LillyDirect: A revolution in patient care or a blurring of ethical lines?

I have been deep diving into Eli Lilly’s new direct-to-consumer program? LillyDirect? and made some fascinating observations:

LillyDirect? offers patients access to telehealth providers and facilitates home delivery of medications for Diabetes, Migraine, and Obesity.? They have partnered with 3 telehealth providers 9am Health (Diabetes), Form (Obesity) and Cove (Migraine)

Owning the supply chain

The direct Lilly medication delivery service makes a lot of sense. Implemented via a 3rd party partner it offers a powerful way to ensure the patient both fulfills their prescription and continues with it.

Calculating ROI?

I signed up for one of the providers and registration is unsurprisingly tracked through as a Lilly referral.? While the telehealth partner should prescribe (or not) based on a patient needs, it should be easy for Lilly to see the data on how many patients in total referred to the provider ended up on Lilly medicines and for how long, thus calculating ROI of the partnership.

Patient Preference

Lilly are careful to position these telehealth clinicians as “independent and will exercise autonomous clinical judgement” but you can see how this effort will disproportionately favor Lilly.? For a start there is a high chance patients referred from Lillydirect are aware and indeed have an opinion on what Lilly medication they want.

Loaded Dice?

The headline image shows where you arrive after clicking on the weight loss provider (Form). The first thing a patient see’s are 2 GLP-1 drugs, with Zepbound (Lilly) being listed ahead of Wegovy (NovoNordisk) in reverse alphabetical order, ensuring the Lilly option is front of the patients mind.?

And looking at their blogs, 4 feature Zepbound vs 1 for Wegovy and Ozempic which helps further stack things in Lillys favor.? ?

This comparator blog between Zepbound vs Wegovy is fascinating, while it does not draw any firm conclusions you are lead to the right answer?

“Zepbound (tirzepatide) has shown the greatest weight loss achieved with any medication to date”

“Zepbound is in a class of its own when it comes to weight loss medications”

While Wegovy is subjected to more mundane treatment, if you don't believe me here is what our mutual friend Chat GPT had to say on the matter:

Based on the text provided, Zepbound appears to be favored more prominently. It is described as offering greater weight loss benefits in clinical trials compared to Wegovy, with detailed mention of its unique action mechanism and higher average weight loss percentages. Wegovy is also positively discussed but seems to be positioned as a slightly less preferred option compared to Zepbound. The emphasis on Zepbound's innovative aspects and its recent FDA approval for weight loss treatment contribute to this perception.

Expanding Access

And what all of the 3 telehealth providers (and Lilly Pharmacy) seem to do well is doing the utmost to help insured patients get access to their medications with minimal or zero cost, hence expanding the pool of patients. Thus while some of the 3rd party telehealth provider patients may still get prescribed non Lilly drugs, overall Lilly will benefit from growing the market

Questionable Patient Experience

I was disappointed with some of the patient experience aspects, especially as that is what the LillyDirect program seeks to improve.? To sign up for one of the partners involved answering a plethora of questions before I saw any personal ROI (return on information)?

And Lilly have said “Future updates may include new products, partners and services”.? Having 3 distinct telehealth providers is already potentially confusing as some patients are likely to have both obesity and diabetes, so are they supposed to sign up for both?? What is this going to be like if they bolt on 10-12 providers?

It also felt a bit mechanical like a directory, it did not seek to understand my needs and where I am in my journey, rather I am asked if I want to ‘Explore telehealth’ , ‘Find in-person care’ or ‘Explore pharmacy services’

Summary

In summary I find it deeply fascinating to reflect on how far should pharma companies should go in stacking these programs in their favour? Let's be realistic why bother investing in them if you won't benefit from them.

There are clear red lines but also many shades of grey involved.