Lawmakers seek answers on Pfizer, Lilly telehealth moves

US Senators are concerned that Pfizer and Eli Lilly's recent forays into direct-to-consumer distribution of medicines via telehealth platforms could violate federal anti-kickback laws.

The four Senators – Democrats Dick Durbin, Peter Welch, Elizabeth Warren, and independent Bernie Sanders – have sent letters to the CEOs of the two pharma groups expressing the concern that their new arrangements "steer patients toward particular medications and create the potential for inappropriate prescribing that can increase spending for federal health care programmes."

Lilly made the first move in this direction with the launch of its LillyDirect service in January, offering access to several of its medicines – including weight-loss therapy Zepbound (tirzepatide) – claiming the move would streamline the supply chain and reduce costs for patients.

Pfizer followed suit in August with PfizerForAll, which currently covers 15 of its most common medicines, along with diagnostics and treatments for COVID-19, flu, respiratory syncytial virus, and migraine.

Both programmes revolve around websites providing information on medicines, access to online physician consultations to allow prescribing, and online pharmacy services to fill those prescriptions and deliver medicines to their homes.

Lilly boosted its online pharmacy capabilities in March via an alliance with Amazon, and both companies have said they intend to ramp up the range of medicines they offer via the telehealth route.

Discussing Pfizer's platform, the lawmakers write that it "creates the impression that any patient interested in a particular medication can indeed receive it with just a few clicks, and the appearance of Pfizer's approval that these chosen telehealth providers can ensure a patient receives the given medication."

They have requested more information on the financial relationships between the two pharma companies and their prescriber networks, and in particular whether there are incentives in place to prescribe specific products and more information on advertising and promotional spending.

"Unsurprisingly, a patient coming straight from Pfizer's website to a telehealth appointment with a prescriber chosen by Pfizer is overwhelmingly more likely to ask for Pfizer's medication," according to one of the letters.

"Further, that prescriber may have an incentive to prescribe such medication, whether or not it is medically necessary or clinically appropriate," it goes on. "Payments by Pfizer hold the potential to induce specific actions of the prescribing pen."

Both Lilly and Pfizer claim their programmes tap into the increased willingness of patients to use telehealth services since they became normalised during the COVID-19 pandemic, whilst opening up direct communication channels, satisfying a desire by consumers for more digital healthcare options, and making it easier for them to source treatments.

The senators have asked Lilly and Pfizer to respond to their letters by 25th November.