Pharma's Direct GLP-1 Sales Divide Doctors, Reshape Obesity Care

NEW YORK, NY – December 18, 2025 – The meteoric rise of GLP-1 weight-loss drugs like Wegovy and Zepbound is now fueling a seismic shift in how medications reach patients, forcing a deep and contentious debate within the medical community. New data reveals that as pharmaceutical giants launch direct-to-patient (DTP) sales platforms, the very structure of obesity care is being challenged, leaving physicians sharply divided over whether this new frontier improves access or dangerously fragments patient care.

A new survey from Sermo, a global healthcare insights platform, shows that awareness of these DTP programs is already widespread, with 71% of 953 prescribing healthcare professionals (HCPs) familiar with them. However, familiarity has not bred consensus. The findings lay bare a profession grappling with the expanding role of pharmaceutical companies in clinical practice. While 31% of HCPs believe pharma is equipped to handle full clinical evaluations and prescribing, a larger combined majority expresses serious reservations: 35% advocate for a limited role with prescribing only under the oversight of a patient’s primary doctor, and 29% insist pharma’s role should be confined to facilitating access, leaving all clinical decisions to the patient’s provider.

“The rise of pharma-run DTP programs is changing the front door of obesity care,” noted Dr. Estylan Dan Arellano, a Sermo Medical Advisory Board Member, in the report. “The challenge now is making sure patients don’t get siloed into pathways where prescribing happens without full visibility into their long-term health needs.”

The Insurance Gap Driving Direct Sales

The rush toward DTP models is not happening in a vacuum. It is a direct response to a cavernous gap in insurance coverage that has left millions of patients unable to afford GLP-1 therapies. With list prices hovering between $1,000 and $1,400 per month, insurance denials have become the norm. Recent analyses show that a staggering 62% of GLP-1 prescriptions for obesity were rejected by insurers in the past year.

This barrier is codified in federal law, which prohibits Medicare from covering weight-loss medications, a policy vestige from 2003. While some employer-sponsored plans offer coverage, many are pulling back due to soaring costs. This has created a vast market of patients who are clinically eligible but financially blocked.

Enter programs like LillyDirect and NovoCare. Launched by Eli Lilly and Novo Nordisk respectively, these platforms allow patients with a valid prescription to purchase medications like Zepbound and Wegovy directly for a cash price of around $499 a month, bypassing insurance and traditional pharmacy benefit managers. According to the Sermo survey, this model has become a grudgingly accepted necessity. More than half of HCPs now consider these pharma-led DTP programs the most clinically acceptable alternative when insurance denies coverage, ranking them higher than telehealth platforms (36%) and compounding pharmacies (26%).

However, this solution raises its own equity concerns. The model relies on digital platforms and telehealth partners, potentially excluding patients in the digital divide or those in underserved communities. Data has already revealed significant racial and socioeconomic disparities in GLP-1 access, with Black and Hispanic patients prescribed the drugs at far lower rates. While DTP lowers the price, it may not close the broader access gap for the most vulnerable populations.

A Call for Connected Care

The most significant anxiety among clinicians centers on the potential for fragmented care. When a patient procures medication through a separate, pharma-run channel, their primary care physician or endocrinologist may be left in the dark. This disconnect is particularly concerning for GLP-1s, which have profound effects on a patient's overall metabolic health.

To bridge this gap, physicians are clear about their needs. The Sermo report indicates that 69% of HCPs want DTP programs to provide structured follow-up reports to the primary provider. Another 64% call for integrated access to dietitians and nutrition specialists, and 52% want shared electronic health record (EHR) notes to ensure a cohesive medical history. Without these integrations, doctors fear they cannot provide comprehensive oversight, manage side effects, or track the long-term benefits and risks for their patients.

From Taboo to Tool: Microdosing Goes Mainstream

Beyond the business model, the clinical application of GLP-1s is also rapidly evolving. A once-controversial practice known as “microdosing”—or, more accurately, physician-led dose reduction—has become a mainstream strategy. Just a year ago, a Sermo study found 91% of HCPs were concerned about patients adjusting their own doses. Today, that script has flipped entirely: 67% of HCPs report they now regularly or occasionally lower GLP-1 doses themselves to manage side effects like nausea and improve long-term tolerability.

This practice is even more prevalent in the newer care models, with 87% of telehealth HCPs and 83% in medical spas or weight-loss clinics reporting they adjust doses downward. This pragmatic shift demonstrates how clinicians are actively adapting treatment protocols in real-time to keep patients on these effective, but often difficult to tolerate, therapies for longer.

A New Era of Long-Term Treatment

This focus on tolerability is crucial as GLP-1s transition from a short-term intervention to a long-term, chronic disease management tool. According to the data, long-term use is now the norm, with 40% of patients remaining on therapy for 6–12 months and another 39% staying on for more than a year. After patients hit their weight-loss goals, 58% of prescribers opt to continue a lower maintenance dose.

The rationale is clear: the benefits extend far beyond the scale. HCPs are observing significant metabolic improvements in their patients, reporting a reduced need for medications to treat diabetes (75%), high blood pressure (70%), and high cholesterol (62%). These findings underscore that GLP-1s are not merely weight-loss drugs but powerful agents of metabolic health, making the need for integrated, long-term, and physician-led care more critical than ever. As these powerful therapies become a mainstay of chronic disease management, the debate over how to deliver them safely, equitably, and effectively is only just beginning.