
“The White House would be wise to push DTC programs as a way to lower costs while keeping America the world’s medicine chest,” says health expert Sally Pipes.
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The Trump administration wants to enable more Americans to purchase prescription medications directly from manufacturers at transparent, discounted prices—thus collectively saving patients tens of billions of dollars by cutting out middlemen in the drug supply chain.
Voters overwhelmingly like the president’s idea. In a recent poll, 90% of Republican voters in congressional battleground districts, along with 85% of Democrats and 82% of independents, said they support these “direct-to-consumer” sales.
DTC sales resonate with people across the political spectrum for good reason. In our convoluted and opaque healthcare system, patients intuitively sense that they’re being taken advantage of. And they’re often correct—especially when it comes to the bloated pharmaceutical supply chain.
In any normal market—whether it’s a retail outlet or a grocery store—prices are clearly displayed for consumers to see and make their purchasing decisions accordingly. But when it comes to pharmaceuticals, patients often have no idea what their prescription costs overall, what their share of the bill will be at the pharmacy counter, and what alternatives exist.
Because they have little insight into the price of their prescriptions, they historically have been at the mercy of insurers and pharmacy benefit managers. These middlemen have exploited this lack of transparency to pocket secret rebates and fees while steering patients toward higher-cost drugs that boost their profits—not toward the drugs best suited for patients’ needs. Today, over half of every dollar spent on brand-name medicines goes not to the companies that developed them, but to non-manufacturing entities like pharmacy benefit managers and insurers.
That’s why families increasingly feel squeezed by high out-of-pocket drug costs, even as manufacturers’ net prices for brand-name drugs have actually fallen for years now.
The nation’s largest pharmacy benefit managers—Caremark, Express Scripts, and OptumRx—are owned by insurance giants CVS Health, Cigna, and UnitedHealth Group, respectively. Together, these three firms wield an effective oligopoly over prescription drug benefits, processing roughly 80 percent of all U.S. prescription claims in 2024.
But as President Trump recently put it, DTC sales enable Americans to “cut out the middlemen” and purchase medicines at completely predictable prices.
Eli Lilly, Pfizer, Bristol Myers Squibb, and Novo Nordisk have launched DTC sales programs for certain medicines in recent years. These drugmakers generally offer patients cash prices that are significantly discounted compared to the nominal “list” price of drugs, along with free shipping—all without the runaround of PBM and insurer restrictions, claims denials, prior authorization, or narrow pharmacy networks.
The administration can support these private-sector efforts by issuing regulations that clarify these purchases will count toward insured families’ out-of-pocket maximums. That’d give patients an added incentive to purchase medicines directly, secure in the knowledge that if they ultimately face other major healthcare costs, their cash purchases of prescriptions won’t have been “wasted.”
DTC drug sales not only make our healthcare market more transparent but also more efficient and competitive. As these sales become increasingly common, they could even drive down insurance premiums, as fewer and fewer drug claims are routed through insurance.
By facilitating the rise of DTC sales programs, the Trump administration wouldn’t merely deliver on the president’s signature campaign promise of lowering drug prices. It’d do so in a way that doesn’t jeopardize America’s biotech industry.
The White House’s other signature drug pricing initiative—importing European-style price caps—would slash American biotech firms’ revenues, resulting in dramatic cuts to research and development budgets. One study estimated that this price-setting could mean hundreds of fewer new medicines developed in the coming decades.
Conservatives know government central planning doesn’t lower costs—it creates scarcity and undermines the private-sector competition that ultimately benefits consumers.
What actually works is what has always worked: markets, competition, and transparency. The polling on DTC programs proves voters understand this instinctively. And the White House would be wise to push DTC programs as a way to lower costs while keeping America the world’s medicine chest.
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