The DTP program launched. The channel didn't.

Why direct-to-patient (DTP) programs plateau after go-live, and the four numbers that tell you what it is costing your brand.

If you have a live DTP program that has not changed since the day it went live, this will show you what that is costing you. It takes four numbers you already have and about an afternoon.

Standing up a DTP program is one of the hardest things a commercial organization can do. It asks marketing, market access, patient services, data, analytics, IT, legal and regulatory to operate as one system, in step with an agency of record, a media partner, a co-pay vendor, a telehealth provider and a pharmacy. Most of those groups had never done it before. The companies that got a program live earned it.

Then, for a lot of programs, the work stopped. Launching the program was the success. The listing went up, the price was published, the compliance sign-off was filed, and the program has not changed since.

That is the pattern worth naming. Not a failure of execution. A definition of success that ended at go-live.

When DTP launch became the finish line

Timing shaped a lot of this. President Trump’s Executive Order, signed May 12, 2025, and the February 5, 2026 launch of TrumpRx.gov put an entire industry on a compliance clock at once. When you build under that kind of deadline, the work goes to the people who manage pricing and compliance. The finish line becomes the launch itself: a program exists, a cash price is published, the listing is live.

That was a real accomplishment. It was also a narrow definition of success. TrumpRx.gov launched with 43 drugs from five manufacturers. A House Energy and Commerce Democratic staff report released February 24, 2026 — titled “TrumpRx: Big Talk, Little Savings” — found a cheaper generic available but undisclosed for 15 of them, and pre-existing GoodRx coupons at the same or similar price for at least seven more. Publishing a cash price is not the same as making a medicine affordable. It is nowhere near the same as building a channel that drives revenue.

The bigger gap is between willingness and use. In a June 2025 survey of 1,000 US adults, 72% said they would be somewhat or very likely to buy prescriptions directly from a manufacturer. Only 22% ever had. Interest held steady across every income bracket. That is a fifty-point gap between the people who would use these programs and the people who have. It is not a demand problem. It is a promotion problem.

A program nobody knows about is not a channel. It is a landing page with a compliance sign-off.

Cash pay is a feature. It is not the DTP program.

The clearest proof is a program with no cash price in it at all.

In March 2025 Lilly extended LillyDirect to connect people with possible Alzheimer’s disease to providers, in person and by telehealth, through Healthgrades and Synapticure. The problem it targets is time. Diagnosis routinely runs beyond two years from the onset of symptoms, specialist wait times were projected to pass a year, and as many as 3,000 Americans progress each day from mild to moderate or severe stages. Unlike every other condition on the platform, there is no mail-order pharmacy attached. The entire value is removing friction from diagnosis.

That is the real job of DTP: reducing the friction between a patient recognizing a problem and starting the therapy that helps. In some categories that means faster access to a prescriber. In others it means knowing the price before the pharmacy counter, getting the medicine delivered, or not being asked to fill out the same form three times. And it can be all of those at once.

The scale of that friction is not a soft number. IQVIA reported 98 million new therapy prescriptions abandoned in 2023. Forty-four million of those were abandoned when the cost was under $10, including prescriptions that cost the patient nothing at all. Only 31% of patients were still on therapy a year later. On the specialty side, CoverMyMeds surveyed more than 500 patients prescribed a specialty medicine and found 60% had difficulty simply receiving their first dose, and three-quarters of providers said prior authorization alone had caused patients to abandon treatment outright.

Close to half of abandonment happens on prescriptions that were already free for the patient. Price is the problem we fund. Friction is the problem we ignore.

What goes wrong after go-live

Across five direct-to-patient programs at top-20 pharma and emerging specialty, the same two things went wrong at almost every one.

The first was the promotional wall. The program was sound. The strategy was right. Volume stayed flat because the budget and the promotional expertise sat in a function that was not in the room.

The second was the measurement gap. Nobody could say what the program was worth. So nobody could argue for more of it. So it stayed exactly the size it was on launch day.

The second one is the fixable one, and it is addressable this quarter. When you can put a number on what the program is leaving on the table, the funding argument writes itself. That is why the arithmetic below exists. It is the argument that should have been on the table.

Do the DTP arithmetic on your own brand

Every brand team should be able to answer this in an afternoon. It does not require a benchmark, a vendor study or an industry average. It requires four numbers you already have.

●      Annual new-to-brand prescriptions.

●      Your primary abandonment rate, the share never filled.

●      Your discontinuation rate in the first six months.

●      Net revenue per patient per year.

Take a brand writing 50,000 new prescriptions a year, with a 25% primary abandonment rate, a 40% six-month discontinuation rate, and $4,000 in net revenue per patient per year.

Never started. 50,000 × 25% = 12,500 people who were prescribed your medicine and never took it. At $4,000 each, that is $50 million prescribed and never realized.

Started and stopped. 37,500 patients started. At a 40% six-month discontinuation rate, 15,000 of them stop inside the first six months, capturing roughly $2,000 instead of $4,000. That is another $30 million.

The pool. $80 million a year, on a brand doing 50,000 new scripts. Run your own four numbers and the arithmetic will be different. The order of magnitude will not.

DTP captures a slice of that pool. That slice is worth more than several channels you are already funding, and it does something no other channel does: it puts the brand directly next to the patient, and it tells you within days whether it worked.

None of this is theoretical. In the second quarter of 2025, roughly 35% of new Zepbound prescriptions were being fulfilled through LillyDirect self-pay. You will say that is a GLP-1 story.

Here is the part that is not. IQVIA tracked the ratio of gross sales to DTC spend across specialty launches. For products launched in 2013, brands returned about $85 in sales for every dollar of DTC in the first two years. For 2022 launches, that ratio fell to roughly 1:1. Nine specialty launches in 2022 generated $1.3 billion in sales against $1.1 billion in DTC spend over 24 months — before sales force, payer rebates, and everything else. Meanwhile pharma put more than $6 billion into DTC television in 2024, with 75 brands spending at least $10 million each.

Eighty-five to one, down to one to one. You are funding a channel where returns collapsed and attribution takes months. The channel you are not funding tells you in days.

What the number is telling you

Whatever your number came to, it has been sitting there since launch, uncounted, because the program was declared finished on the day it went live.

That is the shift. Launch is the floor of a DTP program, not the ceiling. The compliance clock is satisfied. The price is published. What has not been built is a channel:  promoted, measured weekly, and accountable for new patient starts the way every other line of promotional spend already is.

Here is the part that should bother you. Your number is not a one-time loss. It repeats. Every quarter the program sits unpromoted, another cohort gets prescribed your medicine and never starts it, and the loss books itself again.

Meanwhile almost every component you need already exists inside the organization. Co-pay. Patient services. Data. Analytics. Pharmacy relationships. Funded and staffed. What is missing is not a capability. It is a spine — one strategy, one metric set, and one leader connecting marketing, market access, patient services, the data layer and the vendor bench so they optimize the same thing instead of five different things.

That is the work Kairos Meridian does. Create the strategy. Map the patient experience end to end. Apply what works from programs already in market. Optimize the performance against one number, every week. Whether your program is an idea, live, or plateaued.

Run the DTP numbers

Pull your four numbers before your next planning cycle. Then send them over.

If the pool is small, DTP is not your fight this year. If it is large, that is a conversation worth having, and it starts with the problem keeping you up at night.

Book A Conversation Today

The first conversation is short, and it is not a pitch.

Sources

●      Executive Order 14297, “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” May 12, 2025. TrumpRx.gov launched February 5, 2026 with 43 drugs from five manufacturers (White House; CRS Report IF13281).

●      “TrumpRx: Big Talk, Little Savings,” Democratic staff report, House Committee on Energy and Commerce, February 24, 2026.

●      DTC willingness and usage: Model N / Dynata survey of 1,000 US adults aged 25+, fielded June 2025, released October 21, 2025.

●      Abandonment volume, cost thresholds and one-year persistence: IQVIA Institute, “The Use of Medicines in the U.S. 2024.”

●      Specialty first-dose difficulty and prior-authorization abandonment: CoverMyMeds Medication Access Report, patient and provider surveys.

●      LillyDirect Alzheimer’s expansion, diagnostic timeline and progression rate: Eli Lilly press release, March 27, 2025.

●      Zepbound self-pay share, Q2 2025: Eli Lilly and Walmart press release, October 29, 2025.

●      Specialty launch DTC sales-to-spend ratios and 2024 DTC television spend: IQVIA, “Engaging Consumers at Launch” and “Life Sciences and Direct-to-Consumer Television Advertising,” October–November 2025.