Direct‑to‑Employer Prescription Drug Platforms

For decades, employers have relied on pharmacy benefit managers (PBMs) as the primary gatekeepers of prescription drug access and pricing. For most health plans, they are the central figure in designing and administering the plan’s prescription drug benefits. PBM responsibilities include negotiating group discounts with drug manufacturers and pharmacies, developing formularies and processing prescription claims.

Due to staggering costs, a growing number of pharmaceutical manufacturers are experimenting with direct‑to‑employer (DTE) prescription drug platforms, an emerging model designed to give employers more control over costs, access and transparency—often by sidestepping the traditional PBM channel altogether. Notable examples include Eli Lilly’s Employer Connect, which links employers with benefit administrators and a pharmacy network to expand affordable access, and GoodRx’s Employer Direct, which enables employers to access lower costs for some high-impact brand medications by applying targeted subsidies to manufacturers’ discounted cash prices.

While still evolving, these platforms signal a meaningful shift in how high‑cost medications, particularly glucagon-like peptide-1 (GLP-1) for obesity and cardiometabolic care, may be purchased and delivered in employer‑sponsored health plans. This article provides an overview of DTE prescription drug platforms, explores their rising popularity, and outlines their pros and cons.

What Are DTE Prescription Drug Platforms?

DTE platforms allow self‑insured employers to contract directly with drug manufacturers or their designated partners to provide access to specific medications. Rather than routing prescriptions through a PBM’s formulary, rebate and claims infrastructure, employers can purchase drugs at a pre-negotiated net price and design their own cost‑sharing and eligibility rules.

This model is different from direct‑to‑consumer (DTC) and direct‑to‑patient (DTP) approaches, which focus on individuals purchasing drugs directly, often via cash‑pay or telehealth arrangements. DTE platforms are designed specifically for employer benefit strategies, enabling medications to be offered as a covered benefit while avoiding many of the complexities and opacity of PBM contracting.

One of the most important aspects of the DTE model is that it typically bypasses the PBM. In most arrangements:

There are no manufacturer rebates.
There is no traditional formulary placement.
The PBM does not control pricing, utilization or data flow.
Employers pay a transparent, fixed net price for the medication.

By eliminating the rebate mechanism, manufacturers can offer lower upfront prices, while employers gain clearer insight into what they are actually paying. This stands in contrast to the traditional PBM model, where list prices remain high and net costs are obscured by retrospective rebates and fees. However, bypassing the PBM also means employers must carefully consider how these programs integrate—or intentionally sit outside—of their broader pharmacy benefit strategy.

Why Are Employers Paying Attention?

Rising pharmacy costs, driven largely by specialty drugs and GLP‑1 medications, have made traditional PBM arrangements increasingly difficult to manage. Employers often face:

Limited visibility into true net drug costs
Delayed or uncertain rebate flows
Utilization controls that frustrate employees and providers
Budget volatility tied to list prices rather than actual spend

At the same time, employee demand for coverage of obesity and weight-management medications has surged, putting pressure on employers to find solutions that are both affordable and defensible from a fiduciary standpoint. DTE platforms are positioned to replace complexity with predictability, especially for a narrow set of high‑impact drugs.

Specifically, the rapid adoption of GLP‑1 medications for obesity has accelerated interest in DTE platforms. Coverage for these drugs remains inconsistent across employer plans, largely due to cost concerns and uncertainty about utilization. Manufacturers, including Eli Lilly and Novo Nordisk, have responded by launching or supporting employer‑focused access models that offer discounted, fixed pricing outside of PBM channels. Some of these models operate through technology partners such as Waltz Health, which provide eligibility verification, pharmacy routing and clinical safeguards while maintaining transparent pricing. The goal is to make coverage more predictable for employers and more accessible for employees, without relying on rebate‑driven economics.

Platform Pros and Cons for Employers

For employers struggling with opaque pricing and unpredictable spending, these models may offer a more straightforward alternative. Key advantages include:

Greater pricing transparency—Employers typically pay a fixed, upfront net price for medications, eliminating rebate reconciliation and reducing uncertainty about true drug costs.
Improved budget predictability—With pricing set in advance and not tied to fluctuating rebates or formulary dynamics, employers can more accurately forecast pharmacy spend and manage financial risk.
Reduced reliance on PBMs—In most cases, the model bypasses the traditional PBM structure, avoiding rebate-driven incentives, spread pricing, and administrative fees that can distort some of the cost savings that PBMs provide due to their group discounts.
Faster and simpler employee access—Many platforms streamline utilization management, reducing delays caused by prior authorization or step-therapy requirements common in PBM-managed plans. However, keep in mind that this advantage may be lost if an employee is using multiple places to get several different drugs.
Flexible benefit design—Employers can tailor eligibility rules, cost-sharing levels and program scope rather than conforming to a one-size-fits-all formulary approach.
Targeted solutions for high-cost drugs—These platforms allow employers to address specific problem drug classes (e.g., GLP 1s) without overhauling their entire pharmacy benefit.

While the benefits are compelling, DTE platforms also introduce new complexities. Many of the challenges stem from operating outside the traditional PBM ecosystem, which, despite its flaws, has long provided centralized administration, data aggregation and oversight. As such, key tradeoffs for this platform include:

Pharmacy benefit fragmentation—Drugs obtained through DTE platforms may fall outside the traditional pharmacy benefit, meaning prescriptions may not count toward deductibles or out‑of‑pocket maximums. This fragmentation also limits employers’ ability to capture manufacturer rebates, potentially increasing net plan costs. At this time, it remains unclear how member cost‑sharing in these programs is applied to deductibles.
Loss of consolidated data and reporting—Bypassing PBMs can create gaps in utilization and cost data, making it harder to track trends, evaluate outcomes or measure long term ROI. While this platform may provide benefits in some cases, moving away from PBM formularies means losing certainty, standard prescription drug distribution and potential group discounts and rebates.
Increased administrative responsibility—Employers may need to take on greater oversight for vendor performance, clinical safeguards and regulatory compliance.
Limited scalability across drug classes—Most platforms today focus on narrow categories, which can lead to a patchwork of carve-outs as more manufacturers pursue similar models.
Employee confusion and communication challenges—Multiple access pathways for medications can complicate employee understanding of how benefits work and where to go for coverage.
Equity and fairness concerns—Selective access rules may raise questions about why certain drugs are treated differently, requiring careful messaging and governance.

Conclusion

DTE prescription drug platforms reflect a broader unbundling of the pharmacy value chain. Rather than relying on a single intermediary to manage all drug access, employers are beginning to selectively carve out solutions for the most expensive or strategically important medications. At this time, DTE models are unlikely to significantly impact employer-sponsored prescription drug coverage, although they will change how a small number of employers procure specific categories of medications. Its growth underscores a fundamental shift that many employers are no longer willing to trade transparency for simplicity when it comes to pharmacy benefits and are increasingly open to new cost-saving channels.

As manufacturers and employers continue to experiment with these models, the long‑term impact may be less about eliminating PBMs entirely and more about redefining when and where they add value. Contact us for more information about employee benefits.