When Healthcare Data Investments Meet Direct-to-Patient Reality
How Trump's market reforms could render traditional pharmaceutical marketing obsolete—and what it means for agencies betting on intermediary-dependent models
The pharmaceutical industry is facing its most significant structural shift in decades. President Trump's executive order on Most Favored Nation (MFN) drug pricing, signed May 12, 2025 (White House, "Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients"), directs the administration to facilitate direct-to-consumer purchasing programs that bypass traditional intermediaries. For healthcare marketing agencies like Publicis Groupe that have invested billions in physician data, Pharmacy Benefit Manager (PBM) relationships, and traditional healthcare ecosystems, this represents more than policy change—it's a potential existential threat to their business model.
The scope of this transformation is staggering. The U.S. Department of Health and Human Services (HHS) has announced that pharmaceutical manufacturers are expected to align US pricing for all brand products with the lowest price in an Organisation for Economic Co-operation and Development (OECD) country with a Gross Domestic Product (GDP) per capita of at least 60% of US levels (HHS, "HHS, CMS Set Most-Favored-Nation Pricing Targets," May 20, 2025). These pricing changes could reduce drug costs by up to 80% (Axios, "Trump signs order aimed at cutting drug prices by up to 80%," May 12, 2025), fundamentally altering the economics of pharmaceutical marketing and the value chains that agencies have spent years building.
The Intermediary Squeeze: A $300 Billion Disruption
The current pharmaceutical distribution system represents a complex web of intermediaries, each extracting value from the process. Pharmacy Benefit Managers (PBMs) are third party companies that function as intermediaries between insurance carriers and pharmaceutical manufacturers. PBMs create formularies, negotiate rebates (discounts paid by a drug manufacturer to a PBM) with manufacturers, process claims, create pharmacy networks, review drug utilization, and manage mail-order specialty pharmacies (NAIC, "Pharmacy Benefit Managers," June 2, 2025). As of 2024, the top 3 controlled a market of almost $600 billion (Wikipedia, "Pharmacy benefit management").
Roche CEO Thomas Schinecker's recent statement crystallizes the threat: "Half of all the earnings in the supply chain went to intermediaries, known as pharmacy benefit managers, who take 'zero risk' on innovation." His solution? "If the United States would like to cut prices by 50 per cent, it's very easy. We go direct."
This isn't theoretical anymore. Seven of the top-12 pharma companies announced digital investments in patient support between 2023 and 2024 (ZS Associates, "Pharmaceutical industry trends 2025"). Pfizer launched its digital platform PfizerForAll to connect patients with HCPs, find and book vaccine appointments, receive at-home tests and medications and more. LillyDirect, meanwhile, includes home delivery of some Lilly medicines (including GLP-1s) through third-party pharmacy services (ZS Associates, "Pharmaceutical industry trends 2025").
The Data Investment Trap: When Margins Disappear, So Do Budgets
Healthcare marketing agencies have made massive investments in data capabilities over the past decade. Publicis Health's Verilogue works with physicians from around the globe to record live doctor-patient interactions in the exam room, building a database of more than 130,000 healthcare conversations for linguistic analysis (Publicis Health, "Translating Healthcare Insights Into Action," April 19, 2021). The company has invested heavily in data analytics, sentiment analysis through facial recognition, predictive modeling, and outcomes-based media measurement.
These investments made strategic sense when pharmaceutical companies enjoyed US price premiums that justified complex marketing campaigns. But the economic logic collapses under MFN pricing pressure. When pharmaceutical profit margins compress by 50-70%, marketing budgets face proportional cuts. Companies operating at international price levels cannot afford the sophisticated physician data analytics, PBM relationship management, and multi-stakeholder campaign orchestration that agencies have built their business models around.
The global healthcare analytics market is valued at $33.80 billion in 2022 and forecasted to reach $152.32 billion by 2030, with a Compound Annual Growth Rate (CAGR) of 20.70% over the forecast period (PharmiWeb.com, "Healthcare Analytics Market Size/Growth 2025-2035," February 12, 2025), but this growth trajectory assumes pharmaceutical companies maintain current profit margins. Under MFN pricing, pharmaceutical companies will need to justify every marketing dollar against compressed earnings. The complex analytics infrastructure that made sense at 2-3x international pricing becomes a luxury at parity pricing.
The capability mismatch becomes acute when direct-to-patient models eliminate the need for intermediary expertise entirely. Years of investment in understanding physician prescribing patterns, PBM formulary negotiations, and healthcare stakeholder relationships become irrelevant when manufacturers can sell directly to patients through transparent pricing platforms.
The Economics of Direct-to-Patient Transformation
The financial implications for pharmaceutical companies are severe, creating a direct threat to marketing budgets and agency relationships. Most Favored Nation (MFN) pricing would tie US drug prices to the lowest prices paid in economically comparable countries. According to research by the Rand Corporation for the US Department of Health and Human Services, drugs are on average 2.3 times more expensive in the US than in 32 other OECD countries. This price differential represents the core profit margin that funds pharmaceutical marketing operations.
The earnings impact is immediate and substantial. If pharmaceutical companies must align US pricing with international levels, they face potential revenue reductions of 50-70% on their most profitable products. The United States has less than five percent of the world's population yet funds around three quarters of global pharmaceutical profits (White House Fact Sheet, "President Donald J. Trump Announces Actions to Put American Patients First," May 12, 2025). When this pricing arbitrage disappears, so does the budget allocation for complex marketing campaigns.
This revenue compression directly impacts marketing spend. When pharmaceutical companies operated with US price premiums of 2-3x international levels, they could afford the $19.45 billion in annual digital advertising spending that accounts for 88% of healthcare industry digital marketing (eMarketer, "Pharma accounts for nearly 90% of the broader industry's digital ad spending," October 30, 2024). As margins compress under MFN pricing, these marketing budgets become unsustainable.
The transformation is already underway in adjacent markets. Hims, an online men's health platform, boasts a solid $1.7 billion market cap, and recently experienced a 57% revenue increase at the tail-end of 2023 by offering direct-to-consumer prescription services after digital health assessments (Nasdaq, "The New Era of Pharma is Direct-to-Consumer Healthcare"). These platforms demonstrate the viability of bypassing traditional healthcare intermediaries entirely—but they operate on fundamentally different cost structures than traditional pharmaceutical companies.
Technology as the Great Disintermediator
The technological infrastructure for direct-to-patient models is rapidly maturing. More than 85% of biopharma executives surveyed say they are investing in data, Artificial Intelligence (AI) and digital tools in 2025 to build supply chain resiliency, with 90% investing in smart manufacturing to increase efficiency (ZS Associates, "Pharmaceutical industry trends 2025"). Spending on AI in healthcare is projected to reach $188 billion by 2030, representing a 37% compound annual growth rate from 2022 (ZS Associates, "Pharmaceutical industry trends 2025").
These investments aren't just about operational efficiency—they're building the infrastructure for direct patient relationships. AI agents could work across a patient's journey as workflow managers, scheduling appointments, lab tests, and specialty consultations while handling insurance coverage, pharmacy choice, delivery and refills.
When pharmaceutical manufacturers can provide AI-powered patient support, direct delivery, and transparent pricing, the traditional marketing agency value proposition—helping navigate complex intermediary relationships—becomes less relevant.
The Compliance Advantage of Direct Models
One unexpected benefit of direct-to-patient models is regulatory simplification. Streamlined e-commerce platforms can seamlessly connect the consumer healthcare journey while building regulatory compliance directly into the operating model. Rather than managing compliance across multiple intermediaries, pharmaceutical companies can control the entire patient experience within a single, integrated platform.
In the highly regulated pharmaceutical industry, direct models offer companies more control over messaging and compliance, ensuring every communication adheres to regulatory standards without the complexity of multi-party coordination.
Strategic Implications for Healthcare Marketing: The Budget Reality
The shift toward direct-to-patient models creates three critical challenges for healthcare marketing agencies, all exacerbated by the fundamental economics of MFN pricing:
Budget Compression: When pharmaceutical companies lose their US pricing premium—which currently funds three quarters of global pharmaceutical profits—marketing budgets face immediate pressure. The projected growth in global healthcare advertising spend from $44.56 billion in 2025 to $67.87 billion by 2033 (Health Union, LLC, "Why Pharma and Healthcare Advertising Spending Continues to Rise," February 27, 2025) assumes continued high margins. Under MFN pricing, these projections become unrealistic.
Infrastructure Obsolescence: Years of investment in PBM relationships, physician data analytics, and intermediary-focused tools become less valuable when manufacturers sell directly to patients—and become unaffordable when profit margins compress by 50-70%.
Revenue Model Disruption: Agency revenue models built on managing complex multi-stakeholder campaigns face a double threat: clients can reach patients directly through simpler channels, and clients have smaller budgets to allocate to complex campaigns.
Capability Mismatch: Traditional healthcare marketing expertise in navigating intermediary relationships becomes less relevant than direct-to-consumer digital marketing capabilities—and the reduced client budgets make retooling investments more difficult to justify.
The Path Forward: Adaptation in an Era of Compressed Margins
Healthcare marketing agencies face a binary choice: adapt to direct-to-patient reality while managing client budget constraints, or become casualties of structural change. The most successful agencies will likely pivot toward supporting direct-patient relationships rather than managing intermediary complexity—but they must do so with dramatically reduced client spending capacity.
This means developing new capabilities in direct-to-consumer digital marketing, patient experience design, and integrated care delivery platforms while accepting much smaller project budgets. It also means accepting that the traditional high-margin business of managing complex stakeholder relationships may not survive the shift to transparent, direct pricing models.
The bottom line: President Trump's executive order states that Americans will no longer be forced to pay almost three times more for the exact same medicines, often made in the exact same factories. When that price parity becomes reality, pharmaceutical companies lose the profit margins that have historically funded large marketing budgets. The entire intermediary ecosystem—including the agencies that serve it—must justify their existence in a fundamentally different market structure where clients have both different needs and smaller budgets.
The pharmaceutical industry is entering a period of creative destruction where direct-to-patient models challenge every assumption about value creation in healthcare. For agencies with billions invested in the old model, the question isn't whether change is coming—it's whether they can transform quickly enough to survive it.