Geoff examines the different roles of telemedicine, consumer rebates through cash discount cards, and cash-pay pharmacies in direct-to-patient (DTP) prescription access. He argues that while each can improve access, none fully addresses the challenges of prescription fulfillment and adherence. He makes the case for a more comprehensive approach that integrates affordability, insurance coverage, and pharmacy fulfillment throughout the patient journey.
To learn more about BlinkRx's RxOS prescription operating system, visit BlinkRx.
Read on for Geoff's insights.
BlinkRx Insights: Clarifying the Mystery around “DTP”
By Geoff Chaiken, CEO, BlinkRx
Direct-to-patient (DTP) models are increasingly promoted as a solution. But DTP describes three distinct strategies: telemedicine paired with consumer marketing, manufacturer rebates delivered through cash discount cards, and cash pharmacy fulfillment. Each has strengths and limits that matter for pharmaceutical leaders making commercialization decisions.
Over the past decade leading Blink Health, we’ve operated all three at scale. That experience taught us where these models work, where they fall short, and why manufacturers need a more comprehensive approach.
Telemedicine
Examples: Hims, Ro
Telemedicine platforms market to consumers and connect them with practitioners, creating a convenient path to care. Their digital reach can improve access for some populations.
But their reach is narrow. At BlinkRx, we integrate with many of the largest telemedicine providers for our clients. Outside weight loss, we find that less than 3% of prescriptions originate through telemedicine. Even in weight loss, brick-and-mortar doctors write more prescriptions than telemedicine providers.
The economics explain why. Outside of erectile dysfunction, weight loss, and, to a lesser extent, hair loss, telemedicine providers have struggled to generate enough patient lifetime value to justify the high acquisition costs.
Other limitations follow:
- Many direct telemedicine providers don’t accept insurance and charge subscription fees on top of medication costs, consuming money patients could otherwise spend on treatment.
- Generating a prescription doesn’t ensure it gets filled. Insurance support often ends with a benefits check before the prescription reaches a retail pharmacy.
- These platforms generally leave manufacturers without a direct, ongoing patient relationship.
Telemedicine can be powerful in select, primarily cash-pay categories. But manufacturers must solve the leaky bucket: prescriptions that never become first fills and patients who never return for refills. That problem exists whether a prescription comes from a telemedicine provider or a brick-and-mortar doctor.
Consumer rebates through cash discount cards
Examples: GoodRx, TrumpRx
Price-comparison and discount-card websites can deliver manufacturer rebates at the pharmacy counter (direct-to-consumer rebates), sometimes making cash prices lower than insured copays.
In 2017, Blink launched a program with Lilly that reduced cash prices for Lilly insulins by 50%, to approximately $250. Despite the medication’s lifesaving role and significant advertising, uptake was limited.
That experience illustrates three constraints:
- Patients make decisions in dollars, not percentage discounts. In our experience, outside categories such as weight loss, fulfillment drops steeply when out-of-pocket costs exceed approximately $70. The average out-of-pocket price across these programs is about $350.
- Even discounted cash prices often exceed insured copays, and comparing both prices in real time is difficult for most patients.
- Publishing prices and offering discounts doesn’t resolve prior authorizations, inventory shortages, or pharmacy economics that can prevent fulfillment.
These programs can help cash-pay patients. But a discount alone cannot carry a patient through the access journey.
Cash-pay direct pharmacies
Examples: LillyDirect, Eagle Pharmacy
Manufacturer-sponsored cash pharmacies let manufacturers offer prices directly to consumers and build patient relationships. They can provide an important access point for brands with limited insurance coverage.
But cash-only fulfillment has drawbacks:
- Like DTC rebates, patients paying cash often pay more than their insurance copay and discontinue therapy sooner as a result.
- Without adjudicated insurance claims, manufacturers lose a channel for demonstrating demand to insurers, supporting broader coverage, and potentially reducing patients’ costs over time.
Cash pharmacies can bridge a coverage gap. They don’t provide a comprehensive, durable solution across commercial insurance, government programs, and cash-pay options.
Tools, not complete solutions
Each DTP model has a role. But manufacturers need to focus on the outcome: getting every prescription filled and supporting every refill, regardless of prescribing channel, therapeutic area, or how the patient pays.
A new source of prescriptions cannot fix a leaky bucket. In every therapeutic area, including weight loss, brick-and-mortar prescribing remains larger than telemedicine. A solution must serve both.
That requires finding each patient’s best available price, navigating coverage and prior authorization, applying assistance, and routing prescriptions to pharmacies equipped to fill them. Support must continue through delivery, refills, coverage changes, and deductible resets.
When those functions sit across disconnected vendors, patients must navigate the handoffs. A comprehensive platform should manage those transitions so administrative friction doesn’t become an abandoned prescription or missed refill.
Manufacturers need visibility and control across that entire journey: a unified, real-time view of every prescription, the barriers patients encounter, and the actions needed to resolve them. They need infrastructure that scales with demand and stays with patients beyond the first fill.
At BlinkRx, we’ve spent the last decade and nearly a billion dollars building RxOS, our prescription operating system, to provide that visibility and control. We’re passionate about working with every brand to create the best possible prescription journey for its patients and doctors.
Medicines transform lives only when patients can get them and keep taking them. Closing that gap, from first fill through every refill, should be the standard for every commercialization platform.
Learn more about BlinkRx's RxOS prescription operating system.
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