Beyond MFN: Pharma Needs DTP Infrastructure, Not Just Lower Prices
This is Part 2 of “The Infrastructure Era,” a three-part series by Wheel CEO Michelle Davey exploring the evolution of virtual care, the infrastructure gap in direct-to-consumer cash models, and the future of pharma’s patient engagement strategy. In case you missed it, here’s Part 1.
President Trump’s Most-Favored-Nation (MFN) directive has put a spotlight on pharma pricing, giving companies a 60-day ultimatum to lower costs and expand domestic manufacturing. But while pricing grabs headlines, the deeper shift is happening beneath the surface through patient engagement.
As a leader in healthcare, I’ve seen firsthand how often patients are caught in the gaps — waiting weeks for a prescription, abandoning treatment because the cost was unclear, or losing trust when support ends after the first fill. These aren’t abstract policy debates. They are lived experiences that shape outcomes. And they remind us that the stakes here are not about compliance or cost alone, but about people who deserve care that is continuous and trustworthy.
Patients have been ahead of policy for years demanding transparency, affordability, and control over their own care. Today’s healthcare consumers comparison shop for medications, ask questions about cost, and are increasingly willing to walk away from brands that don’t deliver affordable, coordinated access to care. This is where DTC pharma strategy meets direct-to-patient (DTP), and where much of the market still hasn’t realized the ground is shifting.
Historically, DTC has been about direct-to-consumer marketing and awareness, generating demand. In its newer digital form, DTC has evolved to direct-to-cash drug fulfillment, where patients can access medications and therapies directly from pharma manufacturers through coupon discounts and out-of-pocket payments.
DTP or direct-to-patient, by contrast, is about infrastructure. Comprehensive direct-to-patient models connect access, education, prescribing, affordability, fulfillment, and adherence into one compliant, patient-first system. These programs move beyond just generating awareness to enabling access and supporting outcomes — something more continuous, coordinated, and measurable.
The convergence of the DTC and DTP models is what creates real patient impact and is the next competitive advantage for pharma brands.
Where the DTC pharma debate falls short
Recent perspectives from other vendors capture the anxiety in today’s debate. These arguments position compliance as the differentiator to headlines claiming direct care won’t reduce drug costs (even though it’s well known these models can and do lower the cost of care). Both views raise valid concerns, but both miss the bigger point: the question isn’t whether pharma should go direct, but whether they do it in a way that sustains trust and delivers outcomes.
Healthcare compliance is the floor, not the ceiling.
Every credible direct-to-patient platform must meet that bar. Patients, policymakers, and providers already expect rigorous standards for data privacy, prescribing, and clinical independence. The real test is whether the model connects clinical independence, affordability, and access into one seamless patient experience.
Others have suggested the solution is to add another middleman to the system, essentially a PBM 2.0 for virtual care. But this strategy risks recreating the very friction and opacity that patients and regulators are demanding we dismantle. If the last decade has taught us anything, it’s that more toll booths do not improve access or reduce costs — they compound complexity, drive up costs and erode trust.
Lower prescription costs won’t improve care
Critics are right that shallow telehealth, built around pop-up prescribing and cash-pay fulfillment, creates a temporary access point, but it does not deliver sustainable value or outcomes. Patients abandon therapy when affordability tools are missing, when prior authorization delays drag on, or when refill reminders never come. A discounted $499-a-month therapy without support is still unattainable for most people.
The alternative is to make cash-pay and direct fulfillment part of a broader care infrastructure. That means connecting prescribing with benefits verification, copay assistance, pharmacy transparency, and adherence programs. When infrastructure reduces drop-off, accelerates time-to-therapy, and sustains persistence, affordability becomes more than a number on a page. It translates into outcomes that patients and policymakers can see.
This is the real dividing line. Shallow models add noise and cost. Infrastructure models reduce friction, build trust, and deliver measurable outcomes. Compliance and affordability are expected. The future leaders will be those who treat access not as a transaction, but as the beginning of a continuous relationship.
From DTC telehealth to DTP care infrastructure
Legacy direct-to-consumer models were optimized for speed and awareness. They moved scripts, but they didn’t build trust, sustain engagement, or deliver outcomes. That playbook is no longer viable.
Direct-to-patient infrastructure changes the equation. By connecting intake, prescribing, affordability, pharmacy fulfillment, and engagement into one patient-first system, pharma can:
- Reduce time-to-therapy for patients who cannot afford to wait
- Provide early access pathways while coverage evolves
- Support long-term adherence so treatment success becomes measurable
This is what true patient infrastructure looks like. And it is what separates sustainable models from short-lived experiments.
Virtual care infrastructure is pharma’s real competitive advantage
The risks of unchecked costs and weak compliance models are real. But the solution isn’t to abandon direct access or add another middleman. It is to build patient-first infrastructure that makes compliance table stakes, affordability non-negotiable, and outcomes the true measure of success.
The MFN directive may have accelerated urgency for better cash pay pricing, but the real disruptor is today’s consumer — empowered, discerning, and unwilling to settle for impersonal care.
Direct-to-patient care for pharma
At Wheel, we’re powering this next chapter with Horizon™ — our leading enablement platform that connects the full DTP stack of access, education, diagnosis, prescribing, pharmacy fulfillment, and patient engagement in an independent, compliant, evidence-based way. Because today’s patients demand and deserve convenient access to care they can trust, that’s personalized, continuous, and that supports them across the full journey.
DTP virtual care infrastructure is the foundation. It’s time for pharma to start building.
Coming soon: What Pharma Builds Next: DTP Access Meets PSP Support