Direct‑to‑consumer prescription drugs are reshaping how patients obtain treatments such as glucagon‑like peptide‑1 (GLP‑1) therapies, but the convenience comes with hidden cost and coordination challenges.
Growth of online drug channels and price incentives
Companies that sell medications directly to patients reported rapid revenue gains. Hims & Hers said it expects about $2.35 billion in 2025 sales, up 59 % from the prior year, with more than 2.5 million subscribers. IQVIA noted that direct‑to‑patient GLP‑1 programs have pushed monthly cash‑pay prices to between $299 and $499 over the last two years. Novartis launched a platform for Cosentyx offering a 55 % discount off the list price.
A recent Navitus Health Solutions Pulse survey found 68 % of GLP‑1 users said cost influenced their decision to start or continue treatment, while 24 % reported paying more than $250 for each prescription fill. Nearly 40 % of respondents have used discount programs or manufacturer coupons, and over 83 % believe Americans turn to DTC options because traditional channels are too difficult or expensive.
Potential savings versus hidden expenses
Lower upfront cash prices can help patients whose insurance excludes a drug category or who face high out‑of‑pocket costs at the pharmacy counter.
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However, purchases made outside insurance do not count toward the deductible or the annual out‑of‑pocket maximum. If an employee has already met their deductible, paying cash for a DTC prescription may increase total spending for the year because the amount does not reduce the remaining out‑of‑pocket burden. NovoCare’s self‑pay terms explicitly state that payments made outside insurance “will not count toward deductibles or maximum out‑of‑pocket costs.”
These nuances matter for workers on high‑deductible plans. A short‑term affordability fix can become a long‑term expense if the cash purchase fails to contribute to the benefit calculations that protect patients from higher costs later in the year.
Beyond finances, the fragmentation of prescription data across telehealth platforms, pharmacies, and payment channels hampers care coordination. When a drug is ordered through a separate DTC service, the patient’s primary care physician may not see the medication in the electronic health record, making it harder to assess drug interactions or to reconcile the full medication list. This is especially relevant for GLP‑1 drugs, whose side effects—such as reduced gastric motility or risk of pancreatitis—can affect surgical planning and other specialist decisions.
From an employee standpoint, the appeal of a low advertised price can mask longer‑term complexities. While a patient might initially save money, the lack of integration with the broader health plan means the purchase does not help meet deductible thresholds, potentially leading to higher overall expenses. Employers should therefore provide clear guidance on what counts toward insurance benefits and how DTC options fit within the overall cost‑management strategy.
Implications for employers and benefits managers
Employers face a balancing act: they want to keep medication costs manageable while ensuring employees receive coordinated care. One approach is to pair telehealth services with pharmacy options that remain within the benefit design, especially when a drug category is excluded from coverage. This can preserve the financial protections of deductibles and out‑of‑pocket maximums while still offering convenient access.
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Benefits leaders should educate employees about the differences between advertised cash prices and total cost of care. Workers need to know whether a DTC purchase will appear in their health record, whether the lower price is temporary, and whether using the plan’s pharmacy benefit might be more economical over time.
In practice, this means creating resources that explain how deductible and out‑of‑pocket calculations work, and offering support for medication reconciliation when patients use multiple channels. By doing so, employers can help prevent the scenario where a seemingly cheaper prescription ends up costing more after the year’s benefit limits are considered.
Employers must act quickly.
Overall, direct‑to‑consumer drug channels are likely to keep expanding. The decision for employers is not to reject these options outright but to integrate them into a framework that maintains transparency, cost‑effectiveness, and full clinical oversight.
