One of the things we do at DTC Perspectives is speculate on the future of DTC. No time in DTC history has been as uncertain as now with the Kennedy confirmation. One thing we have learned about the second Trump term is nothing can be ruled out.  The idea of incrementalism in policy adjustments is not how he operates.

In past new administrations, we would have been contemplating some possible new DTC guidance tweaking requirements for fair balance. I am afraid we may face a lot more than that under the Kennedy HHS.

Let’s contemplate alternate futures for DTC and the odds of them happening:

1. Total DTC advertising ban

This would include no promotion of prescription drugs to consumers in any medium. Websites for drugs might be allowed but no promotion, just label information. Of course, this raises constitutional issues, but we have seen the Trump playbook is to act and let the courts rule later. One thing we need to understand is the drug industry could “voluntarily” accept a ban because of other business considerations. Price and drug approval can be used by HHS as pressure points to get drug makers to curtail DTC. The total spending for DTC is low in proportion to total drug sales so how far will drug makers go to protect that minor spending.

No time in DTC history has been as uncertain as now with the Kennedy confirmation.

2. Partial ban: no branded television

This is what Kennedy would probably be content doing. Many in Congress, insurance payers, and most medical associations would like to see TV banned. I can see DTC television limited to disease education with no brand mention. Again, this is limiting speech, but would drug companies really fight to keep it? Television is about $5 billion in ad spending or only about 1% of drug sales. Drug companies want their drugs approved and not price-controlled, and that is a big stick HHS wields. DTC expenditures would likely be reallocated to other media such as digital, print, point of care, disease education, and PR programs. There are no shortages of companies who are ready to sell non-TV media.

3. Status quo

The media, ad agencies, and drug companies have lots of influence. They are surely lobbying Congress and The White House not to ban DTC. They can make a strong case that DTC does not cause any public harm and in fact Rx drugs lead to cheaper solutions in disease management. Status quo means there is still a good chance of increased HHS demands for more fair balance and stricter enforcement.

My odds? Total advertising ban: 10%; TV ban: 40%; and status quo: 50%. Why is status quo my highest odds? Kennedy has a lot on his plate to Make America Healthy Again (MAHA). He will need to pick his battles and fighting free speech might be just too much to take on. The $10 billion in DTC is a pittance in America’s $1.4 trillion healthcare system. I think status quo with modifications to make DTC harder to execute is still the most likely approach. The next few months will tell the direction we are heading and make interesting times for all of us DTC practitioners.