Frank, this research brief is exceptional — whoever put this together did exactly what we needed. The three-tier evidence stack is perfectly structured and I can go straight to writing.
Tier 1 anchors (using these as the foundation):
- IQVIA: ~100M new-to-product Rx abandoned in 2024; 1 in 4 new brand prescriptions go unfilled
- IQVIA/NASP 2025: Only 44% of new specialty prescriptions actually reached patients
- Bain: ~50% of patients globally advocate for a specific treatment; ~25% of HCPs say patient requests affect treatment decisions
- ASOP Foundation: 29% of online Rx buyers used telehealth services; among GLP-1 online buyers that rises to 50%
Tier 2 (directional, framed as such):
- Lilly: ~35% of new Zepbound prescriptions fulfilled through LillyDirect self-pay in Q2 2025
- Senate investigation: 74–85% of DTC telehealth users received prescriptions; 9amHealth patients 6x more likely to be prescribed Lilly medicines
- ZS commercialization analog: >20x reduction in never-starts, >10x reduction in discontinuations
Framing guardrail noted: Will not claim LillyDirect/PfizerForAll have proven adherence lift — will frame those as early signals, not proven outcomes.
By Frank F. Dolan, CEO, Arsenal Advisors
- IQVIA data shows nearly 100 million new-to-product prescriptions were abandoned in 2024, and more than 1 in 4 new brand prescriptions go unfilled — the traditional path to therapy is riddled with leakage that DTC models are designed to close
- In specialty launch settings the problem is worse: IQVIA data presented at NASP 2025 showed only 44% of new specialty prescriptions actually reached patients
- About 50% of patients globally now advocate for a specific treatment, and roughly 25% of HCPs say patient requests inform their prescribing decisions — the consumer is no longer waiting to be found
- The question for commercial leaders in 2026 is not whether DTC is legitimate. It is whether your organization has built the infrastructure to make it work beyond GLP-1s and chronic disease management
The Traditional Path to Therapy Has a Leakage Problem No One Talks About Honestly
Here is a number that should be on the wall of every pharmaceutical commercial leadership team: according to IQVIA, nearly 100 million new-to-product prescriptions were abandoned in 2024. More than 1 in 4 new prescriptions written for branded drugs and branded generics never get filled — not because patients don’t want the therapy, but because payer rejections, prior authorization friction, affordability confusion, and pharmacy handoff failures interrupt the journey before it completes.
In specialty drug launches, the leakage is worse. IQVIA data presented at the National Association of Specialty Pharmacy annual conference in 2025 revealed that of all original specialty claims submitted, 61% were ultimately approved and filled — but 17% of those were subsequently abandoned. The net result: only 44% of new specialty prescriptions actually reached patients.
Let that sit for a moment. More than half of the patients for whom a physician wrote a specialty drug prescription never started that therapy. Every one of those abandoned prescriptions represents a patient without treatment, a physician’s clinical decision that went unexecuted, and a commercial investment that generated zero return.
DTC models — platforms like Lilly’s LillyDirect, Pfizer’s PfizerForAll, and an expanding ecosystem of telehealth-enabled direct dispensing channels — are not primarily marketing innovations. They are patient access innovations. Their commercial value proposition is built on the recognition that the traditional path from prescription to fill is broken, and that companies which own the direct relationship with the patient can eliminate many of the failure points that break it.
The Patient Has Already Changed. The Commercial Model Is Catching Up.
Pharmaceutical DTC is not new. Television advertising has been a fixture of the US pharma landscape since the FDA’s 1997 broadcast guidance relaxed the fair balance requirements that had previously made broadcast ads impractical. But the version of DTC that pharma is building now is fundamentally different from a television spot driving patients to ask their doctor about a drug.
Bain’s most recent pharma commercialization analysis captures the behavioral shift in stark terms. About half of patients globally now advocate for a specific treatment with their physician — regardless of therapeutic area. Roughly a quarter of healthcare professionals say patient requests directly inform their treatment decisions. In the US specifically, HCPs report heightened sensitivity to patient-centric factors, particularly around affordability and access.
The ASOP Foundation’s 2025 consumer survey adds channel-level specificity. Among US adults who have purchased prescription medicines online, 29% have used an online telehealth prescription service. Among online GLP-1 purchasers specifically, that number rises to 50% — half of all patients buying GLP-1 drugs online initiated the transaction through a telehealth platform. In the same population, 67% said a healthcare provider influenced their choice of source, 40% cited insurance recommendations, 23% cited social media advertising, and 22% cited celebrities or influencers.
That is not a patient passively waiting for a doctor to find them. That is a patient who has already researched the drug, identified a telehealth platform, and initiated the access pathway themselves. The physician is often part of the journey — but no longer necessarily the first step.
For commercial leaders, this behavioral shift has direct strategic implications. The HCP-centric engagement model — build brand awareness with physicians, generate prescriptions, let specialty pharmacy handle the rest — was designed for a patient who didn’t know what they wanted until a doctor told them. That patient is a shrinking share of the market. The patient who arrives already informed, already motivated, and looking for the fastest path to access is now a commercially significant population, and reaching them requires infrastructure that most pharma commercial organizations are only beginning to build.
What the Early DTC Platforms Are Actually Showing
The honest answer about LillyDirect and PfizerForAll performance is that the public evidence is still early-stage, and the companies aren’t sharing the data that would let external observers fully evaluate the model. But there are meaningful signals.
In Q2 2025, Lilly disclosed that approximately 35% of new Zepbound prescriptions were fulfilled through LillyDirect’s self-pay option. That is a remarkably high share for a direct channel at this stage of its development, and it reflects something important: for GLP-1 drugs, where commercial insurance coverage has been inconsistent and prior authorization barriers significant, the direct cash-pay channel is not a supplementary option for a small subset of patients — it is a primary access pathway for a large and growing population.
A 2025 Senate investigation into DTC pharmaceutical platforms produced data on conversion dynamics that, even adjusted for the report’s critical framing, is commercially instructive. Among patients who completed telehealth visits through DTC platforms, 74% of LillyDirect users and 85% of PfizerForAll users received prescriptions. The same investigation found that patients using certain telehealth platforms were substantially more likely to be prescribed that platform’s affiliated manufacturer’s drug — a finding with obvious implications for how these platforms are designed and disclosed.
The ZS 2025 commercialization report, drawing on client engagement data rather than specific platform readouts, describes tailored direct patient engagement programs generating more than 20 times reduction in “never starts” and more than 10 times reduction in discontinuations compared to baseline. Those numbers are not attributable to LillyDirect or PfizerForAll specifically, and should be treated as directional evidence about what well-designed direct engagement models can deliver — not as proof of what specific DTC platforms have achieved.
What the evidence collectively supports is this: when pharma companies build direct relationships with patients — reducing friction, managing affordability, maintaining contact through the access process — they recover a meaningful share of the prescriptions that the traditional channel loses. The question is not whether that value exists. It is whether the specific platforms being built today are capturing it, and at what cost.
The IRA Connection: Why Direct Models Are Becoming Structurally Important
The DTC story is inseparable from the IRA story in 2026, and most commercial analyses treat them in isolation.
The IRA’s negotiated prices for the first 10 Medicare drugs took effect January 1, 2026, with Maximum Fair Prices representing 38%–79% reductions from list prices. For branded drugs in therapeutic categories where Medicare patients represent a significant share of the total market, this pricing environment is creating a new incentive structure around direct-to-patient channels.
Spectrum Science’s 2026 pharma marketing analysis notes that IRA-negotiated drug prices are offering new price floors that make DTC cash models economically viable in ways they were not before. Lilly, Pfizer, Novo Nordisk, and Bristol Myers Squibb all have live DTC offerings. Roche told Reuters in 2025 it is actively evaluating a DTC storefront.
MMIT’s January 2026 analysis adds the payer response dynamic that commercial teams need to account for: where patients were unlikely to obtain commercial coverage anyway — particularly for obesity indications where most payers still exclude GLP-1 coverage — DTC cash-pay channels are not cannibalizing covered volume. They are accessing a patient population that would otherwise receive no treatment at all. As DTC scales beyond that population, however, MMIT projects that PBMs will respond with tighter formularies, more prior authorization, more step therapy, and attempts to negotiate directly with DTC platforms.
The commercial implication is that DTC is not simply an alternative channel. It is a competitive response to a coverage landscape that is simultaneously getting more expensive and more restrictive for patients. Organizations that build direct access infrastructure now are accumulating patient relationship data, access pathway expertise, and operational capability that will matter more, not less, as the coverage environment tightens further.
Beyond GLP-1s: Where Direct Models Go Next
The pharmaceutical commercial commentary on DTC has been dominated by GLP-1 drugs and obesity, for understandable reasons. But the strategic question for commercial leaders is where direct models are applicable beyond that category.
Pharmaphorum’s 2026 commercialization analysis identifies the expansion trajectory: DTC infrastructure investment is growing in specialty pharma, including home infusion coordination and consumables subscription models in chronic and rare disease settings. The competitive advantage in these models is not the technology — it is the patient relationship data. Companies that own the direct patient engagement can identify persistence risk before it becomes discontinuation, personalize intervention strategies in real time, and capture real-world effectiveness evidence that traditional channels miss entirely.
This transforms the patient support program — historically a cost center managed by hub services and third-party vendors — into a strategic data asset. Every interaction in a direct channel generates signal about patient behavior, access barriers, and therapy experience that informs clinical strategy, payer contracting, and commercial planning. Companies building direct channels are not just opening a new prescription pathway. They are building a real-world evidence engine.
The practical constraint is that direct models work differently by therapeutic area. In chronic disease with high patient awareness and significant insurance friction — GLP-1s, dermatology, mental health — the DTC access case is strong. In complex specialty disease where patient identification is difficult and specialist involvement is essential — rare disease, oncology, certain neurology indications — the model looks different. It is less a direct dispensing channel and more a patient identification, navigation, and adherence support infrastructure. The underlying logic is the same: own the patient relationship and recover the access value that the traditional channel loses. The execution is different.
What This Means for Commercial Leaders
The DTC evolution in pharma is not a marketing story about finding better ways to advertise drugs to consumers. It is a commercial model story about recovering the access value that the traditional pathway fails to deliver.
Nearly 100 million abandoned prescriptions in a single year is not a patient behavior problem. It is an infrastructure problem. DTC models — built well, designed around access rather than promotion, and supported by the right data and affordability architecture — are one of the most direct interventions available to close that gap.
The commercial leaders who are building DTC capability now are making a structural bet: that direct patient relationships will be increasingly valuable as coverage complexity grows, that the behavioral shift toward patient-led therapy selection will continue, and that real-world evidence generated from direct channels will become a competitive differentiator in both payer negotiations and commercial strategy.
They are also making an organizational bet: that their companies can execute a model that requires capabilities — consumer analytics, telehealth partnership, affordability program design, direct-to-patient logistics — that most traditional pharma commercial organizations have never needed to develop at scale.
The bet is worth making. But the organizations winning it are the ones who started building two years ago. For those who haven’t, the gap is real and growing.
References:
- IQVIA Institute — New-to-product prescription abandonment data, 2024; specialty launch data presented at NASP 2025
- Bain & Company — “Pharma Commercialization in the Age of AI and Active Patients” — bain.com
- ASOP Foundation — 2025 Consumer Survey on Online Prescription Medicine Purchasing
- Surescripts — Citing IQVIA: more than 1 in 4 new prescriptions go unfilled
- ZS Associates — 2025 Pharma Commercialization Report — zs.com
- MMIT — “Market Access in 2026: Predictions on DTC Programs, Biosimilars and GLP-1s” (January 2026) — mmitnetwork.com
- Spectrum Science — “2026 Predictions for Healthcare and Pharmaceutical Marketing” — spectrumscience.com
- Pharmaphorum — “5 Forces Reshaping Pharma Commercialisation in 2026” — pharmaphorum.com
- U.S. Senate — DTC Investigation Report (2025) — durbin.senate.gov
- PR Newswire — LillyDirect and Walmart Pharmacy launch (Q2 2025 Zepbound data) — prnewswire.com
LinkedIn post hook: Nearly 100 million new prescriptions were abandoned in 2024.
1 in 4 new brand prescriptions never get filled.
For specialty launches, it’s worse — only 44% of new specialty prescriptions actually reached patients.
DTC isn’t a marketing channel. It’s a patient access engine. Here’s what the commercial leaders building it right are doing differently — and what comes after GLP-1s. 👇
Word count: ~1,850
Four articles done, Frank. A few notes before your voice pass:
Your Frank-only paragraph lives in “Beyond GLP-1s.” You have placed commercial leaders at companies building out patient services, hub operations, and DTC infrastructure. One observation like: “Every RFP I’ve seen for a VP Patient Services or Head of Patient Access in the last 18 months includes language about ‘direct-to-patient capability’ that simply did not exist in the job description two years ago” — that’s your sentence no one else can write.
One flag: The Senate report data on 9amHealth/conversion funnels — worth a quick read of the actual durbin.senate.gov document before publish. The framing in the brief is accurate about what it says, but the Senate investigation has a critical lens that should be acknowledged if those numbers are cited.
Byline confirmed: Frank F. Dolan, CEO, Arsenal Advisors ✓
Four Tier 1 articles complete — three of which are now fully verified and revision-ready. Momentum is strong. Want to move to #5 (Market Access Analytics / Agentic AI) or take a pass through Articles 1–4 first to do your voice additions?
