One of the effects of DTC advertising is its influence on healthcare providers and insurers. Consumers who see DTC ads, of course, ask their doctors about the advertised drugs. But what’s less discussed is how DTC advertising can influence the formulary decisions made by health insurance companies. Insurers—both private and government-controlled—don’t like DTC ads.
Consumers can be a pesky bunch. Insurers don’t want the public pressuring them to cover more expensive drugs. In some cases, they argue that older drugs are just as effective and much cheaper. In others, they insist that newer drugs need more long-term study before widespread adoption. At the end of the day, insurers and the government want to control which drugs are utilized.
DTC creates awareness of new treatments. Consumers want the best options available and hate being told that the latest drug isn’t on formulary. Those consumers then complain to their elected representatives, who in turn criticize insurers for restricting access. The insurers get painted as callous and greedy. That doesn’t let drug makers off the hook either—they’re criticized for high prices.
DTC creates awareness of new treatments. Consumers want the best options available and hate being told that the latest drug isn’t on formulary.
Weight Loss Drugs: A Case Study in DTC Pressure
A great example of this DTC-driven formulary pressure is the new GLP-1 weight loss drugs like Wegovy and Zepbound. Health experts say these drugs could help combat the obesity epidemic. DTC ads for both highlight significant weight loss results. But insurers hate covering these medications, which cost over $1,000 a month. Consumers, meanwhile, are frustrated that only the wealthy can afford them out of pocket. Thanks to DTC, demand has skyrocketed, and the pressure is mounting on insurers to expand coverage.
The Doctor-Patient Dynamic and the Role of DTC
One of the usual criticisms of DTC advertising is that it creates friction between patients and doctors—that patients, uninformed and swayed by marketing, shouldn’t be pressuring doctors to prescribe specific drugs. But there’s another side to this. DTC can also help doctors advocate for coverage when they believe an expensive drug is the best choice for a patient.
DTC as a Consumer Voice in Healthcare
Our healthcare system is a complicated beast, and critics of DTC rarely acknowledge how consumers actually benefit from its influence. The reality is that DTC can help push insurers to cover new treatments faster. Weight loss drugs, for example, will likely see broader coverage sooner rather than later, thanks to the hundreds of millions spent on DTC. At the same time, Lilly and Novo Nordisk will need to lower prices over time to expand access.
We all like to believe that patient care is the top priority when it comes to healthcare coverage. But we know that private insurer profits, government budgets, and drug company pricing all play a role. DTC advertising is one of the few ways consumers can make their voices heard in that equation.
