Americans can buy iPhones straight from Apple and sneakers straight from Nike. In fact, in almost every industry, it's perfectly normal for consumers to buy products directly from manufacturers' websites and have them shipped right to their doors.
But medicines are different. For decades, patients have been forced to run through a gauntlet of middlemen, each of whom piles on fees, to get the treatments they need. The additional costs imposed by these wholesalers, insurers, pharmacy benefit managers, and pharmacies have turned the simple act of filling a prescription into a monthly financial crisis for too many families.
Fortunately, that could soon change. A handful of pharmaceutical companies recently started selling medicines directly to patients, shipping the drugs right to their porch or mailbox, so long as they have a doctor's prescription.
The Trump administration is looking to expand these "direct-to-patient" programs and has announced that a new platform, "TrumpRx," will launch next year to simplify direct sales to consumers. It's a smart move. Bringing prescription drug sales in line with how other markets operate would eliminate hidden markups and save patients billions of dollars.
The American people are already on board with the proposal. Recent polling finds that an overwhelming 86% of voters support manufacturers selling medicines directly to patients, so long as they have doctors' prescriptions. That support is bipartisan.
Direct-to-patient sales could fix one of the biggest problems with our current healthcare system -- the lack of transparency. Patients often don't know what they will owe until they reach the pharmacy counter. Surprise costs undermine trust and make budgeting challenging.
And in many cases, middlemen in the drug supply chain don't merely create uncertainty. They dramatically inflate patients' bills.
That's because insurers and pharmacy benefit managers typically negotiate with drug companies for secret discounts and rebates that reduce the net price of medicines. But because patients aren't aware of these secret discounts, they have to pay their out-of-pocket costs based on the inflated "list" price of medicines. In some cases, patients pay more in copays and co-insurance than their insurer spends on the drug.
These middlemen have become far too influential. Half of every dollar spent on brand-name drugs now goes to pharmacy benefit managers, insurers, and other corporate entities that don't invent or manufacture medicines. No other country in the world allows middlemen to skim such an enormous cut off the top -- which is a key reason America has the world's highest net brand-name drug prices.
Direct-to-patient programs could cut out these middlemen, and their markups, and offer Americans guaranteed, transparent prices that are far below inflated list prices. That enables families to plan and budget with confidence, and would force drug companies to compete on the public prices they offer patients, rather than the secret discounts they offer middlemen.
Historically, medicinal plants were grown in cloister gardens and sold in apothecaries to the patient as prescribed by the treating physician. This is the origin of our Western medicine. The knowledge was shared by a group of professional insiders, monks, and apothecary professionals who formulated and dispensed the prescribed medicinal compounds. In our era, the biotech industry entered this circle of knowledgeable drug-developing specialists. This multi-professional group possesses the insider knowledge to develop and produce drugs, control the system, distribute the medicines to patients, and share the profit. The entrance of the non-value-adding middleman into the traditional network resulted in the abuse of profit here in the United States.
Encouraging drug companies to start selling directly to patients, as President Trump already has, is a far better way to reduce patients' spending than the White House's Most Favored Nation drug pricing proposal. That initiative would tie U.S. drug prices to the prices set by Europe's government-run health care systems, which impose price caps that lead to rationing, shortages, and fewer treatment options. On average, American patients receive new treatments a year sooner than patients abroad.
America's life sciences industry is the most dynamic in the world precisely because we've historically rejected central planning. The Most Favored Nation proposal would take us in the wrong direction.
Direct-to-patient programs offer a better solution. They can lower patients' costs without causing the drug development pipeline to run dry.
Dr. Wolfgang Klietmann is a former clinical pathologist and medical microbiologist at Harvard Medical School.