Interview
5 questions on payer perspectives on direct-to-patient anti-obesity medications
In anticipation of Academy of Managed Care Pharmacy Nexus, we spoke with Michelle Friedman, MPH, Senior Director, Value, Evidence & Access; Arvin Sequeira, Doctor of Pharmacy, Research Fellow; and Shaila Yoshida, MS, Assistant Director, Value, Evidence & Access, about their poster on payer perspectives on direct-to-patient offerings for anti-obesity medications, which was selected for a moderated poster tour and recognized as a Platinum Winner at AMCP Nexus 2026. Their insights show that payer awareness is high, concerns are emerging quickly, and organizations are already evaluating how these models could affect managed care operations.
Key takeaways from our conversation
- Payer awareness is already high. Most surveyed payers were aware of leading direct-to-patient offerings for anti-obesity medications, even if familiarity with specific details varied.
- Managed care implications are top of mind. Payers expect these models to influence areas such as contracting, pharmacy benefit costs, and benefit design.
- Clinical visibility and data access remain key concerns. As medications move through nontraditional channels, payers are questioning how clinical and transactional information will be captured and used.
- The market is moving quickly. Payers are already evaluating budget impact, formulary design, and clinical appropriateness as direct-to-patient offerings continue to emerge.
- The landscape will continue to evolve. Future research may help clarify how payer perspectives change over time, how broader policy shifts affect adoption, and whether these models expand into other therapeutic areas.
Read our panelists' answers
Shaila Yoshida: Direct-to-patient (DTP) offerings for anti-obesity medications (AOMs) are a relatively recent development, but they have quickly become part of the broader market access conversation. The launches of LillyDirect® in January 2024 and NovoCare® in March 2025 marked important shifts in the AOM access landscape, introducing alternative pathways for patients to access treatment amid supply constraints and variability in commercial coverage.
Early uptake suggests these models have gained meaningful traction. Lilly reported that LillyDirect® had served 1 million patients as of January 2026, while the introduction of TrumpRx has further reinforced the growing prominence of direct access models.
As manufacturer-sponsored DTP platforms become a more established part of the AOM landscape, they may expand pathways to treatment while also raising important questions for the traditional managed care model. With DTP positioned to remain an important access lever, we sought to understand payer awareness and perceptions of these models, as well as how payers anticipate DTP may influence the future of AOM coverage and reimbursement.
Michelle Friedman: DTP models for AOMs are not expanding in isolation. Their growth comes amid significant shifts in drug pricing, reimbursement, and access, including implementation of the IRA, renewed focus on most-favored-nation pricing, and ongoing changes surrounding the 340B program. At the same time, growing patient interest in obesity treatment is creating greater demand for accessible treatment pathways. Together, these dynamics make DTP an increasingly relevant consideration within the evolving AOM market access landscape.
Early uptake suggests these models have gained meaningful traction. Lilly reported that LillyDirect® had served 1 million patients as of January 2026, while the introduction of TrumpRx has further reinforced the growing prominence of direct access models.
As manufacturer-sponsored DTP platforms become a more established part of the AOM landscape, they may expand pathways to treatment while also raising important questions for the traditional managed care model. With DTP positioned to remain an important access lever, we sought to understand payer awareness and perceptions of these models, as well as how payers anticipate DTP may influence the future of AOM coverage and reimbursement.
Michelle Friedman: DTP models for AOMs are not expanding in isolation. Their growth comes amid significant shifts in drug pricing, reimbursement, and access, including implementation of the IRA, renewed focus on most-favored-nation pricing, and ongoing changes surrounding the 340B program. At the same time, growing patient interest in obesity treatment is creating greater demand for accessible treatment pathways. Together, these dynamics make DTP an increasingly relevant consideration within the evolving AOM market access landscape.
Shaila Yoshida: Our findings confirmed that DTP models are already firmly on payers’ radar. Ninety-one percent of payers were aware of LillyDirect® and NovoCare®, although only 54% of those familiar with the platforms knew the details of their offerings. Payers also recognized the potential for these models to affect traditional managed care approaches to AOMs.
As DTP models expand, payers are considering both the opportunities and potential challenges they may introduce. Clinical visibility emerged as one concern, particularly around maintaining insight into the patients accessing treatment through DTP channels. More broadly, payers are evaluating where DTP services intersect with their existing capabilities and what that could mean for managed care functions such as benefit design and contracting.
As DTP models expand, payers are considering both the opportunities and potential challenges they may introduce. Clinical visibility emerged as one concern, particularly around maintaining insight into the patients accessing treatment through DTP channels. More broadly, payers are evaluating where DTP services intersect with their existing capabilities and what that could mean for managed care functions such as benefit design and contracting.
Shaila Yoshida: Several key findings emerged from our research. First, payer awareness of DTP offerings for AOMs was high, although familiarity with the details of the two programs was less widespread.
Second, payers anticipated that DTP models could have financial implications for traditional AOM management. Fifty-one percent expected these offerings to affect rebate negotiations for AOMs, while 40% anticipated an impact on pharmacy benefit costs.
Third, half of payers expressed concerns about DTP programs, particularly around limited visibility into a patient’s full clinical profile and the potential implications for benefit design. These findings highlight an important consideration as DTP models evolve: how these services will intersect with existing payer responsibilities and capabilities.
Finally, payers were generally optimistic about TrumpRx as a potential avenue for expanding access, while raising many of the same concerns associated with manufacturer DTP models. One question surfaced repeatedly: whether payers would have access to pricing comparable to that available through DTP channels.
Second, payers anticipated that DTP models could have financial implications for traditional AOM management. Fifty-one percent expected these offerings to affect rebate negotiations for AOMs, while 40% anticipated an impact on pharmacy benefit costs.
Third, half of payers expressed concerns about DTP programs, particularly around limited visibility into a patient’s full clinical profile and the potential implications for benefit design. These findings highlight an important consideration as DTP models evolve: how these services will intersect with existing payer responsibilities and capabilities.
Finally, payers were generally optimistic about TrumpRx as a potential avenue for expanding access, while raising many of the same concerns associated with manufacturer DTP models. One question surfaced repeatedly: whether payers would have access to pricing comparable to that available through DTP channels.
Arvin Sequeira: One of the most surprising findings was how quickly payers are responding to the growth of DTP models. Despite how rapidly the market has evolved, payers are already evaluating the potential implications across areas such as budget impact, formulary design, and clinical appropriateness.
Another finding that stood out was the importance of data visibility. As DTP channels grow, payers raised concerns about maintaining access to clinical and transactional information that traditionally helps inform patient management and benefit decisions.
Michelle Friedman: The question of data visibility was particularly interesting. In traditional access pathways, payers rely on claims and other data sources to understand utilization, evaluate outcomes, and inform coverage decisions. DTP channels raise new questions about how treatment information will be captured and shared. When patients obtain medications outside the pharmacy benefit, payers may not have a complete view of the patient's care.
Another finding that stood out was the importance of data visibility. As DTP channels grow, payers raised concerns about maintaining access to clinical and transactional information that traditionally helps inform patient management and benefit decisions.
Michelle Friedman: The question of data visibility was particularly interesting. In traditional access pathways, payers rely on claims and other data sources to understand utilization, evaluate outcomes, and inform coverage decisions. DTP channels raise new questions about how treatment information will be captured and shared. When patients obtain medications outside the pharmacy benefit, payers may not have a complete view of the patient's care.
Arvin Sequeira: The AOM landscape continues to evolve as new products enter the market and new clinical data emerge. Pipeline therapies such as retatrutide and CagriSema are expected to further reshape the market, giving patients more treatment options while increasing competition. At the same time, there are signs that some employers are scaling back AOM coverage, which could drive further uptake of DTP offerings. As the market expands, it will be important to track how DTP models evolve alongside a broader range of AOMs. Our future research will explore how payers are navigating these changes.
Michelle Friedman: It will also be important to watch whether DTP models expand beyond AOMs into other therapeutic areas. This research offers an early view of how payers perceive DTP, but there is still much to learn as these models mature and the market continues to develop.
Shaila Yoshida: We are also watching broader policy developments that could influence this space, particularly changes in Medicare access to GLP-1 therapies. Medicare Part D has historically excluded coverage of drugs used for weight loss. However, on July 1, 2026, CMS launched the Medicare GLP-1 Bridge, a short-term demonstration that gives eligible Part D beneficiaries access to certain GLP-1 therapies for $50 per month. Early uptake has been strong with reports that roughly 700,000 Medicare beneficiaries have started GLP-1 treatment since the Bridge launched. If this momentum continues, the program could help inform broader GLP-1 access in Medicare. We will continue to monitor the Bridge and assess its implications for commercial coverage and DTP offerings.
As DTP offerings draw growing attention across healthcare, this research offers insight into how payers are thinking about a rapidly evolving model and the questions that lie ahead.
Michelle Friedman: It will also be important to watch whether DTP models expand beyond AOMs into other therapeutic areas. This research offers an early view of how payers perceive DTP, but there is still much to learn as these models mature and the market continues to develop.
Shaila Yoshida: We are also watching broader policy developments that could influence this space, particularly changes in Medicare access to GLP-1 therapies. Medicare Part D has historically excluded coverage of drugs used for weight loss. However, on July 1, 2026, CMS launched the Medicare GLP-1 Bridge, a short-term demonstration that gives eligible Part D beneficiaries access to certain GLP-1 therapies for $50 per month. Early uptake has been strong with reports that roughly 700,000 Medicare beneficiaries have started GLP-1 treatment since the Bridge launched. If this momentum continues, the program could help inform broader GLP-1 access in Medicare. We will continue to monitor the Bridge and assess its implications for commercial coverage and DTP offerings.
As DTP offerings draw growing attention across healthcare, this research offers insight into how payers are thinking about a rapidly evolving model and the questions that lie ahead.
Evaluating direct-to-patient anti-obesity medication models
As DTP offerings attract attention across healthcare, this research offers insight into how payers are thinking about a rapidly evolving model and the questions still ahead. As the market continues to evolve, these insights can help stakeholders better understand the operational and policy considerations shaping this emerging channel.
Download the poster:
Payer perspectives on direct-to-patient (DTP) offerings for anti-obesity medications (AOMs): Results from a 2026 US national payer survey
Download the poster:
Payer perspectives on direct-to-patient (DTP) offerings for anti-obesity medications (AOMs): Results from a 2026 US national payer survey
