Fugh-Berman directs PharmedOut at Georgetown University Medical. Judy Butler is the senior research fellow at PharmedOut.
Want to self-prescribe a prescription drug? No problem! Some of the largest pharmaceutical companies in the U.S. are piloting websites that essentially sell their drugs directly to consumers.
This unprecedented move launches a new dystopic era: pharmaceutical companies as health care provider, no pesky physician middlemen needed. It's what the pharmaceutical industry has always wanted: They have long viewed physicians as inconvenient barriers between the company and their customers. Rather than bribing and wheedling physicians to pretty-please-prescribe-our-drug, companies can now deal drugs straight to the consumers who want them, whether or not those consumers need, know anything about, or will benefit from those drugs.
Lilly's site, launched in January, sells weight loss drugs, diabetes drugs, and migraine drugs, but their main focus is on weight loss drugs. On Aug. 27, Pfizer launched its portal, PfizerForAll, to sell Paxlovid for Covid-19 and Zavzpret (zavegepant), an intranasal migraine drug; the site also promotes vaccine use.
Pharma's one-stop shopping sites encourage patients to click on a button for an instant consultation with a prescriber who will recommend a drug that can then be ordered through the site. It answers a patient's problem of "doctor shopping to find someone who will write them what they know is a solution for their health problem," Lilly CEO Dave Ricks told Yahoo Finance.
It's not a coincidence that Pfizer, Lilly, Amgen, and AbbVie are all hawking anti-CGRP migraine drugs on their direct-to-consumer portals; these drugs don't work well enough to be popular with real-life physicians. We wonder whether the telehealth companies that partner with these pharmaceutical companies tell migraine patients that these drugs are barely better than placebo; they are less effective than cheap, generic triptans, and they take longer to work, leaving patients in pain for longer. But at least they are expensive, at up to $125 a pill.
Cutting out the personal physician is a good corporate move when a company is hawking a mediocre drug.
The drugs marketed on these sites generally need the marketing. Pfizer's Paxlovid, for example, was once hailed as a game-changer in Covid treatment, but sales of the drug have dropped precipitously after it became clear that only a small group of high-risk people benefited from it. Recent studies show that Paxlovid doesn't relieve symptoms more than placebo, and one in five people experience rebound, becoming infectious again (with or without symptoms) after finishing treatment. And Paxlovid can dangerously increase levels of other drugs a patient is taking. Whether or not someone with Covid should take this drug ought to involve a thoughtful discussion with a primary care physician who knows the patient, not some white-coated moonlighter who has never examined -- or even seen -- that patient before.
The same day Pfizer announced its portal, Lilly announced that it was making its popular weight loss drug Zepbound available in less-expensive vials that require the users to draw the drug into a syringe. The discounted drug appears to be competing with sites that sell compounded tirzepatide (the generic name for Lilly's drug Zepbound).
While billed as saving patients money when their insurers won't cover weight loss drugs, the dosages available are not cheap, and may be ineffective. LillyDirect will only sell the 2.5 mg dose of Zepbound (a starter dose), and a month's worth of the 5 mg dose, which will cost $549, compared with about $1000 for the Zepbound pens, that also come in doses up to 15 mg.
Patients with migraines, or Covid, or who want to lose five pounds to look better in clothes, should not be self-prescribing drugs, and that is really what is happening with these portals. Oh, sure, there is some cooperative prescriber involved, from a purportedly independent provider of cooperative prescribers. But the thin camouflage of a white coat can't hide the fact that working for a company tethered to a pharmaceutical manufacturer and prescribing the same drug to almost all comers isn't practicing medicine. When nine out of 10 prescriptions are written for the drug manufactured by the company whose website the customer clicked, that company is simply dealing drugs.