Why Pharma Is Exploring Direct-to-Employer Benefit Models

Key Takeaways

• Manufacturers shift to transaction‑based fees, dropping admin charges.
• Centralized prescription routing enables flexible pharmacy fulfillment.
• Direct‑to‑employer models require multi‑stakeholder alignment.
• Automation reduces costs, improves employee experience.
• Success may expand beyond high‑cost therapies like GLP‑1.

Pulse Analysis

Rising prescription drug costs have forced employers to scrutinize traditional pharmacy benefit manager (PBM) arrangements, which often obscure pricing and add administrative layers. In response, manufacturers are piloting direct‑to‑employer (D2E) models that bypass PBMs and wholesalers, offering transparent, transaction‑based pricing. By removing per‑member‑per‑month (PMPM) fees and other ancillary charges, these models aim to align manufacturer incentives with employer cost‑containment goals, creating a more predictable spend profile for large workforces.

Andel’s approach exemplifies the operational shift behind D2E. The company operates a non‑dispensing pharmacy platform that receives prescriptions via Surescripts, triages them, and forwards each order to the most suitable dispensing pharmacy nationwide. This centralized routing, coupled with automation, enables per‑prescription fees while eliminating spreads on drug prices. Employers benefit from a streamlined experience—no separate telehealth or wrap‑around service fees—and employees see faster, more consistent fulfillment. The model’s flexibility also allows manufacturers to experiment with pricing structures that directly reflect drug utilization, fostering a data‑driven feedback loop for cost management.

Scaling D2E requires coordinated effort among manufacturers, employers, and pharmacy networks. Operational hurdles include integrating workflow systems, ensuring pharmacy capacity, and maintaining regulatory compliance across jurisdictions. However, early successes with high‑demand, high‑cost therapies like GLP‑1 agonists suggest broader applicability. If outcomes demonstrate sustained savings and improved member satisfaction, the industry could witness a gradual migration toward D2E for a wider array of treatments, reshaping the traditional distribution ecosystem and prompting legacy intermediaries to adapt or risk obsolescence.