient cash price offering may benefit a manufacturer more financially than significant rebates for preferred formulary placement. This is difficult with biologics with higher COGS and cold chain shipping costs, but other manufacturers have already experimented with similar models for oral products. We should expect more of these direct-to-patient models soon as gross-to-net pressure continues to mount. This is a model to watch closely.
Manufacturers that may benefit from this strategic model include:
Large organizations with an extensive portfolio of drugs
Small organizations that may be forced to engage major stakeholders (Wholesalers, PBMs, Retail Chains, etc.) at non-sustainable rates to secure commercial success
Any company with a pharmacy benefit product(s) that PBMs/Payers are closely monitoring and tightly managing
If any of the scenarios above resonate with you as you consider a direct-to-patient model, Archbow can help. We have the right advisors with decades of commercial planning experience to make a difference in your program design efforts, and we have recently supported similar initiatives with multiple clients.
Learn more about Team Archbow and the methodology that matters most to successful programs. Contact us today for assistance with your strategic and tactical patient support needs. Our team works seamlessly to align even the most complicated patient, product, and reimbursement journeys.
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Archbow Consulting helps pharmaceutical and biotech companies in the USA and Europe design, build, and optimize product distribution and patient access strategies. Archbow was founded by industry veterans to meet a need in the marketplace for consulting options that offer diverse real-world experience, can leverage deep connections across the industry, and can also provide actionable strategic guidance. We invite you to learn more about our team, services, and client’s success, connect with us via email, LinkedIn, or subscribe, and connect with us via email, LinkedIn, or subscribing to this blog, email, LinkedIn, or subscribing to this blog which you can do below.